NORTH COAST EMERGENCY MEDICAL SERVICES Policy # 2304
POLICIES AND PROCEDURES Page # 1 of 2
Subject: Medical Control
Determination of Death --Basic Life Support Personnel
Associated Policies: 2305, 2307
I. Authority and Reference (incorporated herein by reference)
A. Division 2.5 of the Health and Safety Code.
B. California Code of Regulations, Title 22.
C. North Coast Emergency Medical Sevices Policies and Procedures.
II. Purpose
To establish regional policy and procedure for basic life support (BLS) personnel to determine and document death in the prehospital setting. For the purpose of this policy, "BLS personnel" is defined as a rescuer who is currently certified as a First Responder or Emergency Medical Technician-I within the North Coast EMS region.
III. Policy
A. Do Not Resuscitate (DNR) requests: CPR should not be initiated on a pulseless, non-breathing patient when a valid "Do Not Resuscitate" (DNR) request,"No Code," or "No CPR" order meeting policy #2307 requirements is presented.
B. Obvious Death: CPR does not need to be initiated if a pulseless, non-breathing patient has one or more of the following conditions:
1. Decapitation.
2. Decomposition.
3. Incineration of the torso and/or head.
4. Visible exposure, destruction, and/or separation of vital internal organs (brain, spinal cord, liver, heart, or lungs).
5. Rigor or livor mortis (without contributing environmental factors- see special considerations).
C. Possible Death: If any doubt exists regarding the patient's conformance with the criteria above for obvious death, then CPR shall be initiated (unless impossible) and maintained until transfer of patient care to ALS personnel, or patient delivery at a receiving hospital.
D. North Coast EMT-IIs/Ps may discontinue CPR upon voice orders from a base hospital physician. EMT-Is transferring care to ALS personnel are authorized to follow an EMT-II/Ps instructions to discontinue resuscitation.
E. At no time shall BLS personnel discontinue CPR unless one or more of the following criteria are met:
1. The rescuer is physically exhausted and unable to continue.
2. Spontaneous circulation and respiration is restored.
3. CPR is being transferred to other persons qualified to perform CPR.
4. A California-licensed physician at the scene (i.e., tele- communication orders cannot be accepted by BLS personnel) assumes total responsibility for the patient by ordering BLS personnel to discontinue CPR.
5. A Valid "Do Not Resuscitate" (DNR) request," No Code," or "No CPR" order meeting policy #2307 requirements is provided.
IV. Procedure
A. In any event where death is determined by BLS personnel, cancel ALS response, notify the appropriate agency with primary investigative authority (coroner, law enforcement) and all pertinent facts and findings should be documented as soon as possible. Refer to your County Coroner's policy regarding disposition of the deceased.
B. If death appears to be from other than natural causes, the body and scene should be disturbed as little as possible to protect potential crime scene evidence.
C. A First Responder or EMT-I who does not begin resuscitation of a pulseless and apneic patient shall document the prehospital event on a First Responder Report or Prehospital Care Report (PCR). The report shall be delivered and received by the base hospital with jurisdiction not later than 24 hours after the call.
D. The base hospital shall review all determination of death documentations by BLS personnel, and provide retrospective medical control to assure proper prehospital application of this policy.
V. Special Information
A. Division 2.5 of the California Health and Safety Code, Section 1798.6(a), states that the authority for patient care management in an emergency shall be vested in that licensed or certified health care professional, which may include any paramedic or other pre-hospital emergency personnel, at the scene of the emergency who is most medically qualified specific to the provision of rendering medical care.
B. If directed by a law enforcement officer to transport a victim who is obviously dead, comply with the order and document the incident upon arrival at the hospital. Provisions of the California Penal Code make it unlawful to willingly fail or refuse to comply with any lawful order, signal or direction of any peace officer.
C. Hypothermia can mask the positive neurological reflexes which indicate life, so it is imperative to be certain no contributing environmental factors exist, such as cold water submersion or cold exposure. If there exists any possibility that either of these could be a factor, resuscitation should be started immediately.