CRITERIA FOR DEATH/WITHHOLDING RESUSCITATION*

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Policy:

CPR and Advanced Life Support (ALS) treatment are to be withheld only if the patient is obviously dead or a valid North Carolina Do Not Resuscitate form (see separate policy) is present.

Purpose:

The purpose of this policy is to:

·         Honor those who have obviously expired prior to EMS arrival.

Procedure:

1.      ICEMS Senior Paramedics will be responsible confirming and documenting death outside of the hospital setting. If a patient is in complete cardiopulmonary arrest (clinically dead) and meets one or more of the criteria below, CPR and ALS therapy need not be initiated:

·         Body decomposition

·         Rigor mortis

·         Dependent lividity

·         Blunt force trauma

·         Injury not compatible with life (i.e., decapitation, burned beyond recognition, massive open or penetrating trauma to the head or chest with obvious organ destruction)

·         Extended downtime with Asystole on the ECG

·         When presented with a valid North Carolina Do Not Resuscitate Order.

1.      If a bystander or first responder has initiated CPR or automated defibrillation prior to an EMS paramedic’s arrival and any of the above criteria (signs of obvious death) are present, the paramedic may discontinue CPR and ALS therapy. All other EMS personnel levels must communicate with medical control prior to discontinuation of the resuscitative efforts.

2.      If doubt exists, start resuscitation immediately. Once resuscitation is initiated, continue resuscitation efforts until either:

• Resuscitation efforts meet the criteria for implementing the “Discontinuation of Prehospital Resuscitation” policy (see separate policy).