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ROC Study Frequently Asked Questions and Reminders

1. If the patient's internal defibrillator delivers a shock, does it count as a protocol shock?

     No, it does not count as a protocol shock. Only shocks delivered by AED (you or bystander) or by other external defibrillation device (Zoll, LP,  Philips) will count.

2.  What about airway management?

     Use a BVM & OPA for the first 6 minutes. Only after 6 minutes have passed, consider using a King or ETT airway. The only exception to the 6-minute guideline is patient regurgitation.

3.  When can I move the patient?

     Unless the scene is unsafe, you shouldn't move the patient any sooner than 10 minutes from the time of your arrival, unless the patient's pulse returns.

4.  What if the patient regains a pulse?

     If your patient regains a pulse, manage the ABCs, but do NOT over-ventilate, even if the ETCO2 levels are (temporarily) above normal.  Additionally, follow the BioTel Post-Cardiac Arrest Guidelines

5.  What if  V-Fib (VF) or persistent VT (pVT) returns after the patient regains a pulse, or converts to a non-shockable rhythm?

    Resume the ALPS protocol, including CPR, defibrillation, epi, and the 2nd ALPS dose.

6.  What if  VF or pVT returns after you've given all of the ALPS drugs?

    Follow ACLS/BioTel treatment guidelines, but DO NOT administer any more amiodarone or lidocaine.

    Additionally, DO NOT start an amiodarone or lidocaine drip (even if a pulse returns).

7.  What if one of the ALPS syringes breaks?

     Upon opening the kit, if one or both of the syringes are broken, do not start the ALPS protocol. Instead, treat the patient according to BioTel guidelines and (this may not apply to all agencies) complete the CPR study form in your ePCR.

8.  What if starting ALPS,you give one syringe, but the other one breaks?

     Discontinue the ALPS protocol.  Treat the patient according to BioTel guidelines and (this may not apply to all agencies) complete the CPR study form in your ePCR.

9.  What about patients in VF or pVT who are not eligible for ALPS? .

    Treat the non-eligible patients with 30:2 CPR, and follow the appropriate BioTel treatment guideline.

10.  What about patients in a non-shockable rhythm, such as PEA or asystole? Is ALPS given for anything other than V-fib or persistent V-tach?

    No. ALPS is given ONLY to patients in V-fib or persistent V-tach

     Treat these non-eligible patients with 30:2 CPR, and follow the appropriate BioTel treatment guideline.

11.  What if another agency has started CPR prior to your arrival?

    These patients should be considered for ALPS, UNLESS lidocaine or amiodarone have already been given. REMEMBER: Take into account the number and dose of all prior shocks delivered by AED or other external defibrillation device (Zoll, LP,  Philips) when determining ALPS  or epi drug doses and drug timing.

12. What if I have a patient that starts out in asystole or PEA, and later converts into V-fib or persistent V-tach?

    If the patient converts to VF or pVT,  begin the ALPS protocol if the patient is eligible.

13. I noticed that the ALPS syringes will sometimes work without using the adapter. Is this OK?

    No, you must use the ClearLink adapter provided in the kit. This is an FDA requirement, no exceptions.

14. What if I open the ALPS kit, but I don't give any of the study drugs?

    Any box opened in the presence of a patient automatically means they are enrolled in the study even if they did not receive any of the ALPS drugs.

15. What do I tell the hospital staff (in the E.R.) when I hand them the orange sheet (from the bottom of the ALPS kit)?

     Tell the E.R. staff -   1. The orange sheet has contact information about the ROC study
                                  2. The E.R. should follow their treatment guidelines
                                  3. They should limit the amount of lidocaine given to the patient in the E.R. over the next 2 hours to 100-200 mg
                                        (since lidocaine may have already been administered in the ALPS kit). It is up to the E.R. staff to either keep the
                                        orange sheet with the patient record, or discard it.

16. What do I do with the ALPS box or syringes after I deliver the patient to the hospital?

You can discard the ALPS box in any trash recepticle. Dispose of the syringes the same way you'd dispose of any other glass syringe - empty the contents of the syringe (if not already empty), and put the syringe in a Sharps container.


Do not administer ALPS to any patient being transported to the V.A. hospital.

Please use the event buttons on the Lifepak monitors. This can record the time any drug or procedure is done, and helps with your documentation (the ePCR in RescueMedic).

The drug kit number should be documented in your narrative and on the ROC study form.

DFR - The ALPS study kit should be in the red bag in the pocket opposite the controlled substances pocket.  These are glass syringes; thus the pocket cannot be packed with other equipment.

The ROC study form must be completely filled out if the patient was enrolled in the ROC study. Even if you open the box but don't use the syringes, you MUST fill out the ROC study form.

When you've completed your documentation, upload the ECG (done on every EKG patient, whether enrolled in the ROC study or not).

Lifepak monitors - Each morning, both a User Test and a Transmission Test should be performed on the Lifepak.  For the transmission test, push the “Transmit” button.  For “Site”, scroll to the bottom and select “Test”.

The orange script on the bottom of the ALPS kit is given to the Emergency Department physician. 

We're aware that some personnel in the EDs are still unaware of the ROC study, and steps are being taken to get ROC study information to all ED staff.


If you have any questions about any ROC protocols, send them here
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