Protocol 1: CPR & Cardiac Arrest

This Wilderness Medical Protocol applies only to normothermic patients (core temperature >90°F; 32°C) in cardiac arrest with CPR being performed according to current standards supported by the 2015 International Liaison Committee on Resuscitation (e.g., American Heart Association, European Resuscitation Council, etc.). This protocol amends those standards for remote and high risk situations. Chest compressions are to be initiated for patients in cardiac arrest evidenced by pulselessness or those with an unblocked airway with no breathing evident. To be effective, CPR must be started promptly for a patient with a patent, unobstructed airway. Even then, its benefits are limited in a wilderness setting.

CPR should NOT be Started or may be Discontinued at some point after initiation:

Any pulseless person who has been submersed in cold water (70°F; 21.1°C) for more than one hour and not connected to a source of air.
Any pulseless person with an obvious lethal injury (i.e. decapitation, exsanguinations, massive head injury). This also includes severe trauma to the chest that would prevent CPR.
CPR may be discontinued if cardiac arrest persists continuously for over 30 minutes of sustained high-quality CPR.
Where rescuers are at risk of injury or death. Scene safety is always paramount.



Below are Special Circumstances regarding providing CPR:

HYPOTHERMIA - Chest compressions should NOT be performed on any individual suspected of being hypothermic. Regardless of whether or not a pulse is found, ONLY positive pressure ventilations (mouth-to-mask; rescue breathing) should be administered due to the possible fragile electrical state of the heart. Be sure to check ABCs for a full 60-seconds on any patient considered to be hypothermic (core temperature <90°F; 32°C). Evacuate to definitive care slowly and carefully and rewarm the patient's core, continually checking the warming mechanisms to ensure they remain effective.
LIGHTNING - CPR should be administered immediately when safe to do so, to all lightning strike victims who appear breathless and/or pulseless. Respiratory paralysis may continue long after cardiac activity returns.
COLD WATER SUBMERSION - CPR should be administered immediately to any unconscious (and not breathing and/or pulseless) patient who has been submersed in cold water (70°F; 21.1°C) for less than one hour.



All patients who received CPR, regardless of outcome, must be evacuated to definitive care.


Last Updated: Nov. 2019

These protocols were written by Jeffrey Isaac, PA-C (of Wilderness Medical Associates International) and have been edited and authorized by the executive medical and curriculum directors Kathryn Vaughn, MD, FAWM & Jennifer Kay, RN, BNS, CCRC, CCRP, WALS, for use by Center for Wilderness Safety, Inc.


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