Dead On Scene Administrative Guideline Flashcards
Obvious death criteria
- Decapitation
- Decomposed
- Burned beyond recognition
- Extrusion of brain matter
- Removal of lower half of body
- Rigor Mortis
- Absent signs of life with a signed DNR order present
Patient has signs of
obvious death YES?
May consider withholding resuscitative efforts
Patient has signs of obvious death NO?
Assess Cause of Cardiac
Arrest
Non-traumatic:
All the following criteria for either
Witnessed or Un-witnessed must be met:
Un-witnessed arrest:
- Prolonged downtime is likely
- PEA/Asystole or non-shockable
rhythm noted
Non-traumatic:
All the following criteria for either
Witnessed or Un-witnessed must be met:
Witnessed arrest:
- 20 minutes of resuscitation with:
- PEA and EtCO 2 <20 mmHg
OR - Asystole or non-shockable
rhythm noted
Penetrating Trauma
Pulseless at EMS arrival AND estimated time to Level I Trauma Center is >15 minutes
Blunt Trauma
Pulseless at EMS arrival; consider bilateral needle thoracostomy and if no return of pulses, terminate resuscitation
If any of the above criteria are met
and if patient is normothermic,
withhold or withdraw resuscitation efforts THEN
Call for Law Enforcement and secure the scene (if not already done)
Document time of notification, arrival on scene, and badge number of
responding personnel
If NONE of above criteria are met?
Follow your AG’s, dummy.
Special considerations
For scene safety and/or family wishes, the provider may decide to implement CPR
even if all the criteria for death are met.
DNRs, POLST, ADs, etc are only considered valid if they________
- Are intact: it has not been cut, broken or shows signs of being repaired
- Display the patient?s name and the physician?s name
In cases where the patient’s status is unclear, appropriateness of withholding resuscitation efforts is
questioned, or if there is question on the validity of the provided forms…
EMS personnel should initiate CPR
immediately and then contact online medical direction. Proceed with resuscitation until additional
information can be obtained to clarify the best course of action.
With Traumatic Arrest patients
Resuscitation efforts may be terminated in any blunt trauma patient who is apneic, and pulseless.
Victims of penetrating trauma found apneic and pulseless should be rapidly assessed for the presence of
other signs of life, such as pupillary reflexes, spontaneous movement, response to pain, and electrical activity on EKG.
Cardiopulmonary arrest patients in whom
mechanism of injury does not correlate with clinical condition suggests what?
A non-traumatic cause of arrest.
They should have standard ALS resuscitation initiated
