For the list's perusal. This is our protocol for recognition of death
(apologies for the length of the post)
RECOGNITION OF DEATH BY AMBULANCE SERVICE PERSONNEL
To assist paramedics to identify cases In which death is unequivocal and
resuscitation futile the following protocols will be followed with three
clear groups of patients only. This Protocol does not remove the
requirement for formal certification of death by the registered medical
practitioner but the benefit to paramedics are as follows
1. To avoid any unnecessary distress to relatives by undertaking
resuscitation where there is no chance of success.
2. To save time, resources and the energy of ambulance personnel in
undertaking futile resuscitation.
3. To expand the role of ambulance personnel by formally acknowledging
decisions that paramedics are competent to make.
4. To ease the workload of local A & E Department where clinicians are
frequently called upon to confirm death in situations where paramedics
are fully competent to do so.
GROUP A
CONDITIONS UNEQUIVOCALLY ASSOCIATED WITH DEATH
- Decapitation
- Massive cranial and cerebral destruction
- Hemicorporectomy (or similar massive injury)
- Decomposition
- Incineration
- Rigor Mortis
-Foetal Maceration
Whilst all of these conditions are associated with death, clinical
confirmation of death must be ascertained by:
1. No response to stimuli
2. Absence of pulse
3. Absence of breathing
In this group clinical confirmation of death can be recognised by
confirmation of cardiac arrest
DO NOT RESUSCITATE
GROUP B
CONDITIONS REQUIRING ECG EVIDENCE OF ASYSTOLE
- Submersion for more than 3 hours in adults over 18 years of age, ~
with or without hypothermia
- Continuous monitored asystole, despite Cardio Pulmonary Resuscitation
(CPR}, for more than twenty minutes in a normothermic patient
- Patients who have received no resuscitation for at least fifteen
minutes after collapse and have no pulse, or respiratory effort on
arrival of the Ambulance Personnel.
TIMINGS MUST BE ACCURATE and once again clinical confirmation of death
must be ascertained by
1. No response to stimuli
2. Absence of pulse
3. Absence of breathing
DO NOT RESUSCITATE
GROUP C
TERMINAL ILLNESS
Cases of terminal illness where a General Practitioner or Hospital
Doctor has given clear instructions that the patient is not for
resuscitation. ~
In order to be effective the DO NOT RESUSCITATE policy should be clearly
~ written in the patients Hospital Notes and GP Notes, if not, a
suitably clear letter from the GP or clear instructions in nursing or
carers records.
It is important to remember that such a policy can always be superseded
by a clear and subsequent decision to the contrary should the patient
have changed his mind.
If there is any doubt as to the enforceability of the DO NOT RESUSCITATE
policy, the presumption is always that resuscitation should be given.
Ultimately the paramedic must use his own professional judgment as to
whether the policy applies to the situation in question.
I work for Sussex Ambulance Service Trust, but I believe these are the
protocols for the whole of the country. I'm sure someone will put me
right on this if that's not correct.
Mark Parsons - Paramedic
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
|