Date Published

March 30, 2022

Updated For

ALS PCS Version ALS PCS Version 5.2


Hello, I have a question regarding the 4th analysis when youre actively calling for a medical TOR. If theyre around Ill speak with family to give them an update on what weve been doing, that Im going to call and doctor and what the outcome of that phone call may be. Often, after Ive had that chat, and made the call by the time Im back the 2mins has passed and a 4th analysis may have been done by my partner. What would you like to see happen there. Do we perform that 4th analysis or is that only performed just prior to departure if were transporting. Thanks for your help.


Please continue on with your 4th (and/or more) analysis while establishing contact with the BHP or providing the BHP with information. Until the decision to terminate resuscitation has been made, care should continue with an analysis every 2 minutes. The BHP may even request information from this and further analyses while on the phone with you. This information may aid in their decision on whether to transport or not. Should the TOR be granted with information only from the 3rd analysis, document your findings and the rationale for the lack of a 4th analysis on the ACR. Note that if there is a significant change in patient condition (i.e. new PEA or shockable rhythm) it is essential to notify the BHP, as this information may change the decision on the TOR.

We would suggest performing the fourth analysis at the scene and not to move the patient to the truck unless you are anticipating, or looking for, a transport order (i.e. fresh arrest, younger patient narrow complex PEA with faster rate). Generally, TORs will be granted after 4 no shocks. If you have moved the patient into your truck on the 4th analysis and you were looking for a TOR, it can become complicated in pronouncing the patient. This can tie up your care team at the scene for many hours, where you would then only be able to take orders from the Coroner.



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