I am looking for clarification on whether or not pre-arrival shocks count towards consideration of a medical TOR with the new 20 minute protocol. 
I have reviewed the companion document and note it does state, "As a general rule, Paramedics do NOT count pre-arrival interventions in their patient care. Care delivered prior to arrival can be "considered" and documented." 
I also found a previous Ask Mac response from Dec 22 2017 asking the same question, however the answer was at the time of the previous Medical Cardiac Arrest Directive (4 analyses only). In Mac's response at that time they did state, "SWORBHP Medical Council believes that ANY defibrillation delivered to a patient during a cardiac arrest resuscitation should be counted and considered as a contraindication to the application of the TOR." 
Looking for clarity between these statements and the new protocol. 
Thanks for the information! 

SWORBHP Medical Council’s stance on counting shocks prior to EMS arrival has not changed with the new iteration of the medical directive, when it comes to being considered for the Medical TOR. If there have been defibrillations prior to EMS arrival, the patient does not qualify for a Medical TOR.

However, you would not count defibrillations prior to EMS arrival as part of the refractory VF/VT in your three consecutive shocks. An exception to this refractory VF/VT count would be if you are involved with a study protocol.

Cardiac/Circulation,Medical Cardiac Arrest

defibrillation, Medical TOR, pre-arrival intervention, Pre-arrival shock

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