Page 221 - ATP-P 11th Ed

DETERMINATION OF DEATH /
DISCONTINUING RESUSCITATION PROTOCOL

SPECIAL CONSIDERATIONS
1. Immediate determination of death is appropriate in a trauma patient without
pulse or respirations in the setting of multiple casualties when resuscitative ef-
forts would hinder the care of more viable patients.
2. Patients that are struck by lightning, have hypothermia, cold-water drowning, or
intermittent pulses may require extended cardiopulmonary resuscitation. SECTION 2
3. It is assumed that personnel do not have access to ECG, or other monitoring
equipment to evaluate heart rhythm, or deliver countershocks.

Signs and Symptoms
1. Obvious Death – Persons who, in addition to absence of respiration, cardiac activity,
and neurologic reflexes have one or more of the following:
a. Decapitation
b. Massive crushing and/or penetrating injury with evisceration of the heart, lung or
brain
c. Incineration
d. Decomposition of body tissue
e. Rigor mortis or post-mortem lividity
Management
1. In the setting of obvious death, resuscitative efforts should not be initiated.
2. If resuscitative efforts have been initiated, consider termination of resuscitation:
a. After 15 minutes (if the cause is unknown or due to trauma) or after 30 minutes
(when the cause is due to hypothermia, electrical injury, lightning strike, cold water
drowning, or other cause known to require a prolonged resuscitative effort) when:
i. There is persistent absence of pulse and respirations despite assuring airway pa-
tency and effective ventilation as well as administration of resuscitative fluids
and medications.

210 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 211