In the case of a workable drowning VSA, that is not in a shockable rhythm, would it be in the best interest to call for a TOR, preform 20 minutes or resuscitation or transport early? Would this fall under extenuating circumstances?

If the underlying cause of arrest is thought to be hypoxia due to the submersion injury, then it is reasonable to stay on scene and manage the airway while continuing your high-quality resuscitation. Reasons to leave early would include suspected reversible cause that led to the drowning: (Example: non-opioid overdose), OR, if you are unable to complete resuscitation up to your standard (Example: cannot adequately manage the airway or ventilations).  

If the patient will not meet the TOR Criteria, for any reason, then you would consider initiating transport after a minimum of four analyses (see SWORBHP Memo dated July 19, 2023.) 

Cardiac/Circulation,Medical Cardiac Arrest

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https://files.sworbhp.ca/app/uploads/2023/07/19185710/SWORBHP-Memo-Non-TOR-Cardiac-Arrest-July-19th-2023-docx.pdf