TERMINATION OF RESUSCITATION (TOR)
For patients for whom resuscitation has been initiated EMS personnel may terminate resuscitation in the following circumstances. On-line medical direction is required to terminate resuscitation if it is available.
BASIC/AEMT:
Medical cardiac arrest:
1. High quality CPR has been performed for 30 minutes
AND
2. AED advised “No shock advised”
AND
3. Paramedic care is > 20 additional minutes to arrival (total of 40 minutes down time).
4. Call medical direction for TOR order
PARAMEDIC:
Medical cardiac arrest (see also CARDIAC ARREST/MEDICAL):
1. 30 minutes of adequate compressions and ACLS care have been provided
AND All of the following are true
1. There has been no return of spontaneous circulation (ROSC)
2. End tidal CO2 is less than 15
3. The family is supportive of the termination of resuscitation
4. There are not mitigating factors that would support transport or continuation of resuscitation (hypothermia, LVAD (Left Ventricular Assist Device), unsafe scene, for example)
Traumatic cardiac arrest
Pulseless, apneic, and in asystole
1. 10 minutes of high-quality CPR without ROSC
2. Final rhythm continues to be asystole
3. All potentially life saving procedures have been performed (i.e. establish airway and decompress the chest)
Pulseless, apneic, and in rhythm other than asystole
1. Transport within ten minutes to trauma center if possible
2. Consider Termination of Resuscitation if transport not advisable and:
a. No ROSC
b. All potentially life saving procedures have been performed (i.e. establish airway and decompress the chest)
c. Arrest is not medical in origin
d. At least 10 minutes of high quality CPR have been performed
4. Notes: There may be mitigating circumstances calling for transport. Transport decision must take risk of continuing resuscitation in moving vehicle into consideration. Hypothermia, lightning strike victim, scene safety, inadvisability of leaving patient at scene, persistent shockable rhythm, LVAD in place (mandatory transport) and other issues are reasonable considerations when considering transport.
5. OB patients approximately 20 weeks or later should be transported for possible emergency c-section.
6. Contact on-line medical direction for termination.
Remain with deceased until released by law enforcement or medical examiner
Assist surviving loved ones with contacting spiritual support, family or grief resources as needed
For patients for whom resuscitation has been initiated EMS personnel may terminate resuscitation in the following circumstances. On-line medical direction is required to terminate resuscitation if it is available.
BASIC/AEMT:
Medical cardiac arrest:
1. High quality CPR has been performed for 30 minutes
AND
2. AED advised “No shock advised”
AND
3. Paramedic care is > 20 additional minutes to arrival (total of 40 minutes down time).
4. Call medical direction for TOR order
PARAMEDIC:
Medical cardiac arrest (see also CARDIAC ARREST/MEDICAL):
1. 30 minutes of adequate compressions and ACLS care have been provided
AND All of the following are true
1. There has been no return of spontaneous circulation (ROSC)
2. End tidal CO2 is less than 15
3. The family is supportive of the termination of resuscitation
4. There are not mitigating factors that would support transport or continuation of resuscitation (hypothermia, LVAD (Left Ventricular Assist Device), unsafe scene, for example)
Traumatic cardiac arrest
Pulseless, apneic, and in asystole
1. 10 minutes of high-quality CPR without ROSC
2. Final rhythm continues to be asystole
3. All potentially life saving procedures have been performed (i.e. establish airway and decompress the chest)
Pulseless, apneic, and in rhythm other than asystole
1. Transport within ten minutes to trauma center if possible
2. Consider Termination of Resuscitation if transport not advisable and:
a. No ROSC
b. All potentially life saving procedures have been performed (i.e. establish airway and decompress the chest)
c. Arrest is not medical in origin
d. At least 10 minutes of high quality CPR have been performed
4. Notes: There may be mitigating circumstances calling for transport. Transport decision must take risk of continuing resuscitation in moving vehicle into consideration. Hypothermia, lightning strike victim, scene safety, inadvisability of leaving patient at scene, persistent shockable rhythm, LVAD in place (mandatory transport) and other issues are reasonable considerations when considering transport.
5. OB patients approximately 20 weeks or later should be transported for possible emergency c-section.
6. Contact on-line medical direction for termination.
Remain with deceased until released by law enforcement or medical examiner
Assist surviving loved ones with contacting spiritual support, family or grief resources as needed