Paramedic Kardex

Obviously Deceased:

Resuscitative measures are not indicated for declared dead patients.  Criteria is cardiopulmonary arrest victim with one or more of the following (which must be clearly documented on PCR):​​​

• Decomposition

• Incineration

• Massive crush injury &/or evisceration of heart or brain

• Decapitation

• Obvious fatal external exsanguination

 

SEE Note below for the following patients:​

• Rigor mortis (see ** NOTE below)

• Lividity (see ** NOTE below)

• Traumatic FA (see ** NOTE below)

• Unwitnessed, non-trauma FA with no bystander CPR or AED placement prior to EMS arrival AND found by cardiac monitor to be Asystole in 2 leads and meets criteria (see ** NOTE below)

 

When a patient meets the criteria of Obvious Deceased, resuscitation is not indicated and my be withheld or terminated by EMS Personnel.  Base Hospital Contact is NOT required.

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UPDATE: Even if proper paperwork is present, if the family is does not agree, make BHC for determination.

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**NOTE**: 

The following must be performed and documented to meet criteria for “Obvious Deceased’:

Respiratory Status

• Open airway

• looking, listening and feeling for respirations,

• Auscultation of the lungs for 30 seconds,

Cardiac Status

• Palpating a central pulse for minimum of 15 seconds,

• Auscultation of apical pulse for 15 seconds,

Neurological Status

• Assessing for pupil response with penlight/flashlight,

• No response to painful stimuli

For any uncertainty, check rhythm in 2 leads to confirm and confirm Asystole

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**Important** - If there are signs of life based on the above assessment, resuscitation intervention is required unless the patient is a DNR.

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Approved DNR documents (complete & signed):

• State EMSA/CMA prehospital DNR request

• Medic Alert medallion/bracelet with engraved directions

• DNR order written by MD

• POLST (Physician Orders on Life Sustaining Treatment)

 

Immediate Family means: 

Spouse, adult child, parent of a patient, adult sibling or domestic partner: EMS can withhold or withdraw resuscitative measures if immediate family is on scene and they make a unanimous decision to withhold resuscitation. UPDATE - This requires BHC, even if the family is unanimous.

 

Attorney in Fact or Healthcare Agent has legal authority to make medical care decisions.  MD or family must be present to give verbal orders (no phone).  Anyone giving DNR orders should sign ePCR. UPDATE - This requires BHC, even if the family is unanimous.

 

A DNR will be disregarded if the patient’s immediate family requests resuscitative measures BHC. UPDATE - This requires BHC, even if the family is unanimous.

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Documentation:

• Destination - Coroner shall be selected as the destination for patients declared dead in the field

• Patients with Respiratory, Cardiac, and Neurological status checks should have those documented on the ePCR

• Patients at a Skilled Nursing facility with a POLST form, and i Cardiac arrest or a near terminal state, should not be transported to the Hospital unless

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SPECIAL CIRCUMSTANCES

• When CPR is withheld do to patient meeting Obvious Death Criteria, the patient should NOT be transported from the scene by EMS.

• If a DNR/POLST patient dies in the back of an ambulance and YOU HAVE NOT STARTED DRIVING, you can take the patient back into the assisted living facility.

• Base Hospital Physicians have the authority to discontinue efforts if appropriate, this requires a Base Order.

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Caution:

• Normal skins may appear as lividity, poor hygiene/gangrene may be mistaken for decomposition. 

• Burn victims appearing incinerated may be alive.  Confirm rhythm in these patients with cardiac monitor. 

• Hypothermia (especially in children, elderly and debilitated) may simulate death.