Another Victim Survives DOA Declaration

[Chief1C]

http://www.jems.com/news_and_articles/news/2010/01/firefighters_find_priority_4_victim_still_breathing_during_body_recovery.html

Maryland.

Although, in PA; our protocols use the wording, obvious death, to include incineration. I wish the article explained his injuries a little more. Any injury could be "life threatening", even burns to two extremities could be with infection and whatnot. Not defending them, a stethoscope would have worked, had they not been able to feel for a pulse. Clearly, if there was a fire, there could be obstacles which would make doffing firefighting gloves and touching things, dangerous. I can't imagine, if he was breathing on his own, the whole time, the toxins, smoke, water, heat; inhalation.

[fireflymedic]

Okay -

For those states where medics are allowed to terminate resucitation efforts OR declare death on scene - what is your protocol for doing so?

Here there are a few things required

1. Determination of Death class must be completed

2. 6 inch strip must be ran confirming asystole in all 3 leads

To even qualify for it -

1. Injury incompatible with life (burned beyond recognition - and no large surface area does not equate, we're talking entire consuming of body by fire and is blackened, or complete decapitation)

2. Resucitation effort exceeding 30 min with no return of pulse or shockable rhythm (or complete exhaustion of provider, but I'm not aware of a case involving that). They keep flipping back and forth - have to work it to the hospital and let doc decide

3. Presence of Dependent Lividity or Rigor Mortis

Anybody else out there follow a similar protocol? I should think so, but with the amount of these cases happening, it's making me question whether the medics are just not following protocol and calling people dead they think should be dead OR further training needs to be happening. Either way, there's a problem and it needs to be fixed !

[spenac]

First this news was already posted in news feed.

Second why do a strip? Asystole is a workable rhythm.

[DwayneEMTP]

Second why do a strip? Asystole is a workable rhythm.

I think that most would disagree with you in the vast, vast, majority of cases. Traumas, excessive time down, etc.

Dwayne

[Dustdevil]

Well, he did say that it was a "workable" rhythm, not necessarily a statistically salvageable rhythm. I have to agree with that. Look up asystole in any textbook and you'll find a strategy for working it. Therefore, it really adds little to nothing to your assessment of a DOS. Conversely, you will find no textbook protocols for resuscitating decapitation or rigor mortis, so those are useful assessment tools.

[p3medic]

We have a protocol for treating asystole, for this reason, we don't run a strip on any arrest we decide not to work. If we opt not to attempt resus, we use other criteria, apnea, pulselessness in the setting of trauma, rigor, lividity, etc...

[aussiephil]

With regards to Asystole, we have a protocol & can call it if it is refractory asystole.

[p3medic]

Refractory asystole I can call too, however putting the electrodes on and identifying asystole doesn't make it "refractory" unless I attempt to tx it. Putting the EKG on just to "make sure" makes it look like I'm not. If I'm not sure, I should be treating it.