TOR/ROLE

Question 1

Obvious death criteria

Answer 1

decomposition/ larval infestation/ purification

signs of rigor mortis or gravitational dependent post mortem hypostasis

Major traumatic injuries- decapitation, cranial destruction, truncal destruction, obvious injuries with exsanguination

multi casualty where clinical resources are overwhelmed and triage pack guide utilised

Question 2

Determination of death

Answer 2

no central pulses
asystole for >30 seconds
fixed and dilated pupils with no corneal reflexes
no signs of breathing
no auscultated heart sounds

Question 3

Withholding resus criteria

Answer 3

prolonged cardiac arrest of downtime greater than 15 minutes
unwitnessed
first assessed rhythm asystole
not received a defib shock
no compelling reason or special circumstances

Question 4

Expected death withholding resus

Answer 4

credible evidence the death was expected as a result of a terminal illness
VAD substance
DNR wishes clearly communicated and reasonable

Question 5

Withholding resus in an aged care environment

Answer 5

aged over 80 and
obviously frail 7-9
7 severely frail -dependent for personal care- 9 terminally ill approaching end of life

Question 6

Terminating resus

Answer 6

presenting rhythm is asystole not SJA witnessed and remain in asystole after 20 minutes

presenting shockable rhythm not SJA witnessed, progresses quickly and remains in asystole or wide slow PEA <40 bpm after 20-30 mins with no other favourable signs of response

destination to ED is >15 mins with 20 mins of maximal ALS with no ROSC at any stage with no compelling reasons

Authorised SJA clinician make reasonable decision

prolonged CPR in blunt traumatic cardiac arrest after reversible causes addressed and delivery to ED can not be achieved from 25 mins of arrival to scene, can cease efforts after 10 minutes

Question 7

PEA TOR

Answer 7

narrow PEA complex and/or rate >40 bpm must have CSP or ASMA approval

Question 8

Less favourable prognostic indicators

Answer 8

prolonged down time
unwitnessed
non shockable presentation
no bystander CPR
no AED shock
EtCO2 falling
wide complex PEA
advanced frailty
>80 yrs
significant comorbidities

Question 9

Favourable prognostic indicators

Answer 9

shorted downtime
witnessed
shockable presentation
bystander CPR
AED shock
normal/ high EtCO2 35-45mmHg
narrow PEA complex
low frailty
<80 more likely ICU candidate
less significant comoridities

Question 10

Reportable deaths

Answer 10

appears unexpected unnatural violent or resulted directly or indirectly from injury

person held in care (child welfare act, prisons act, alcohol or drug authority, mental health act, young offender act)

appears to have been caused or contributed by action of a police force member

person who has unknown identity