DETERMINATION OF DEATH / DISCONTINUATION OF PREHOSPITAL RESUSCITATION [3.16]
TERMINATION OF RESUSCITATIVE EFFORTS:
A. NONTRAUMATIC CARDIAC ARREST1. Discontinuation of CPR and ALS intervention may be implemented after contact with medical control if all of the following criteria have been met.a. Patient must be least 18 years of age.b. Patient is in cardiac arrest at the time of arrival of advanced life support, no pulse, no respirations, and no heart tones.c. ACLS is administered for at least twenty (20) minutes, according to AHA/ACLS Guidelinesd. There is no return of spontaneous pulse and no evidence of neurological function.e. Patient is asystolic in two (2) leadsf. No evidence or suspicion of any of the following: drug/toxin overdose, hypothermic, active internal bleeding, preceding trauma.g. All Paramedic personnel involved in the patient’s care agree that discontinuation of the resuscitation is appropriate.2. All seven items must be clearly documented in the ambulance patient care report (PCR).3. Direct medical oversight (DMO) should be established prior to termination of resuscitation in the field. The final decision to terminate resuscitative efforts should be a consensus between the on-scene paramedic and the DMO physician. CONTACT MEDICAL DIRECTION for confirmation of terminating resuscitation efforts.4. If any of the above criteria are not met and there are special circumstances whereby discontinuation of pre-hospital resuscitation is desired, contact Medical Control.5. Logistical factors should be considered, such as collapse in a public place, family wishes, and safety of the crew and public.a. Examples: Patient too large to extricate, significant physical environmental barriers, unified family wishes with presence of a living will.6. All patients who are found in ventricular fibrillation or whose rhythm changes to ventricular fibrillation should in general have full resuscitation continued and be transported.7. Patients who arrest after arrival of EMS should be transported.