Question: As far as the TOR mandatory patch point goes: if we are able to relay to the BHP that we would like to transport as opposed to terminating (e.g. public place, family insists we do so etc.) then why not allow the discretion of the paramedic to dictate whether to spend the time actually doing the patch? Since the physician is relying on us to paint a picture of the scene and if the BHP will accept our interpretation of the events unfolding and most likely state to transport anyway, patching to get permission to initiate transport seems to be more of a delay than a benefit.
This is a great question! You make a great point that rarely if ever, a BHP will disagree with a paramedic wishing to transport a patient in cardiac arrest and insist upon TOR. As such, one could question the value (as you do) of the Mandatory Provincial Patch Point.
With that said, we would suggest that when a paramedic patches to BHP during a cardiac arrest, it is more an opportunity to seek direction overall in the arrest management. From our viewpoint as BHPs, it is not purely patching to get permission to initiate transport as you suggest. There may be other mitigating factors involved given how heterogeneous, dynamic, and truly life threatening these cases are, and MD input may be of some value into the decision making that surrounds at least some of these patients. As a provincial wide system, the Mandatory Patch Point was developed to ensure that at least at one point in every out of hospital cardiac arrest, prior to transport or TOR, touching base (pardon the pun) with an emergency physician is accomplished by the resuscitating paramedics in the field