Transcript Policy Revisions – August 2004

Policy Revisions – August 2004
Contra Costa EMS Agency
Policy Changes
• Policy 19 – Determination of Death in the
Prehospital Setting – Revised
• Policy 34 – Search for Donor Card – New
(previously a section in Policy 19)
Reasons for Changes
• To aid in field pronouncement of patients
without chance of survival
• To allow field personnel to make decisions
on stopping or not initiating resuscitation
(without base contact)
Major patient categories in Policy 19
• Obvious death – no changes to policy
• Probable death – now has distinction
between medical and traumatic arrests
• Adults in whom CPR can be discontinued –
now defines “failure of resuscitative efforts”
more precisely
Probable Death – Medical Arrests
Definition:
• Patients in whom there is total absence of
observers or witness information; or
• Patients in whom it is known that the arrest
occurred more than 15 minutes earlier and
no resuscitative efforts have begun
Probable Death – Medical Arrests
• Procedure
– BLS rescuers
• follow first-responder defibrillation treatment
guidelines
– ALS rescuers
• Assess for apnea and pulselessness
• If conditions met, place cardiac monitor and
document asystole for 1 minute
• If asystole not present, begin resuscitation
Probable Death – Medical Arrests
• Base contact not needed but base remains as
resource if questions exist
• Resuscitation should begin if:
– Suspected hypothermia
– Suspected drug overdose or poisoning
– If any question exists at to presence of vital
signs
Probable Death - Trauma
• Procedure differs in one way from medical
arrests:
– If patient has agonal rhythm, resuscitative
efforts can be withheld.
– Agonal rhythm defined as wide, bizarre QRS
with rate of 20 or less
Discontinuing Adult CPR
• Can be done if initial resuscitative efforts
unsuccessful:
– After two rounds of cardiac drugs given
– Adequate ventilation with or without intubation
– Patient continues with asystole or agonal
rhythm
• Base contact not required
Discontinuing Adult CPR
• Resuscitation should not stop if transport
under way
• Resuscitation and transport may be prudent
when safety concerns exist or public setting
of arrest are problematic
Discontinuing Pediatric CPR
• Base station contact required if
discontinuation of efforts appears
appropriate
• Not directly addressed in text of policy
Dispatch Issues
• Minor rewording of policy
• Dispatchers will inform responding crews if
DNR papers are present (per the caller) and
will that paperwork be presented on crew
arrival
Coroner Issues
• Policy now more concise
• No change in policy
Policy 34 – Search for Donor Card
• Now is “stand-alone” policy
• More concise wording
• Moved from Policy 19 since doesn’t apply
to patients who have died