Question: If a patient from, for example, a structure fire is VSA with severe 3rd degree burns to the majority of their body and asystolic upon arrival would this fall under a medical or trauma cardiac arrest protocol? I would assume there is a high likelihood that the cause of arrest is more asphyxial in nature from smoke and toxic fume inhalation so it would be a medical protocol. That being said would this patient also meet medical TOR protocol since the arrest is asphyxial in origin? In discussion there seems to be so many variables put forward that there is no general consensus on which protocol to follow. Assuming there is no associated blunt trauma (e.g. structural collapse or explosion) or any penetrating trauma (e.g. explosion or injury occurred prior to burns) and the only trauma is the burns themselves what's the most advisable course of action to follow?

 This would not be a traumatic arrest. We agree, most likely they have arrested from an asphyxial etiology or the burns themselves. As such, this care for this patient would fall under the medical cardiac arrest directive and possibly the Medical TOR.

I would direct you to the Feb 6th question here: http://www.sworbhp.com/askmac/searchengine/med_cardiac_arrest.html

The debate of the Medical TOR applying to arrests of an asphyxial nature is one of our most common questions. This is one of the very rare situations where the teaching philosophy of SWORBHP has varied from the directives.

The debate has centered upon whether the medical TOR has to be an arrest of suspected cardiac etiology in nature (as it says in the directive) or can it also include arrests felt to be asphyxial in etiology (such as drowning, hanging, inhalational exposure, electrocution- not an exhaustive list).

The concern of the Medical Council was how does the paramedic decide what arrest was caused by asphyxia vs. one of cardiac etiology when often details even on scene are difficult to obtain? You can imagine how many FAQ we would get as to what constitutes a cardiac arrest from a cardiac cause vs. an asphyxial!

The consensus from the SWORBHP Medical Council was for the paramedic to not attempt to break it down asphyxial vs. cardiac on scene... It gets too confusing.

We feel it is reasonable if all other criteria for TOR are met, patch to the BHP and let them be involved in the decision making. We did not want to have to place the paramedic in the difficult position of having to decide on scene- you have enough to do! If the BHP decides that a TOR is reasonable, then follow that protocol, and if not, transport the patient and continue resuscitation as directed.

As an aside, the support for this decision comes from the ROC trial currently underway all across North America looking at CPR rates. It was felt by ROC investigators that it was too difficult and unfair to make a paramedic decide on scene what caused the arrest, so arrests caused by asphyxia are treated the same as arrests caused by a presumed cardiac etiology. The Medical Council from SWORBHP thought this would be easier for all paramedics to adopt this same strategy for TOR.

Cardiac/Circulation,Medical Cardiac Arrest

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