Some patients in cardiac arrest may not be brought to hospitals for medical help, memo says

EMS workers and hospitals are bombarded with coronavirus patients.

April 2, 2020, 3:48 PM

Cardiac patients who cannot be revived at home must be declared dead, according to jarring new orders given to EMS teams in New York.

Effective immediately, patients in cardiac arrest will not be transported to a hospital if first responders cannot get a pulse on their own while administering CPR, a new internal memo obtained by ABC News states. City hospitals are overrun with COVID-19 patients and some cardiac patients may not receive the medical care they need to survive.

“These orders are binding and the FDNY will devise a plan for implementation,” Deputy Fire Commissioner Frank Dwyer told ABC News.

The FDNY on Thursday issued new orders in response to REMSCO guidelines set forth during the COVID-19 pandemic. The EMS orders pertain to all FDNY EMTs, paramedics and firefighters. The orders apply to adult cardiac arrest patients only (18 years and older) and "if the patient meets criteria for obvious death, do not initiate resuscitation." Every occurrence will also be documented by the department.

In a blunt advisory on March 29, the Nassau County Regional Emergency Medical Advisory Committee on Long Island stated, “There is no medical benefit to transporting patients in cardiac arrest with CPR in progress.” The statement goes on to justify the new protocol with a statistic saying successful resuscitation rates increase when patients are not moved during CPR.

There is an exception to the new overarching rule. Patients in cardiac emergencies may be transported to a new location if there is “imminent physical danger” in the area to the responder.

The new approach shows how stretched thin EMS and hospitals are and how emergency rooms are trying to minimize the number of difficult arrivals.

“We always have to balance benefit versus risk in health care and right now the risk is that we use up resources on a population where intervention may be both futile or even worse,” said Dr. Vinayak Kumar of the ABC News Medical Unit.

Patients who go into cardiac arrest outside a hospital have a slim chance of survival and CPR risks "wide dissemination" of coronavirus particles, according to American College of Cardiology guidance issued last month.

“In the event of a cardiac arrest, efforts at cardiopulmonary resuscitation causing aerosolized pathogens could result in the wide dissemination of virus particles to clinicians, health care workers, and other patients,” the American College of Cardiology said.

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