Date Published

February 6, 2012

Updated For

ALS PCS Version ALS PCS Version 5.2


Question: In the December 11, 2011 powerpoint on Termination of Resuscitation. The slide on page 37 states the Medical TOR applies to all medical VSA that are cardiac in nature and asphyxial in origin including hanging, drowning electrocution. The webinar from our recerts states Arrest thought to be non cardiac in origin, i.e. OD, Trauma, Hanging, Drowning are a contraindication to the TOR. Could you please clarify?


 Thank you for this question - it is certainly one of our most frequent and you are correct - there is a discrepancy in our messaging vs. the directive. This is one of the very rare situations where 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 on the directive) or can it also include arrests felt to be asphyxial in etiology (such as drowning, hanging and 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.



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