How do I properly patch for rolling medical TOR or cease resuscitation order, especially in instances involving a public place?
Thank you for the great question.
First, lets solidify definitions:
A Rolling TOR is when a TOR is granted after the ambulance has left the scene and is en route to a health care facility. Paramedics should be aware that some Base Hospital Physicians may not have a working familiarity with the term Rolling TOR or what it means as it is a rarely performed prehospital occurrence. The paramedic who is patching in these circumstances might have to remind and explain this to the physician.
A public place is meant to define a location where, at the discretion of the paramedic, it is felt that pronouncing the patient and then leaving the body in full view of the public while awaiting the coroner to attend or release the body would be inappropriate. Classic examples of such would include (but are not limited to) on the ice at a packed hockey arena, on the floor beside the table at a packed restaurant.
Should a Rolling TOR be granted by a BHP, according to the Deceased Patient Standards, If termination of resuscitation occurs in the ambulance en route to the health care facility, the crew will advise dispatch to contact the coroner, and continue to the destination unless otherwise directed by dispatch. Paramedics should follow any local policies with regard to specifically where in the health care facility the deceased patient is to be taken on their arrival (e.g. Morgue vs. ER). SWORBHPs teaching to the BHPs who grant the rolling TOR is: BHP to notify the receiving facility (if not their own) that a patient will be transported who is already pronounced. The receiving facility will then register the patient in the ED, confirm and document the time of the TOR by the BHP and contact the coroner. For full details regarding this, please see the BHP orientation videos on the SWORBHP website: https://www.lhsc.on.ca/southwest-ontario-regional-base-hospital-program/base-hospital-patch-bhp-orientation/cme
Please see another post on Ask MAC from Jan 31, 2012 regarding death in a public place. The punch-line being that in any environment (public or not) that timely defibrillation is the key element of survival. Thus, it is the preference of the SWORBHP Medical Directors that cardiac arrest protocols are followed where the patient is found and as often as possible and when (of course) scene safety concerns are considered.