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Policy Revisions – August 2004. Contra Costa EMS Agency. Policy Changes. Policy 19 – Determination of Death in the Prehospital Setting – Revised Policy 34 – Search for Donor Card – New (previously a section in Policy 19). Reasons for Changes.

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policy revisions august 2004

Policy Revisions – August 2004

Contra Costa EMS Agency

policy changes
Policy Changes
  • Policy 19 – Determination of Death in the Prehospital Setting – Revised
  • Policy 34 – Search for Donor Card – New

(previously a section in Policy 19)

reasons for changes
Reasons for Changes
  • To aid in field pronouncement of patients without chance of survival
  • To allow field personnel to make decisions on stopping or not initiating resuscitation (without base contact)
major patient categories in policy 19
Major patient categories in Policy 19
  • Obvious death – no changes to policy
  • Probable death – now has distinction between medical and traumatic arrests
  • Adults in whom CPR can be discontinued – now defines “failure of resuscitative efforts” more precisely
probable death medical arrests
Probable Death – Medical Arrests

Definition:

  • Patients in whom there is total absence of observers or witness information; or
  • Patients in whom it is known that the arrest occurred more than 15 minutes earlier and no resuscitative efforts have begun
probable death medical arrests6
Probable Death – Medical Arrests
  • Procedure
    • BLS rescuers
      • follow first-responder defibrillation treatment guidelines
    • ALS rescuers
      • Assess for apnea and pulselessness
      • If conditions met, place cardiac monitor and document asystole for 1 minute
      • If asystole not present, begin resuscitation
probable death medical arrests7
Probable Death – Medical Arrests
  • Base contact not needed but base remains as resource if questions exist
  • Resuscitation should begin if:
    • Suspected hypothermia
    • Suspected drug overdose or poisoning
    • If any question exists at to presence of vital signs
probable death trauma
Probable Death - Trauma
  • Procedure differs in one way from medical arrests:
    • If patient has agonal rhythm, resuscitative efforts can be withheld.
    • Agonal rhythm defined as wide, bizarre QRS with rate of 20 or less
discontinuing adult cpr
Discontinuing Adult CPR
  • Can be done if initial resuscitative efforts unsuccessful:
    • After two rounds of cardiac drugs given
    • Adequate ventilation with or without intubation
    • Patient continues with asystole or agonal rhythm
  • Base contact not required
discontinuing adult cpr10
Discontinuing Adult CPR
  • Resuscitation should not stop if transport under way
  • Resuscitation and transport may be prudent when safety concerns exist or public setting of arrest are problematic
discontinuing pediatric cpr
Discontinuing Pediatric CPR
  • Base station contact required if discontinuation of efforts appears appropriate
  • Not directly addressed in text of policy
dispatch issues
Dispatch Issues
  • Minor rewording of policy
  • Dispatchers will inform responding crews if DNR papers are present (per the caller) and will that paperwork be presented on crew arrival
coroner issues
Coroner Issues
  • Policy now more concise
  • No change in policy
policy 34 search for donor card
Policy 34 – Search for Donor Card
  • Now is “stand-alone” policy
  • More concise wording
  • Moved from Policy 19 since doesn’t apply to patients who have died