The phrase "Nothing to do in the hospital I can't do in my bus" is a sign of pride and hubris and mayube ignorance. The concept of universal "Snatch and run" is a denial of responsibility. Field operators need to know how to balance and choose based on each case; it isn't an either/or, zero-sum situation.
If algorithms showing how to determine irrecoverability in the field have been adopted, then the system has decided how to choose who is not going to need prompt definitive care soon because they are truly irretreivably dead. If an ER decides that field measures (pacing, defib, CPR, drugs ) ARE equivalent to what the have to offer, then their decision not to treat (as the OP seems to be saying) is made and the receiving hospital will have to defend it.
First and foremost, in America most field asystoles are due to infarct, which is (if you think about it) a trauma. Most MI cases presenting with clinical death are not recoverable, and for those cases field treatment without transport IS just as good (or bad). People develop MIs while in hospitals and die there. This is a fact most of us have observed time and again.
CPR and defibrillation do not equal pacing. Field pacing when the pacing mechanism has been insulted (resulting in a potentially mostly-viable myocardium) is a great advancement but not defintive. Those MI cases which are salvageable usually (not always) require prompt pacing and, depending upon the case, cardiovascular surgery either as a vascular bypass, an assistive device, or a transplant. CPR and drugs, without advanced diagnostics and sophisticated interventions, were designed to get the pt in, not to supplant definitive care. Are CPR and field treatment a waste? No, they are absolutely vitally essential, starting with good bystander CPR and hopefully AED. But I resort to the CO2 analogy; you fight your way through the fire, turn around and it's flaming again.
Unconscious and apparently (palpation) pulseless presentation due to extremely weak cardiac activity can respond to defib and drugs but will still need hospitalization. EKG and AED are diagnostic for field treatment and pt may recover consciousness, sometimes spontaneously (Seen it).
Should a traumatic case (gunshot, exsanguination, penetrating injury) present clinically dead and is somehow salvageable, prompt surgery and hospital level treatments to correct mechanical damage and any contributory problems (exsangination requiring blood transfusion, respiratory injury, vascular damage, central nervous system damage, shock, etc) is necessary. Again, field treatment is vital but not definitive because advanced diagnostics and invasive procedurs are probably needed.
As for poisoning leading to clinical death (carbon monoxide, CO2, cardiotoxins like digitalis, drugs of abuse, etc), what are your measures to reverse the toxin in most cases? Not many, and are those carried and trained with? To some degree, the ambulance can equal "wait and see and support vitals" as in the hospital whiel enroute, but as a rule of thumb any case headed for the ICU needs to get there sooner rather than later.
I am not saying "snatch and run" all the time. I am not saying field measures and operators are futile. I am not saying a hospital can do miracles versus a good amblance and crew, or that all crews are target-fixated, "single combat with Death" cowboys. I am saying that the role of field techs, while absolutely essential and important, and in the face of getting more tools and missions, is not general medical practice nor is it defintive for cases of true asystole.
Defintive versus field measure.
