Date Archives: 30-Oct-2012

Question: I recently had my recerts and have a question concerning Medical TOR. The way it was explained to me was that a TOR was a pronouncement. It was explained to me, if we receive a TOR in the back of the unit before the vehicle is put into drive, we have stay on scene with a patient until the coroner comes. Likewise if we received the TOR while the vehicle was in motion we could continue to the hospital. I really don't understand the difference as to whether the vehicle is in gear or not. I was under the impression that if we receive a TOR, it is simply that, terminate resuscitation and continue transport (no lights and sirens) with no resuscitation. The decision on route would then be, do we go to the morgue or to the ER. I understand the delicacy of appearances and you may have to leave scene with lights and sirens but once away from the scene, judgment on activation of emergency signals would be up to the driver/crew. Could you elaborate some more on this?

My question concerning TOR is this. Is a patient deemed dead at the time of TOR or are they deemed dead when assessed either at the hospital by an ER physician or at the scene by the coroner?

Question: If the patient requires ventolin and has a fever but cannot tolerate the mdi, would it then be appropriate to use the nebulizer.

Question: Two questions which seem simple but as an educator I get asked all the time. 1.) FBAO VSA patient, you are unable to clear the airway, should we follow the BLS that indicates an oral airway should be inserted? 2.) Unwitnessed VSA, do we need to do a full two minutes of CPR or just CPR until we get the pads on.

Question: What is the rationale behind no longer doing a 45 second pulse check on a severely hypothermic patient? BLS patient care standards in section 4-11 assessments #3 states a 45 second pulse and breathing check.

I understand that ALS standards trump BLS standards. Other than a summary that came from RPPEO August 2011 on the new November Directives where it stated no more 45 second pulse checks, there is no mention in the new Directives of this change that I could find.