5-10 TERMINATION OF RESUSCITATION

Notes:

• This protocol addresses discontinuation of field resuscitation.
• If the patient does not meet Presumed Dead On Arrival criteria, they will receive full resuscitation efforts based on current guidelines.
• Studies have shown that rapid transport to a hospital after unsuccessful pre-hospital ACLS resuscitation attempt rarely results in survival to hospital discharge.
• Patients that do not respond to pre-hospital efforts will generally not be transported to the hospital.

ALL - PERFORM/CONFIRM ALL ABOVE INTERVENTIONS

EMS personnel may cease or withhold resuscitation efforts when the following circumstances are present upon arrival:

• Presence of Do Not Resuscitate (DNR) orders
  • Valid Wisconsin Do Not Resuscitate wrist band attached to the patient.
  • Direct order from medical control physician.
• Presence of irreversible biological death
  • Decomposition
  • Rigor mortis
  • Dependent lividity (dependent mottled, bluish appearance) with
    • Pulselessness AND
    • Apnea AND
    • No shockable rhythm
• Traumatic injuries
  • Injuries incompatible with life such as decapitation or transected torso
  • Bodily position not compatible with life(i.e.contortion)
    • Efforts should be made to document absence of vital signs
  • Penetrating trauma
    • No pupil response
    • No spontaneous movement
    • No shockable rhythm or organized EKG activity in two leads
  • Blunt trauma
    • Pulseless AND
    • Apneic AND
    • No shockable rhythm
  • In a multiple-patient or mass casualty incident these patients are triaged BLACK.

Contact Medical Control for the following:

• A physician on scene wants to direct continuing or discontinuing resuscitation in conflict with the direction this protocol or medical control gives you
• Other circumstances of obvious death not listed above
• Determination of death confirmation

PARAMEDIC - PERFORM/CONFIRM ALL ABOVE INTERVENTIONS

EMS personnel may terminate resuscitation if ALL of the following conditions are met:

• Cardiac arrest prior to EMS arrival
• Patient is >18 years old
• Patient is not visibly pregnant
• Patient is not hypothermic due to an environmental extreme
• Patient displays no signs of neurologic function
• ALL of the following ACLS Interventions have been performed:
  • At least 3 rounds of ACLS medications have been administered.
  • Successful placement of ET tube or supraglottic airway, confirmed by approved methods.
  • Patent IV/IO line.
  • Quantitative ETCO2 is less than 15mmHg after 20 minutes of ACLS care have been provided.
• All three of the following are true:
  • There has been no return of spontaneous circulation during resuscitation efforts
  • The arrest was not witnessed by EMS personnel
  • No shockable rhythm was witnessed (noV.Fib/V.Tach)

Exceptions:

• Full resuscitative efforts and transport will be initiated if:
  • The patient arrested during EMS care
  • The patient is in law enforcement custody
  • The arrest occurred in a crowded public space
  • Carrying out initial resuscitation on scene is felt to be unsafe.
  • Patient is less than 18 years old
• Resuscitation may be continued as necessary if provider safety is in question.
• Continue resuscitation efforts and transport the patient if the arrest is due to penetrating trauma and you are less than 15 minutes from a trauma center. If transport time exceeds 15 minutes, contact medical control.

Contact Medical Control for the following:

• Termination recommendations for patients that do not meet all the criteria
• Persistent rhythm of PEA despite 20 minutes of ACLS and no ROSC noted
• A paced rhythm and no ROSC noted throughout resuscitation efforts

Post-termination Procedures:

• Document time that resuscitation efforts were terminated.
• Documented asystole in two cardiac leads AND place a copy of rhythm strip in the chart.
• Contact Coroner. Do not disturb potential evidence.
• Remain with deceased until released by law enforcement or coroner.
• Assist surviving loved ones with contacting spiritual support, family or grief resources as needed.