Ontario Paramedic Practice Exam

What are the indications of initializing a medical TOR?

1. Equal to or over 30 days

2. Altered Level of Awareness

3. No obvious ROSC

4. Arrest not witnessed by EMS

The correct answer is: No obvious ROSC

Initializing a medical termination of resuscitation (TOR) is an important decision that paramedics make when assessing a patient in cardiac arrest. The relevant consideration for this decision is the absence of a return of spontaneous circulation (ROSC), which signifies that the patient has not regained a pulse or circulation despite resuscitative efforts. This is critical because if there is no ROSC after appropriate interventions, continuing resuscitation may not be warranted. In this context, not having an obvious ROSC typically indicates that the patient is unlikely to survive, given the resources available at the scene and the duration of the resuscitation attempt. Paramedics are trained to evaluate multiple factors in such situations, including the patient's history, response to interventions, and the overall likelihood of a favorable outcome. While altered levels of awareness and other considerations like whether the arrest was witnessed can play a role in assessing the patient's condition, the definitive indicator for moving forward with a medical TOR is the absence of ROSC. This criterion helps paramedics make informed decisions in line with established protocols.