Question: Seeking clarification: Traumatic Cardiac Arrest where TOR does not apply and we are transporting to nearest ER. While en-route, the medical directives currently state we are to transport with CPR and no further treatment. Is it acceptable to intubate if required, IV and epi q 4 min, consideration of bilateral chest needles? Would I require an order to proceed with the chest needles if patient is in PEA.

Same question for hypothermic arrest, is it permissible to intubate, IV access, patch for further orders, i.e. epi?

 When, for whatever reason, the TOR for Traumatic Arrest is not applicable or ordered by the BHP, and transport is initiated, yes, it is completely acceptable to attempt procedures you describe (IV, epi, advanced airway etc) en-route but NOT on scene. Same rules apply to the hypothermic cardiac arrest.

The complicating and limiting factors however would be having the ability to accomplish these procedures successfully in the back of a moving ambulance as well as having an extra responder available in the back with you performing CPR. As for chest needles, as per the Tension Pneumothorax Medical Directive, they remain a Mandatory Provincial Patch Point and as such, contact with the BHP should be initiated.

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