Policy Revisions – August 2004

Contra Costa EMS Agency

Policy Changes

• Policy 19 – Determination of Death in the Prehospital Setting – Revised

• Policy 34 – Search for Donor Card – New

(previously a section in Policy 19)

Reasons for Changes

• To aid in field pronouncement of patients without chance of survival

• To allow field personnel to make decisions on stopping or not initiating resuscitation (without base contact)

Major patient categories in Policy 19

• Obvious death – no changes to policy

• Probable death – now has distinction between medical and traumatic arrests

• Adults in whom CPR can be discontinued – now defines “failure of resuscitative efforts” more precisely

Probable Death – Medical Arrests

Definition:

• Patients in whom there is total absence of observers or witness information; or

• Patients in whom it is known that the arrest occurred more than 15 minutes earlier and no resuscitative efforts have begun

Probable Death – Medical Arrests

• Procedure– BLS rescuers

• follow first-responder defibrillation treatment guidelines

– ALS rescuers• Assess for apnea and pulselessness

• If conditions met, place cardiac monitor and document asystole for 1 minute

• If asystole not present, begin resuscitation

Probable Death – Medical Arrests

• Base contact not needed but base remains as resource if questions exist

• Resuscitation should begin if: – Suspected hypothermia– Suspected drug overdose or poisoning– If any question exists at to presence of vital

signs

Probable Death - Trauma

• Procedure differs in one way from medical arrests:

– If patient has agonal rhythm, resuscitative efforts can be withheld.

– Agonal rhythm defined as wide, bizarre QRS with rate of 20 or less

Discontinuing Adult CPR

• Can be done if initial resuscitative efforts unsuccessful:– After two rounds of cardiac drugs given– Adequate ventilation with or without intubation– Patient continues with asystole or agonal

rhythm

• Base contact not required

Discontinuing Adult CPR

• Resuscitation should not stop if transport under way

• Resuscitation and transport may be prudent when safety concerns exist or public setting of arrest are problematic

Discontinuing Pediatric CPR

• Base station contact required if discontinuation of efforts appears appropriate

• Not directly addressed in text of policy

Dispatch Issues

• Minor rewording of policy

• Dispatchers will inform responding crews if DNR papers are present (per the caller) and will that paperwork be presented on crew arrival

Coroner Issues

• Policy now more concise

• No change in policy

Policy 34 – Search for Donor Card

• Now is “stand-alone” policy

• More concise wording

• Moved from Policy 19 since doesn’t apply to patients who have died