CRITERIA FOR OBVIOUS DEATH ON SCENE
ALL LEVELS
RESUSCITATION EFFORTS SHOULD BE WITHHELD UNDER THE FOLLOWING CIRCUMSTANCES:
1. Valid New Mexico Do Not Resuscitate Order present: Refer to Do Not Resuscitate (DNR)
2. Scene Safety: The physical environment is not safe for providers to treat patient.
3. Pt is Dead on Arrival (DOA): A person is presumed dead on arrival when all five "Signs of Death" or at least one associated "Factor of Death" present.
MINIMUM SIGNS OF DEATH (All FIVE signs of death must be present)
1. Unresponsiveness.
2. Apnea.
3. Absence of palpable pulses at carotid artery.
4. Unresponsive pupils.
5. Asystole is recorded on the Cardiac monitor in all three (3) leads.
FACTORS OF OBVIOUS DEATH
1. Damage or destruction of the body incompatible with life, such as:
2. Decapitation
3. Decomposition
4. Deforming brain injury
5. Incineration or extensive full thickness burns
6. Lividity/Rigor mortis of any degree.
7. Major blunt or penetrating trauma.
8. Exanguination
Patients with ventricular assist devices (VAD) should not be pronounced dead at the scene.
SUDDEN UNEXPLAINED INFANT DEATH (SUID)
An infant <12 months who is apneic, asystolic (no heartbeat or umbilical cord pulse), and exhibiting lividity and/or rigor mortis may be presumed dead. Contact Medical Control for confirmation of death.
NEONATE
A neonate who is apneic, asystolic, and exhibits either neonatal maceration (softening or degeneration of the tissues after death in utero) or anencephaly (absence of a major portion of the brain, skull, and scalp) May be pronounced dead. Contact Medical Control for confirmation of death.
When efforts to resuscitate are not initiated or are terminated EMS providers shall:
1. Document time that efforts are stopped or when you decided not to start efforts.
2. Notify law enforcement, who will alert the Office of Medical Investigation.
3. Consider the possibility of a crime scene and restrict access.
4. Any decision to move the body must be made in collaboration with law enforcement and the medical examiner.
5. Leave any resuscitation adjuncts such as advanced airway devices, IV/IO access devices, electrode pads, etc., in place.
6. Inform family on scene of patient's condition and offer to contact family, friends, clergy, or other support systems.
DOCUMENTATION
1. Complete a patient care report in all cases. Include ECG rhythm strips and code summary with the patient care report.
2. Document special orders including DNR, on-line Medical Control, etc.
3. MCI conditions may require a triage tag in addition to a PCR.
4. Record any special circumstances or events that might impact patient care or forensic issues.
5. Document everything you observed and assessed during patient contact.
6. In adults prolonging resuscitation efforts, beyond 30 minutes without ROSC is usually futile unless cardiac arrests compounded by hypothermia or submersion in cold water.
7. EMS providers are not required to transport every victim in cardiac arrest to a hospital. Unless special circumstances are present, it is expected that most resuscitations will be performed on scene until ROSC or a decision to terminate resuscitation efforts is made based on the listed criteria. Transportation with continuing CPR is justified if hypothermia is present or suspected.
8. An ETCO2 level of 20 mmHg or less measured 20 minutes after the initiation of advanced cardiac life support accurately predicts irreversible death in most patients in cardiac arrest.
ALL LEVELS
RESUSCITATION EFFORTS SHOULD BE WITHHELD UNDER THE FOLLOWING CIRCUMSTANCES:
1. Valid New Mexico Do Not Resuscitate Order present: Refer to Do Not Resuscitate (DNR)
2. Scene Safety: The physical environment is not safe for providers to treat patient.
3. Pt is Dead on Arrival (DOA): A person is presumed dead on arrival when all five "Signs of Death" or at least one associated "Factor of Death" present.
MINIMUM SIGNS OF DEATH (All FIVE signs of death must be present)
1. Unresponsiveness.
2. Apnea.
3. Absence of palpable pulses at carotid artery.
4. Unresponsive pupils.
5. Asystole is recorded on the Cardiac monitor in all three (3) leads.
FACTORS OF OBVIOUS DEATH
1. Damage or destruction of the body incompatible with life, such as:
2. Decapitation
3. Decomposition
4. Deforming brain injury
5. Incineration or extensive full thickness burns
6. Lividity/Rigor mortis of any degree.
7. Major blunt or penetrating trauma.
8. Exanguination
Patients with ventricular assist devices (VAD) should not be pronounced dead at the scene.
SUDDEN UNEXPLAINED INFANT DEATH (SUID)
An infant <12 months who is apneic, asystolic (no heartbeat or umbilical cord pulse), and exhibiting lividity and/or rigor mortis may be presumed dead. Contact Medical Control for confirmation of death.
NEONATE
A neonate who is apneic, asystolic, and exhibits either neonatal maceration (softening or degeneration of the tissues after death in utero) or anencephaly (absence of a major portion of the brain, skull, and scalp) May be pronounced dead. Contact Medical Control for confirmation of death.
When efforts to resuscitate are not initiated or are terminated EMS providers shall:
1. Document time that efforts are stopped or when you decided not to start efforts.
2. Notify law enforcement, who will alert the Office of Medical Investigation.
3. Consider the possibility of a crime scene and restrict access.
4. Any decision to move the body must be made in collaboration with law enforcement and the medical examiner.
5. Leave any resuscitation adjuncts such as advanced airway devices, IV/IO access devices, electrode pads, etc., in place.
6. Inform family on scene of patient's condition and offer to contact family, friends, clergy, or other support systems.
DOCUMENTATION
1. Complete a patient care report in all cases. Include ECG rhythm strips and code summary with the patient care report.
2. Document special orders including DNR, on-line Medical Control, etc.
3. MCI conditions may require a triage tag in addition to a PCR.
4. Record any special circumstances or events that might impact patient care or forensic issues.
5. Document everything you observed and assessed during patient contact.
6. In adults prolonging resuscitation efforts, beyond 30 minutes without ROSC is usually futile unless cardiac arrests compounded by hypothermia or submersion in cold water.
7. EMS providers are not required to transport every victim in cardiac arrest to a hospital. Unless special circumstances are present, it is expected that most resuscitations will be performed on scene until ROSC or a decision to terminate resuscitation efforts is made based on the listed criteria. Transportation with continuing CPR is justified if hypothermia is present or suspected.
8. An ETCO2 level of 20 mmHg or less measured 20 minutes after the initiation of advanced cardiac life support accurately predicts irreversible death in most patients in cardiac arrest.