6.5 Systems of Care and Handoffs
Key Takeaways
- Resuscitation outcomes depend on systems, not only individual skill.
- Early activation, public access defibrillation, EMS notification, hospital capability, and post-arrest destination planning all matter.
- Handoffs should communicate rhythm, downtime, shocks, medications, airway, ETCO2, ROSC time, and suspected cause.
- A clean handoff prevents repeated work and missed post-arrest priorities.
6.5 Systems of Care and Handoffs
AHA guidelines emphasize systems of care because survival requires coordinated links. BLS/ACLS candidates should know what information must move from rescuer to EMS, EMS to hospital, and code team to ICU or cath/stroke teams.
Current official baseline
Use the 2025 AHA CPR and ECC Guidelines as the current baseline for BLS, adult advanced life support, post-arrest care, education, and special circumstances. Use the official AHA 2025 CPR and ECC Guidelines page when your course materials or training-center instructions differ from third-party summaries: AHA 2025 CPR and ECC Guidelines.
What you need to know
| Decision point | What to do |
|---|---|
| Chain of survival | Recognition, activation, CPR, defibrillation, advanced care, post-arrest care, and recovery form a connected system. |
| Destination | ROSC after suspected STEMI, stroke symptoms, refractory arrest, or special circumstances may change facility needs. |
| Handoff data | Report collapse time, no-flow/low-flow time, rhythm sequence, shocks, drugs, airway, ETCO2, ROSC, vitals, and likely cause. |
| Team continuity | The receiving team needs what happened and what still needs doing, not every detail in chronological order. |
How this shows up on BLS/ACLS questions
BLS and ACLS items usually test priority. Read the patient state first: age, pulse status, breathing status, rhythm, stability, and number of rescuers. Then choose the action that protects perfusion, oxygenation, defibrillation timing, or the correct algorithm branch. If an answer sounds advanced but delays CPR, shock delivery, ventilation, or an urgent stability intervention, it is usually a distractor.
Scenario anchor
After ROSC, the team leader tells EMS: witnessed collapse, bystander CPR, initial VF, three shocks, epinephrine twice, amiodarone once, intubated with ETCO2 38, ROSC at 14 minutes, ST elevation now present.
Common traps
- Giving a vague handoff such as "we coded him and got him back."
- Forgetting rhythm and shock history.
- Ignoring destination needs after ROSC.
Study action
Write this section as a one-line rule in your own words, then test it with mixed questions from the BLS/ACLS practice bank. Do not review only the matching topic. Mix it with nearby branches so you can tell when the rule applies and when it does not. For example, compare respiratory arrest with a pulse against pulseless arrest, or compare unstable tachycardia against VF/pVT arrest. The exam rewards that discrimination more than memorizing isolated facts.
During resuscitation of a cardiac arrest patient, the team leader announces "Everyone clear!" before delivering a defibrillation shock. This is an example of which principle of high-performance ACLS teamwork?
A team member disagrees with the team leader's decision to administer epinephrine 3 mg instead of 1 mg. What is the appropriate action?