EMS and the holy water

[Stevo]

i thought i'd ask around here, seems different locales have a slightly different take of declaring death.

where and when is it appropriate for ems to call it quits?

may i start off with a popular joke.....

Cross Examining The Coroner


A defending attorney was cross examining a coroner. The attorney asked, "Before you signed the death certificate had you taken the man's pulse?" The coroner said, "No."

The attorney then asked, "Did you listen for a heart beat?", and again the coroner said, "No."

Then the attorney asked, "Did you check for breathing?", and again the coroner said, "No."

"So when you signed the death certificate you had not taken any steps to make sure the man was dead, had you?"

The coroner, now tired of the brow beating said, "Well, let me put it this way. The man's brain was sitting in a jar on my desk, but for all I know he could be out there practicing law somewhere."

~S~

[Jon]

Dependant lividity, decapitation, non-survivable trauma (in arrest and entrapped), full evisceration, and SOMETIMES rigor mortis in a warm enviroment.

Cold-water drownings get worked, usually.

[SafetyPro2]

For BLS, here's our criteria. If the patient is pulseless and apneic and has the following, we can "determine" death and withhold treatment.

Decapitation
Incineration
Decomposition
Massive crush injury
Evisceration of heart, lung or brain tissue
Extrication >15 minutes and unable to provide resuscitative measures
MCI with insufficient resources (i.e. a black triage tag)
Drowning with submersion >1 hour
Rigor mortis
Post-mortem lividity

For the last two (rigor and lividity), we're also required to do the following:
- open the airway, look/listen/feel, then auscultate the lungs for 30 seconds
- auscultate the apical pulse for one minute and palpate the carotid (or brachial for infants) for 60 seconds
- check pupil response and response to painful stimuli (which for us is limited to interdigital pressure)

For ALS, they can use the same criteria, or upon contacting the base hospital, the base physician can "pronounce" death based on the ALS unit's findings and report.

[TTLWHKR]

DEAD ON ARRIVAL (DOA)
STATEWIDE EMS PROTOCOL

Criteria:
A. Patient presenting with the following
1. Decomposition.
2. Rigor mortis (Caution: do not confuse with stiffness due to cold environment)
3. Dependent lividity.
4. Decapitation.
5. Unwitnessed cardiac arrest of traumatic cause.
6. Traumatic cardiac arrest in entrapped patient with severe injury that is not compatible with
life.
7. Incineration.
8. Submersion greater than 1 hour.
B. In cases of mass casualty incidents where the number of seriously injured patients exceeds the
personnel and resources to care for them, any patient who is apneic and pulseless may be
triaged as DOA.
1 Exclusion Criteria:
A. Obviously pregnant patient with cardiac arrest after trauma, if cardiac arrest was witnessed by
EMS practitioners. These patients should receive resuscitation and immediate transport to the
closest receiving facility. See Trauma Patient Destination Protocol # 180.
B. Hypothermia. These patients may be apneic, pulseless, and stiff. Resuscitation should be
attempted in hypothermia cases unless body temperature is the same as the surrounding
temperature and other signs of death are present (decomposition, lividity, etc…). See
hypothermia protocol #681.
Treatment:

A. All patients:
1. Initial Patient Contact – see Protocol # 201.
2. Verify pulseless and apneic.
3. Verify patient meets DOA criteria listed above.
a. If any doubt exists, initiate resuscitation and follow Cardiac Arrest Protocol # 331
and consider medical command contact.
b. If patient meets DOA criteria listed above, ALS should be cancelled.
4. If the scene is a suspected crime scene, see Crime Scene Preservation Guidelines #919.
5. In all cases where death has been determined, notify the Coroner or Medical Examiner’s
office or investigating agency. Follow the direction of the Coroner or Medical Examiner’s
office/investigating agency regarding custody of the body.
Possible Medical Command Orders:
A. If CPR was initiated, but the medical command physician is convinced that the efforts will be
futile, MC physician may order termination of the resuscitation efforts.
Note:
1. In the case of multiple patients from lightning strike, reverse triage applies, and available resources
should be committed to treating the patients with no signs of life unless they meet the other criteria
listed above.

[Stevo]

interesting .....


what about unwitnessed codes, the ones where lividity hasn't quite taken place yet

what would it normally take anyways?

~S~

[nyc.ems]

if its a peds or infant,for the sake of parents and family,i would continue with cpr.lividity,rigor, and or obvios death on adultsits different.if no signs and not sure work them up...

[TTLWHKR]

Originally Posted by Stevo

interesting .....


what about unwitnessed codes, the ones where lividity hasn't quite taken place yet

what would it normally take anyways?

~S~

Call the funeral home.

[FFEMT1764]

Our protocols say the same thing as you guys already said with the addition of anyone in asystole that did not have a witnessed arrest...example you call freddo on the phone and tell him you are coming over...takes you 5 minutes to get from your place to his...you get there he is dead...he is not going to get worked...asytsole is asystole- it rarely changes back to something more workable...

[coloradoemt]

Originally Posted by FFEMT1764

Our protocols say the same thing as you guys already said with the addition of anyone in asystole that did not have a witnessed arrest...example you call freddo on the phone and tell him you are coming over...takes you 5 minutes to get from your place to his...you get there he is dead...he is not going to get worked...asytsole is asystole- it rarely changes back to something more workable...

I just had this conversation with the training instructor yesterday. Dead id dead unless it is a child and then it is situational. When it comes to kids, the parents are looked at as patients as well... sometimes.

[FFEMT1764]

Yes, unless the parents deaded the child, then the are suspects and contaminating a crime scene!