EMS Policy Manual - Contra Costa Health Services

Contra Costa
Emergency Medical Services
DETERMINATION OF DEATH
IN THE PREHOSPIAL SETTING
POLICY #: 19
PAGE: 1 of 4
EFFECTIVE: 01/01/12
REVIEWED: 10/01/11
I. PURPOSE
To provide criteria to aid prehospital personnel in determining death in the field.
II. DEFINITIONS
Agent: An individual, eighteen years of age or older, designated in a power of attorney for health
care to make health care decisions for the patient, also known as “attorney-in-fact.”
Immediate Family: The spouse, domestic partner, adult child(ren) or adult sibling(s) of the patient.
Conservator: Court-appointed authority to make health care decisions for a patient.
Advanced Health Care Directive (AHCD): A written document that allows an individual to provide
health care instructions or designate an agent to make health care decisions for that person. AHCD is
the current legal format for a living will or Durable Power of Attorney for Health Care (DPAHC).
Standardized Patient-Designated Directives:
• Statewide Emergency Medical Services Authority/California Medical Association Prehospital DNR
(Do Not Resuscitate) Form
• Physician Orders for Life Sustaining Treatment (POLST): A standardized, signed, designated
physician order that addresses a patient’s wishes about a specific set of medical issues related to
end-of-life care
• A standard DNR medallion/bracelet (e.g. Medi-Alert).
III. POLICY
A. Prehospital personnel do not pronounce death but may determine death in certain situations.
B. Prehospital personnel need not initiate CPR or may direct the discontinuation of CPR when
death has been determined using the criteria outlined in this policy, or when presented with an
approved Do Not Resuscitate order.
C. If any doubt exists as to the presence of vital signs, or if hypothermia, drug overdose, or
poisoning is suspected, begin CPR and follow the appropriate field treatment guidelines.
D. The body of a patient who has been determined to be dead from any of the reasons identified in
the Coroner section of this policy shall not be disturbed or moved from the position or place of
death without permission of the Coroner or the Coroner's appointed deputy.
E. If any questions exist about application of this policy base hospital direction may be utilized.
IV. OBVIOUS DEATH
A. Pulseless, non-breathing patients with any of the following:
1. Decapitation
2. Total incineration
3. Decomposition
4. Total destruction of the heart, lungs, or brain, or separation of these organs from the body
5. Rigor mortis or post-mortem lividity without evidence of hypothermia, drug ingestion, or
poisoning
6. Mass casualty situations.
B. Procedure:
1. Do not initiate CPR
2. In patients with rigor mortis or post-mortem lividity: