Protocol Status: PUBLISHED
Protocol:
Version: 2026.01
Effective Date:
Last Reviewed:
Medical Director Approval:
Clinical Note: This content reflects current GCEMS clinical guidelines as of the dates listed above. If content appears inconsistent with current policy, use the most recent approved guideline and notify leadership for correction.

CPR

 

Ensure adequate space to work

 

The following is listed in the order of importance; each rescuer has a specific job during the arrest:

 

FIRST CREW ON SCENE

 

FIRST RESCUER

 

  • Begin continuous CPR compressions; push hard (adult: >2 inches; child: >1½ inches) push fast (100-120/min); change compressors every 2 min (limit changes/pulse checks to <5 sec) during entire arrest

 

SECOND RESCUER

 

  • Attach AED/monitor and defibrillate as necessary; provide ventilations with BVM
  • First and second rescuers rotate every 2 min

 

SECOND CREW ON SCENE

 

THIRD RESCUER

 

  • Assumes airway; consider BIAD/intubation; compressions should not be stopped to intubate

 

FOURTH RESCUER

 

  • Establish Team Leader/Code Commander: Utilize Cardiac Arrest Checklist

 

FIFTH RESCUER

 

  • Initiate IV/IO and administer appropriate medications at request of code commander
  • ALL CREWS
  • Follow appropriate arrest protocols

 

FIRST/SECOND OR THIRD RESCUER

 

  • Once advanced airway is in place, ventilate every 6-8 sec; DO NOT interrupt compressions except for changes/pulse checks
  • Continue cardiac arrest protocol

 

CODE COMMANDER

 

  • Responsible for patient care
  • Ensures high quality compressions
  • Ensures frequent compressions changes
  • Responsible for communication with family
  • Operates monitor; utilizes the event button
  • Measures medications and gives to 5th rescuer at time of administration

 

PEARLS:

 

  • Ensuring high quality compressions with minimal interruptions takes priority.
  • Adequate compressions with timely defibrillation are the keys to success.
  • Monitor in paddles mode with metronome on.
  • Do not hyperventilate!  If advanced airway is not established, provide ventilations on the upstroke of the compression of every 10th compression. Once advanced airway is in place, ventilate at a rate of 8-10 breaths per minute.
  • Each breath should be administered over 1 second with just enough air to notice chest rise.
  • Provide compressions while monitor/AED is charging.
  • Keep all breaks in compressions to less than 5 seconds.
  • Consider possible CAUSE of arrest early: For example, resuscitated V-fib may be a STEMI and more rapid transport is indicated.
  • Consider traditional ACLS "H's and T's" for PEA :
    • Hypovolemia, Hypoxia
    • Hydrogen ions (acidosis)
    • Hyperkalemia
    • Hypothermia
    • Hypo/Hyperglycemia
    • Tablets/Toxins/Tricyclics
    • Tamponade
    • Tension pneumothorax
    • Thrombosis (MI)
    • Thromboembolism (Pulmonary Embolism)
    • Trauma.
  • When considering CAUSE , consider utilizing relevant protocols in conjunction:
  • Maternal Arrest - Treat mother per appropriate protocol with immediate notification to (Medical Control) and rapid transport.