Date Published

February 21, 2012

Updated For

ALS PCS Version ALS PCS Version 5.2


Question: This is in regard to the Medical TOR protocol. If we've reached the mandatory patch point at three consecutive non-shockable analyses (and made the call to the BHP) and there is any sort of delay (meaning we've reached the fourth analysis), do we then transport? People are getting confused because some heard that they were to keep analyzing while they waited for the BHP to come on the line. That's not how I perceived it. Regardless of any delay at any time, the protocol states that we only analyze a total of four times (unless you are an ERU) followed by CPR for the duration of the call, correct? People hear different things, and I just want clarification so that we can all be on the same page. Thanks


 What an excellent question! First, hopefully there are not excessive delays in getting ahold of the BHP. This is one of the reasons why the SWORBHP Medical Council has advocated for early initiation of the patch to BHP during a cardiac arrest.

In the event of a delay, the risk of not initiating transport is that if a TOR is not eventually granted once the BHP is reached, then we have delayed the transport of this critical patient.

The risk of initiating transport is that you are now transporting a patient CODE 4 which carries risk in itself for a patient who we know has a very low likelihood of survival plus you may now receive a TOR in the back of the ambulance.

For certain, repeated analysis on scene is not the answer.

The SWORBHP would suggest that as per protocol, initiate transport following the fourth analysis if the patch to the BHP has been delayed. If contact with the BHP is achieved and a TOR is eventually obtained while you are in the back of the ambulance, then follow the Deceased Patient Care Standard which can be found here:



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