Notes – Determination of Death/Withholding Resuscitative Efforts

Determination of Death/Withholding Resuscitative Efforts

Patient Safety Considerations

  1. In cases where the patient’s status is unclear and the appropriateness of withholding resuscitation efforts is questioned, EMS personnel should initiate CPR immediately and then contact direct medical oversight.

Notes/Educational Pearls

Key Considerations

  1. For scene safety and/or family wishes, provider may decide to implement CPR even if all the criteria for death are met
  2. At a likely crime scene, disturb as little potential evidence as possible

Pertinent Assessment Findings

  1. No recommendations

Quality improvement

Associated NEMSIS Protocol(s) (eProtocol.01)

  • 9914201 – Cardiac Arrest-Determination of Death/Withholding Resuscitative Efforts
  • 9914169 – Cardiac Arrest-Do Not Resuscitate

Key Documentation Elements

  • Clinical/situational details that may be available from bystanders/caregivers
  • Documentation of details surrounding decision to determine death
    • Time of contact with direct medical oversight
    • Time of death determination
  • Names/contact information for significant bystanders

Performance Measures

  • None recommended

References

  1. ‘Do Not Attempt Resuscitation’ in the Out-of-Hospital Setting. American College of Emergency Physicians; October 2003. ACEP Policy Statement.
  2. Millin MG, Galvagno SM, Khandker SR, Malki A, Bulger EM. Withholding and termination of resuscitation of adult cardiopulmonary arrest secondary to trauma: resource document to the joint NAEMSP-ACSCOT position statements. J Trauma Acute Care Surg. 2013;75(3):459-67.
  3. National Guidelines for Statewide Implementation of EMS “Do Not Resuscitate” (DNR) Programs National Association of Emergency Medical Services Directors and the National Association of Emergency Medical Services Physicians. Prehosp Disaster Med. 1994;9(2):197-9.
  4. National Association of EMS Physicians, American College of Surgeons Committee on Trauma. Termination of resuscitation for adult traumatic cardiopulmonary arrest. Prehosp Emerg Care. 2012;16(4):571.
  5. National Association of EMS Physicians, et al. Withholding of resuscitation for adult traumatic cardiopulmonary arrest. Prehosp Emerg Care. 2013;17(2):291.