Out of hospital termination of resuscitation

Squad51

Squad51

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Our protocol allows us to terminate resuscitation if all advanced measures have been performed and the patient remains in Asystole for 20 minutes. There are certain guidelines as well. Like it can't be in a public place, so don't leave them in the middle of WalMart. (Nursing homes aren't considered a public place.) There are a couple other qualifications like can't be a minor, pregnant, a crime victim etc. I was just wondering what everyone's thoughts on it were? Do you think it's the general public's expectation that we transport their loved one to the hospital when they call 911 or is it okay to terminate in the field?
 
We terminate in the field after 30 minutes or until ROSC, of course. If in a public place we transport to the morgue.
 
re

Follow your protocols. But generally dont transport dead bodies in an ambulance, thats not what it is for.
 
re

Absolutey going to be area dependent ftsmith stated
 
We call for the PD and the coroner. Once one of them gets there and is willing to take control of the scene, we're done and go back in service. We never transport to a morgue. If we're in a public place, we stay there until PD gets there.

Usually PD is enroute to all arrests anyway, so they'll get there before we call it from what I understand.
 
Totally appropriate to terminate in the field and I wish there was a bigger push in my area to do it. I am one of very few providers who does it on a routine basis.

Bottom line is dead bodies don't belong screaming down the road at break neck speed lights and sirens to put everyone at risk and likely be pronounced upon arrival to the hospital.

When your dead your dead....
 
I am so happy we finally have a protocol that allows for field termination without contacting medical control. We work an arrest for 30 minutes with certain criteria that must be met. If there is no ROSC we then are able to stop efforts. Before, we could request to stop efforts, but it was a total tossup as to whether or not the doc you happened to get would let you do it.

I think it is a shame that we have to put people at risk to rush a corpse to the ER for absolutely no reason at all, and wish more systems allowed for us to make the call as to when to stop resuscitative efforts.
 
20 minutes of resus with no ROSC, asystole in I,II,III nil breathing, heart sounds pupils fixed and dilated. IC paramedics can call a PEA

we can stop resus if the pt presents in asystole with > 10 minutes of down time with no CPR
 
Our Paramedics can and do pronounce in the field - sometimes after ALS or BLS interventions, sometimes not. Depending on the situation. It requires that they call medical control, of course, as the medical control doctor is then the pronouncing MD.

As far as terminating resuscitation, for us a termination of resuscitive efforts is something slightly different. It is an order by medical control to stop futile efforts, but the patient is still transported to the ER and is not pronounced until he or she arrives at the hospital. This situation sometimes arises in a situation where a BLS ambulance either initiates CPR in an inappropriate situation (obvious signs of death) or is 'forced' by protocol to continue CPR, and then transports the patient. If the patient is pronounced in the back of the ambulance, then the hospital won't take them, and the ambulance is out of service for hours sitting by the roadside waiting on the medical examiner with the dead body. The TRE avoids this situation.
 
Situational, typically we do not transport unless your heart is beating again. But then again, no one is going to leave a dead 4yr old in the middle of a McDonalds play area either even after 20mins of trying to revive.
 
EMTs and medics in Massachusetts can choose to not start resuscitation for the obviously dead. If a patient in arrest is worked and efforts are not successful, the medic can call the doc and ask to cease efforts after 20 minutes. Basics are stuck till ALS arrives.
 
Epi-do said:
I am so happy we finally have a protocol that allows for field termination without contacting medical control. We work an arrest for 30 minutes with certain criteria that must be met. If there is no ROSC we then are able to stop efforts. Before, we could request to stop efforts, but it was a total tossup as to whether or not the doc you happened to get would let you do it.

I think it is a shame that we have to put people at risk to rush a corpse to the ER for absolutely no reason at all, and wish more systems allowed for us to make the call as to when to stop resuscitative efforts.
Click to expand...

We transport cold if we get ROSC, if they code again en route we still transport cold

Sent from my Desire HD using Tapatalk
 
3 rounds of ACLS with asystole/PEA can be called in the field. Obvious death can be called in the field. If we have a persistent ventricular rhythm without pulses they can end up getting transported depending on what OLMD wants and how far out we are.

Traumatic arrests are an entirely different beast to deal with.

I have yet to meet a medic who won't transport a pedi code unless obvious signs of death are present. Is it right? Probably not. Does it help their and the family's peace of mind? More than likely.
 
Yes, we can stop resus on anybody there is no hard and fast rule depends on lots of things eg somebody in VF might get worked for 20 to 40 minutes while somebody who is in asystole might only get worked for five or ten.

If the person is obviously dead or it's not going to do them any good to be resuscitated then I won't even begin eg somebody with end stage cancer or who is on a bunch of machines, whats the point?

Give the cardiac arrests to somebody else anyway I hate them
 
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