New York City EMTs instructed not to take cardiac arrest patients to hospital if no pulse is found after CPR in efforts to mitigate COVID-19 risk

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New York City Emergency Medical Service (EMS) teams who cannot find or restart a pulse while administering CPR on adult cardiac arrest patients have been instructed not to bring those patients to hospitals to mitigate the risk of Covid-19 exposure to EMS workers, according to a memo obtained by CNN and the chair of the regional emergency medical advisory committee familiar with the edict.

“In the event a resuscitation is terminated, and the body is in public view, the body can be left in the custody of NYPD,” states the memo sent to NYC EMS providers outlining the temporary change issued in response to the ongoing pandemic.

If the New York Police Department (NYPD) response is delayed, EMS teams are instructed to call the police department’s Dead on Arrival Removal teams, according to the memo.

Josef Schenker Chair of the New York City Regional Emergency Medical Advisory Committee (REMAC) — which issued the memo — explains that the patients that fall into this category — cardiac arrest patients who fail to regain pulse after CPR in the field — are less likely to be revived and transporting them puts EMS workers at risk. The transport in an enclosed space, the ambulance, can potentially expose EMT’s to Covid-19.

The memo was issued effective immediately on March 31.

“The number of cardiac arrests has gone up significantly over this current pandemic. The reality is we need to do our best to protect our providers,” Schenker said, adding that “the standard of care is maintained.”

“Doing CPR, performing rescue breathing are very, very high risk procedures in this environment,” Schenker said, even with personal protective equipment (PPE). “The likelihood that you’re going to have a success resuscitation after doing all the CPR in the field is so low that the risk of doing CPR in that ambulance is so great it outweighs the benefit of the transport,” he said. “The success of that resuscitation is very low,” he said adding, “The risk is more dangerous than the benefit.”

He reassured that the Emergency Medical Technicians (EMT) provide the same level of care as a hospital. “The ambulance is bringing the Emergency Room (ER) to the patient providing the same care that you would get in the hospital. It does not add a significant amount of success.” Schenker explained that EMT’s do approximately 30 minutes of resuscitation and 20 minutes of advanced life support. Schenker said all these life-saving measures are taken before a patient is transported.

General procedures dictate that patients are usually only transported to a hospital once the patient has a pulse again. If no pulse is found, the general procedure is to reach out to a group called medical control, a group of doctors who are on call to offer assistance, for a decision as to whether or not they can pronounce a patient dead on the scene or take them to the hospital, Schenker said. The memo eliminates that step, unless a medical control physician provides a direct order to bring the patient to the hospital.

REMAC is the group that develops, approves and implements prehospital treatment and protocols for EMS providers in NYC.

The director of communications for the New York State Health Department Jonah Bruno, said the department “has not issued, or approved, any such guidance but we are working with EMS providers throughout the state to ensure the health and safety of all New Yorkers, as we mount a coordinated response to the Covid-19 pandemic.”

The NYC Department of Health and Mental Hygiene deferred to the state health department when asked about the memo.

While this guidance is temporary, REMAC continues to update their protocols as warranted by the current situation, according to notifications being sent to EMS providers.

“We will follow these guidelines and devise a plan to implement these policies, ” FDNY Deputy Commissioner Frank Dwyer said in a statement to CNN.

The FDNY provides EMS services within the city of New York. CNN has reached out to the NYPD for comment.

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