4.3. DETERMINATION OF DEATH/TERMINATION OF RESUSCITATION MEASURES

Related Names

None.

Purpose of assistance

All patients who have signs of clinical death, it is necessary to carry out the full volume of resuscitation measures, including cardiac resuscitation (CPR), with the exception of the situations listed below.

Description of patients

Signs of clinical death should be considered in any unconscious patient with no breathing and no pulse on the carotid artery.

Inclusion/exclusion criteria

Resuscitation should begin in all patients with missing breathing and pulse, except in the following cases (not applicable to patients due to lightning strike, drowning, hypothermia):

1. Diseases or injuries or conditions that clearly indicate biological death (irreversible brain death):

a) decapitation – complete separation of the head from the body;
b) signs of decomposition or decay – the skin is swollen or torn, with or without a rupture of soft tissues. The presence of one of the signs indicating the onset of
death at least within the last 24 hours;
c) transsection of the trunk – the body is completely cut below the level of the shoulders and above the hips along all important organs and vessels, while the spine may or may not be dismembered;
d) burns – 90% of the body surface with deep burns, complete absence of hair and charred skin;
d) injuries incompatible with life (massive blunt trauma, complete bleeding of the body, damage to brain matter);
e) useless and unethical attempts, as defined by the police agency/protocol, are associated with “convincing reasons” for refusing resuscitation;
f) if the patient is not breathing with a blunt or penetrating injury, there is no pulse, and there are no other signs of life (spontaneous movements), (there is no ECGactivity or pupil reaction, etc.) at the time of arrival of the EMF team;
c) non-traumatic cardiac arrest with obvious signs of death, including characteristic skin color or cadaveric spell

OR

1. A valid order to refuse resuscitation “DO NOT RESUSCITATE” (form, card, bracelet) or other medical order (for example, a doctor’s order on resuscitation measures/a medical order on resuscitation measures), if it:

a) meets state requirements for color and design;
b) intact: not cut, broken or showing signs of recovery;
c) displays the patient’s name and the doctor’s name.

Patient care

Condition assessment

An initial examination should be performed for signs of clinical death.

Treatment and intervention

1. If all of the above signs are present, there is no need for CPR.
2. If all signs of death have been detected after starting CPR, you can stop resuscitation and contact medical guidance.
3. If the signs are different from those given above – clinical death is undeniable, so you must immediately start resuscitation or continue it. In case of confirmation of death during resuscitation, the instruction “Termination of resuscitation measures” comes into force.
4. Do not comply with the requirements (DO NOT RESUSCITATE/MRPRZ/RLPRZ) with signs of life:

a) if there is a bracelet or a “DO NOT RESUSCITATE” transfer form and there are signs of life (pulse and breathing), provide standard appropriate treatment according to existing protocols corresponding to the patient’s condition;
b) a request for permission to discontinue treatment in these conditions for any reason receives direct medical supervision;
c) if there is documentation of “DO NOT INTUBATE” (DO NOT RESUSCITATE/MRPRP/RLPRP), the patient should receive full treatment according to the protocols, except for any intervention prohibited in the patient’s previous referral;
d) if for any reason an intervention is considered that is prohibited in the previous referral, immediate medical supervision should be obtained.

Patient safety

In cases where the patient’s condition is unclear and the appropriateness of stopping resuscitation is questioned, EMD personnel should immediately initiate CPR and then seek direct medical supervision.

Useful information for training

Key points

1. To ensure safety at the scene and/or at the request of relatives, doctors can begin the procedure of resuscitation, even if there are all signs of death.
2. When working at a potential crime scene, try to move possible investigative evidence as little as possible.

Relevant evaluation results

No recommendations.

Key elements of documentation

1. Clinical/situational details that can be learned from relatives/bystanders.

2. Description of causes of death:

a) communication time with medical guidance;
b) time of ascertainment of death.

3. Names/contact details of third parties whose presence at the scene is important.

Criteria for the effectiveness of care

There are no recommendations.