Date Published

June 4, 2020

Updated For

ALS PCS Version 5.2


Unfortunately, not every call is straightforward, nor fits nicely into our Medical Directives.

For example,

You arrive on scene to find an adult patient trapped under a large grain bin.  The only visible portion of the patient’s body is their head and left arm.  The bin is covering their chest up to the clavicle area.  Therefore, your assessment abilities are limited.

C - You palpate no carotid pulse.  You are unable apply the defib pads to the patient and therefore cannot analyze the rhythm nor determine a “Monitored HR” for TOR assessment.

A - The airway is filled with blood and tissue, requiring suctioning.

B - Once the airway is cleared, you attempt to ventilate and are unable to do so.

D – Altered LOA (GCS 3)

What do you do now? 

Does this patient meet TOR criteria? They are ≥ 16, with altered LOA, no detectable HR nor RR and you are unable to obtain an SBP.  They have no palpable pulses.  However, you are unable to obtain a “Monitored HR”, determine their underlying rhythm, nor able to deliver defibrillation.

Do you continue the resuscitation?  How?  Time to call for direction!

In cases where the directives are not clear, as in this situation, patching to the BHP is designed to: Address situations that fall outside of the Medical Directives, help direct management and provide advice for your individual call circumstance.


Additional Resources:

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