Initiation of CPR and Determination of Death

Section 1 - ADMINISTRATIVE POLICIES

1.05 INITIATION OF CPR AND DETERMINATION OF DEATH

Patients found in cardiopulmonary arrest by EMS personnel will receive cardiopulmonary resuscitation unless they meet the following EXCEPTIONS:

• Trauma Related Cardiac Arrests who meet the criteria set forth in the DETERMINATION OF DEATH IN TRAUMA PRACTICE PARAMETER (1.06).
• The patient who has been decapitated or whose thorax or abdomen has been transected.
• The patient with no palpable pulse or blood pressure, who exhibits no response to stimuli, no respiratory effort, is not exposed to an environment likely to promote hypothermia, (such as cold water or low ambient air temperatures), and is asystolic in two or more electrocardiograph leads, PROVIDED that one of the following are present:
  • Rigor mortis
  • Decomposition of body tissues
  • Dependent lividity
  • Incineration
• The patient who, upon arrival of EMS personnel, is attended by a physician licensed in the State of Florida, AND where the physician is willing to write a statement of his relationship to the patient, a "Do Not Resuscitate" order, and a rationale for this order on the Patient Care Report or agency abbreviated Patient Care Report. EMS personnel must attempt to verify the identity of the physician before withholding cardiopulmonary resuscitation.
• A patient who is subject to a current order, of unquestioned validity written by the patient's physician to withhold cardiopulmonary resuscitation. ALL WRITTEN DOCUMENTS SHOULD BE CONSIDERED INVALID UNLESS VALIDITY IS ESTABLISHED BOTH AT THE SCENE AND IN CONJUNCTION WITH THE ON-LINE MEDICAL CONTROL PHYSICIAN.
• When presented with a State DNR form which is appropriately completed.
• Cardiopulmonary resuscitation may be halted when:
  • Effective spontaneous ventilation and circulation have been restored.
  • Resuscitation efforts have been transferred to persons of no less skill than the initial providers.
• Medical Related Cardiac Arrests meet the criteria set forth in the ASYSTOLE PRACTICE PARAMETER (4.02)
• ALL DECISIONS CONCERNING THE WITHHOLDING OR CESSATION OF RESUSCITATION, NOT COVERED BY THE ABOVE EXCEPTIONS, MUST BE MADE IN CONJUNCTION WITH MEDICAL CONTROL.
• Document original body position and location. Disposable supplies (i.e. ETT, IVs, EKG electrodes, TCP electrodes, or Hands free defibrillation pads) will be left in place. If EMS crews receive confirmation from patient's physician that they will sign the death certificate airway devices and IV's can be removed. Contact Law Enforcement and follow agency SOG’s regarding patient body care and removal. If the body is moved for treatment purposes do not move it back into the original position.