What are your Services SOP or Protocols on declaring Clinical Death?

[lupinman]

Hi guys,

I've decided to emerge from the shadows and announce my return with a question. What are your services SOP or Protocols on declaring Clinical Death? Who is allowed to declare death? Do you obtain EKG tracing? If so, is it on all Patients, no matter the apparent cause of the death?

thanks

[Kiwiology]

All Ambulance Officers regardless of practice level can declare death (to include withholding and ceasing resuscitation) and Intensive Care Officers can sign the deceased person certificate for the Police.

Such practice is regardless of suspected cause of death; remembering that only a Doctor (Medical Officer) can certify death and its cause; the difference is subtle but important

The old Ambulance Standard Operating Procedures required a rhythm strip to be obtained "in all three leads" but the new Operations Manual does not have such a requirement, doing so is prudent however

This type of practice is fairly common in the Commonwealth nations in more-or-less the same from; e.g. Australia, South Africa and the UK, not sure about Canada; nb in UK only a State Registered Paramedic can perform such the ECA/ECSW cannot, well they can't do anything except fetch bags and drive so that kind of goes without saying

The ability to declare death (including withholding and ceasing resuscitation) is a power all ambo's should have regardless of their practice level; it doesn't take a Consultant Rocket Surgeon to figure that somebody who is unconscious without pulse, respiration and meaningful cardiac electrical activity is D-D-D-D-DEAD.

I know in US it's fairly restrictive and in many cases only the Paramedic is able to determine death in very limited circumstances (obvious death +/- not able to withhold resuscitation +/- only able to cease resuscitation after working the patient and/or contacting the Medical Control Physician) which if you ask me is understandable but pretty bloody pointless and not very dignified for the patient or their family.

Edited May 11, 2012 by Kiwiology

[BushyFromOz]

http://www.ambulance.vic.gov.au/Media/docs/x01_CPG_ADULT-web-835ff459-ac3e-454e-880b-0fac0c92c212-0.pdf

Page 26

[croaker260]

http://www.adaweb.ne...ZAc0=&tabid=798

What are your services SOP or Protocols on declaring Clinical Death?

• Absence of respiratory effort (MCI only).
  
• Injury incompatible with life (i.e., decapitation, severe head trauma, evisceration
  of the heart or brain, or burned beyond recognition).
  
• The patient shows signs of decomposition, rigor mortis, or dependent lividity.
  
• Whenever resuscitative measures (CPR) are instituted, they should be continued until arrival at a hospital, until directed by a physician to stop the resuscitation, or other circumstances dictate, unless the above criteria apply.
  

V. PATIENTS WHO ARE REFRACTORY TO FIELD INTERVENTIONS:

At times, the paramedic may have begun ALS measures on a patient who does not meet the requirements for Obvious death / Non-salvageable. After extensive ALS interventions without improvement, the likelihood of survival is minimal or non-existent. Examples include:

• Patients who have been without any vital signs for at least 20 minutes

(confirmed).

OR

• Patients who are in Asystole (confirmed in two leads) for at least 10 minutes and

have received appropriate ALS intervention.

OR

• Any other unforeseen circumstances where the likelihood of survival is minimal

or non-existent and aggressive ALS measures have been attempted.

In this case the paramedic should contact medical control for permission to stop

resuscitation efforts. Document thoroughly.

Who is allowed to declare death?

All EMS providers in the system, BLS or ALS. Transport or non-transport.

Do you obtain EKG tracing?

Not on obvious deaths.

If so, is it on all Patients, no matter the apparent cause of the death?

N/A

Edited May 11, 2012 by croaker260

[Bieber]

Obvious death (decomposition, rigor mortis, dependent lividity, injuries incompatible with life; i.e. decapitation, burned to a crisp, etc) as well as blunt trauma victims with no vital signs on ALS contact and cardiac arrests with an initial rhythm of asystole who do not respond to treatment with online medical consult. Our new protocols will be less restrictive.

[craig]

x

Edited May 12, 2012 by craig

[craig]

bloody page, cant get the thing to load up the algorithm......

just a one page pic........

Protocol C2

Album: parso

Uploaded 11 May 2012 - 21:28