Cgabryszek: Created page with "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..."

2022-11-18T18:43:33Z

Created page with "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..."

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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.

5-10 TERMINATION OF RESUSCITATION - Revision history