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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.

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Policy Revisions – August 2004

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  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

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