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 

Summary:

• 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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