1. Policy Revisions – August 2004 Contra Costa EMS Agency

2. 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)

3. 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)

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. Discontinuing Pediatric CPR Base station contact required if discontinuation of efforts appears appropriate Not directly addressed in text of policy

12. 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

13. Coroner Issues Policy now more concise No change in policy

14. 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