DOA?

[pierce]

I had my first DOA the other day, it was an obvious one...rigor moris, lividity, cold to touch, and bowel movement (of course, apnea and acardia). So I was pretty confident calling it myself, as a Basic. However, it led me to wonder exactly when I'm allowed to "declare" a DOA. Mainly, what has to been there to keep me from starting CPR until a medic arrives?

[Ridryder 911]

You should had been taught this in basic CPR, ad EMT course. The conclussive signs of death as you mentioned. You should also refer to your protocols and policies.

Be safe,

R/R 911

[JakeEMTP]

As a basic we were taught in class that we're not really aloud to declare anyone DOA. However, the instructor mentioned the fact that if we need to take more than 2 steps between compressions and breaths, they are probably dead.

In all seriousness, as Ridryder mentioned check your local protocols for declaring a person dead.

[Just Plain Ruff]

Jake, what do you mean take two steps between cpr and a breath?????

[nsmedic393]

i think he means; you are doing compressions on the chest then you walk to the other side of the highway and give two breath to the head.

[Just Plain Ruff]

oh well then there is that

[Nate]

If you give a soft kick and it hurts your foot...its dead. (Joke for those who don't know what one is.)

[lizard90048]

Well, in Los Angeles County, all this is outlined in Section 814 of the LA County EMT-I/Paramedic/MICN policy.

Basically, it outlines these obvious signs of death:

I. Determination of Death: A patient may be determined dead if, in addition to the absence of respiration, cardiac activity, and neurologic reflexes, one or more of the following physical or circumstantial conditions exist:

A. Decapitation

B. Massive crush injury

C. Penetrating or blunt injury with evisceration of the heart, lung or brain

D. Decomposition

E. Incineration

F. Pulseless, non-breathing victims with extrication time greater than fifteen minutes, where no resuscitative measures can be performed prior to extrication

G. Pulseless, non-breathing victims of a multiple victim incident where insufficient medical resources preclude initiating resuscitative measures

H. Drowning victims, when it is reasonably determined that submersion has been greater than one hour

I. Rigor Mortis (Requires assessment as described in section II.A.)

J. Post-Mortem Lividity (Requires assessment as described in section II.A.)

II. Patients Determined to be Dead:

A. If the initial assessment reveals rigor mortis and/or post-mortem lividity only,

EMT-Is and/or paramedics shall perform the following assessments to determine respiratory, cardiac, and neurologic status:

NOTE: Assessment steps may be performed concurrently.

1. Assessment of respiratory status:

a. Assure that the patient has an open airway.

b. Look, listen and feel for respirations. Auscultate the lungs for a minimum of 30 seconds.

2. Assessment of cardiac status:

a. Auscultate the apical pulse for a minimum of 60 seconds.

b. Adults and children: Palpate the carotid pulse for a minimum of 60 seconds.

Infants: Palpate the brachial pulse for a minimum of 60 seconds.

3. Assessment of neurological reflexes:

a. Check for pupil response with a penlight or flashlight.

b. Check for a response to painful stimuli.

I would assume that you have similar criteria in your area. Check your state's EMT Scope of Practice, and your local County's expanded Scope of Practice.

Also, be aware that your scope may change from time to time. I.E.: In LA County it is now recomended to poke all suspected fatilities with a pointed stick.

-Ian in LA

[Thunderchild145]

Obviously it depends on your protocols, but there are several obvious signs of death, which are

A) Rigor Mortis

Obvious Mortal Injury (Decapitation, etc.)

C) Post-Mortem Dependant Lividity

D) Putrefaction/Decomposition

If you see any of them, or multiple of them combined, it's pretty safe to say that the pt s dead. There are also a few others like Pulselessness, Apnea, Death of others in the same compartment, that when combined with the above 4 can help in making that kind of call. When in doubt though, attempt resuscitation.

[Just Plain Ruff]

would frozen like a block of ice be a criteria?????