Paramedic Practice in England with Adrenaline Following Return Of Spontaneous Circulation (ROSC)

Abstract

Background Post-resuscitation shock is a condition witnessed by paramedics following out of hospital cardiac arrest. Paramedic practice within England is largely influenced by clinical guidelines from the Joint Royal Colleges Ambulance Liaison Committee (JRCALC). Currently JRCALC recommend local Ambulance Services to produce guidance for administration of adrenaline following return of spontaneous circulation (ROSC) in out of hospital card arrest. Aims To understand what current practice is undertaken for adrenaline administration by non-specialist paramedics within England following ROSC. Methods An electronic anonymous survey shared on social media that is open to non-specialist paramedics in England. The survey involved frequency distribution questions, Likert ratings and a clinical scenario. Results The survey was fully completed by 98 non-specialist paramedics. The majority (75% n = 74) reported that they had a clinical guideline to follow from their employer. Paramedics experience of patients achieving ROSC varied. The survey found 83.67% ( n = 82) reported ROSC one or more times in the last 12 months. Over half of the respondents have given adrenaline following ROSC (57.14%, n = 56 ). A proportion of paramedics ( n = 8) have given adrenaline following ROSC without any local guideline available. Paramedics reported high levels of confidence in their ability to administer adrenaline in ROSC. However, the absence of a clinical guideline is the primary reason paramedics do not administer adrenaline. Following this respondents primarily chose to transport the patient to hospital. The majority of patients chose to administer 250ml sodium chloride within the first 5 minutes. The dose of adrenaline varies across paramedic practice. The main doses were 10mcg and 100mcg selected to be administered. Conclusion Non-specialist paramedic practice for post ROSC adrenaline administration is undertaken by paramedics within England. However, the availability of a local clinical guideline varies and reduces paramedics ability to administer this as a treatment option. Dosing of adrenaline in paramedic practice has a large variance from 10mcg to 100mcg. The standardisation of paramedic practice in a national clinical guideline should be explored further to ensure safe and equal availability of care to for patients across England.