It is the expectation of the SWCPM that each patient has a documented set of vitals that serve as a baseline assessment and provide an accurate picture of the patient’s condition at the start of the call. In cases where the patient is found to be vital signs absent (VSA), it is standard practice to document a heart rate (HR) of zero and a respiratory rate (RR) of zero. Some patients in cardiac arrest may experience agonal breathing, which is a gasping or labored breathing caused by a lack of oxygen supply. Firefighters can document agonal breathing patterns as part of their assessment. 

It is also important to have a baseline set of documented vitals to demonstrate any changes in the patient’s condition. Upon initial assessment, a patient may be in cardiac arrest with HR = 0 and RR = 0. After successful resuscitation, the patient may experience a return of spontaneous circulation (ROSC), regain a palpable pulse, and begin to breathe independently. If a firefighter successfully obtains ROSC, a repeat set of vitals, including RR and HR, should be documented in the vitals section of the MAR. If ROSC is achieved under the care and direction of paramedics, firefighters can still document the ROSC in their MAR as part of the transfer of care.