• Friday September, 19 2025

  • @ 09:43 – Mount Joy Road

  • @ 14:10 – John J. Williams Highway

Nature: Medical Emergencies

City: Millsboro

 

On Friday, September 19^th, the Indian River Volunteer Fire Company was alerted on two separate and distinct medical emergencies associated with manpower assists for cardiac arrest incidents within the local fire district.  The alerts were in addition to the emergency medical services of the Sussex County Paramedics and nearest EMS providers.

The cardiac arrest emergency response protocols in Delaware are detailed in the official Basic Life Support (BLS) and Advanced Life Support (ALS) guidelines, which are updated periodically. These protocols are based on standards from the American Heart Association (AHA) and apply to EMS providers, first responders, and qualified laypersons.

General guidelines for all responders

• Safety first: All responders must prioritize scene safety and observe body substance isolation (BSI) precautions before approaching the patient.

• Universal protocol: The protocols follow the basic steps of checking for responsiveness, breathing, and a pulse. If there is no pulse, CPR should be initiated.

• High-quality CPR: Rescuers must perform high-quality chest compressions with minimal interruptions. The adult compression rate is 100 to 120 per minute, with a depth of 2 to 2.4 inches.

• AED application: An automated external defibrillator (AED) should be applied and used as soon as possible. Rescuers should follow the AED's voice prompts and minimize any interruption in chest compressions.

Basic Life Support (BLS) protocol

In Delaware, BLS protocols for EMTs and first responders focus on providing initial, immediate care to stabilize the patient.

• CPR: Provide high-quality chest compressions and ventilations. For adult patients, the ratio is 30 compressions to 2 breaths without an advanced airway.

• Defibrillation: Administer defibrillation using an AED, following the device's prompts. The AED should remain on and connected to the patient throughout the resuscitation effort.

• Transport: If an ALS unit is not expected to arrive quickly, BLS units should begin transport to the nearest appropriate medical facility while maintaining contact with medical control.

• Monitoring: BLS providers may monitor IV fluids and use pulse and CO-oximetry where equipped.

Advanced Life Support (ALS) protocol

ALS protocols, used by paramedics, incorporate advanced treatments under a set of standing orders. Paramedics are expected to begin treatment based on protocol before contacting medical control.

Standard procedures: In addition to BLS procedures, ALS providers establish vascular access (IV or IO) for medication administration and secure an advanced airway as soon as possible.

• Rhythm analysis: The protocol outlines specific treatments based on the cardiac rhythm observed on the monitor.

• Ventricular fibrillation/pulseless VT: Administer a shock at 360 joules, followed immediately by CPR. Administer epinephrine 1 mg IV/IO every 3–5 minutes and consider amiodarone or lidocaine.

• Asystole/PEA (pulseless electrical activity): Do not shock. Administer epinephrine 1 mg IV/IO every 3–5 minutes.

• Reversible causes: Paramedics investigate and treat potential reversible causes of cardiac arrest, following the AHA's "H's and T's" guidelines.

• Duration and transport: The protocols may specify that resuscitation is performed on the scene for a minimum duration (e.g., 20 minutes) before transport to the hospital. The highest-level provider on the scene directs patient care.

Emergency response units from Indian River included two fully staffed and trained first responders to assist and provide services where needed.