Date Published

July 5, 2024

Updated For

ALS PCS Version 5.3


What is a “Rolling TOR”?

  • A Termination of Resuscitation (TOR) order from a BHP that occurs in the ambulance en route to a health care facility

(Deceased Patient Standard – BLS PCS v 3.4)

  • The receiving hospital physician will then assess/declare the patient
  • Unlike a Medical or Trauma TOR, wherein the patient whose time of death is the time the TOR is granted by the BHP

Why Would a Rolling TOR be Used?

A Paramedic believes that ongoing resuscitation is likely futile to warrant withholding resuscitation…

But left the scene due to circumstances such as:

  • Scene is a public place
  • Scene is unsafe
  • Bystanders/Family not coping well
  • Primary/Secondary Mandatory Patch Points failed

Key point: 

The ambulance must be in motion transporting the patient to the ER. 

**If stationary, paramedics must follow usual protocols outlined in the Deceased Patient Standards before being able to leave scene.**

Obtaining a Rolling TOR Order & Next Steps

  • The patch to the BHP should be explicit in the request and clear that the ambulance is in motion
  • E.g. “I am requesting an order for a Rolling TOR. The ambulance is in motion...”
  • If granted:
  • Per the Deceased Patient Standard, “advise CACC to contact the coroner, and continue to the destination unless otherwise directed by CACC”
  • Advise the receiving facility about the order in your notification patch
  • Take the patient to the ED, like any other resuscitation patient*

* Unless you have other direction from your local policies

**The receiving facility may not know what a Rolling TOR is, you may need to explain the procedure during transfer

Documentation After a Rolling TOR:

It is prudent to document as detailed as possible. Include the following, as appropriate:

  • The rationale/details surrounding request for a “Rolling TOR”
  • Time of TOR
  • Name of BHP who granted TOR
  • Pronouncement by MD (name & time) – this would happen in the ER after Transfer of Care
  • Coroner Notified 


  • A Rolling TOR is a special kind of TOR wherein the patient is still transported to the ER, however, if granted, paramedic resuscitation stops en route
  • The wheels must be in motion for a Rolling TOR to be granted
  • The patient is taken to the ER to be assessed/declared by the ER physician*
  • The receiving facility will likely be unfamiliar with this practice and you will need to explain it to them

*Unless you have other direction from your local policies



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