The Role of a Paramedic

What were the paramedics doing, and why?

When paramedics attend to a cardiac arrest, they have a sequence of actions they perform to ensure that the person they are assisting has the best possible chance of survival. The specific procedures performed may vary depending on local protocols, resources, and the person’s condition. You may see both firefighters and paramedics assisting in emergency care. The crew on the scene works as a team, collaborating with each other to provide comprehensive care. Here is a list of first responder actions that you may have observed:

• • Paramedics quickly assess the situation to determine if it’s true cardiac arrest and not something else. They check a person’s responsiveness, breathing, and pulse. If cardiac arrest is suspected or confirmed, they initiate emergency procedures immediately. They may ask family or people around if someone knows about that person’s past medical history, allergies, medications, the last time they consumed food, and if someone witnessed the collapse.
  • Cardiopulmonary resuscitation (CPR) is a fundamental step and critical treatment in the management of cardiac arrest. Paramedics perform high-quality chest compressions to maintain blood circulation and oxygenation. They also provide rescue breaths using a breathing device known as a bag-valve-mask to deliver oxygen to the patient’s lungs. To assist in the delivery of oxygen, they may insert a device into the person’s mouth to protect the airway from the tongue and assist in airflow.

• • Suction may be used if there are excessive fluids, vomit, froth, or blood in the mouth. They will use either a manual or electronic suction device to clear the mouth of any substances. The device is similar to what you may have experienced at the dentist. They may need to repeat this several times based on how much fluid is being produced by the person in cardiac arrest.

• • Paramedics carry an automated external defibrillator (AED) to deliver electric shocks to the heart in a controlled manner. This aims to restore a normal heart rhythm, particularly when the problem lies in the ventricles (a part of the heart responsible for pumping blood out of the heart). The machines analyze the patient’s heart rhythm and administer shocks if appropriate. The AED often has additional leads that can be connected to a patient to provide feedback on the quality of CPR and monitoring of the vital signs.

• • Automated CPR devices like LUCAS or Auto-Pulse may be available to the crew. These devices can provide automatic delivery of chest compressions, allowing paramedics to focus on other critical life-saving tasks. These devices are especially valuable when staffing resources are limited and CPR is likely to go on for a long time.

• • Paramedics may administer certain medications during cardiac arrest to help support the heart’s function and restore a regular rhythm. Paramedics establish intravenous (IV) access to deliver medications and fluids. This is similar to getting your blood drawn for tests in your primary care doctor’s office. In some cases, they prefer to use another method called intraosseous (IO) access, which is through bones. This is done through a small drill that allows them to insert a needle into the core of the bone. It allows medications and fluids to enter the heart and body circulation within seconds.

• • In some cases, paramedics may need to secure the patient’s airway with advanced techniques. This can involve endotracheal intubation, which involves inserting a plastic tube into the person’s breathing pipe or using an inflatable option to secure a clear airway to help with getting oxygen in and blowing off carbon dioxide. 

• • Paramedics continuously monitor the patient’s vital signs, including heart rhythm, blood pressure, oxygen levels, and carbon dioxide levels to adjust treatments.

After giving initial resuscitation and treatment to stabilize the vitals and, most importantly, the heart rhythm, paramedics transport the person to the hospital. During transportation to the nearest hospital with expertise in advanced care for cardiac arrest patients, paramedics provide ongoing monitoring and continue interventions as needed. Depending on local protocols, paramedics will also consult with their designated medical director or base hospital to discuss any treatment options. 

In some circumstances, even after prolonged efforts to ensure stability or heart rhythm, they may take the hard decision to terminate resuscitation in the field. This happens when all interventions and treatments have been exhausted, and the outcome is determined by nature.  

In any scenario, whether it happened at home or in public, family and lay rescuers who witness cardiac arrest experience severe trauma of their own. This unexpected event may cause uncertainty about what happened and how to process it. At Heartsight, we believe answers to your questions that may reduce some of this uncertainty should be available to you as soon as you are ready to receive them. We hope that in the near future, paramedics will carry links to these resources along with their medications and devices. Heartsight resources are designed to help anyone affected by this life-altering, traumatic experience. 

Sources

Community AED & PAD Guide: https://www.peelregion.ca/paramedics/defibrillator-program/_media/community-aed-pad-guide.pdf

Thank you to our contributors

Paul Snobelen & Sachin Agarwal