Determination of Death
Purpose: To provide guidance for determining when prehospital resuscitation attempts at not indicated.
Medics should use good judgment and common sense in the application of these guidelines. Multi-casualty
incidents are an exception to this policy.
- In all situations where any possibility of life exists, make every effort to resuscitate the patient.
o Very often, the reported "down time" is an inaccurate parameter of resuscitation potential, as the patient may have been in bradycardia or simply unconscious for a period of time, yet still
perfusing blood to the brain. Additionally, information received from bystanders in regards to time
is usually inaccurate.
o Pupil size and response to light can be inaccurate indicators of death, as medications taken orally or directly in the eyes can affect them. Pupils can fixate after one or two minutes of global
anoxia. Additionally, children and hypothermic patients may have fixed and dilated pupils from
anoxia and yet be resuscitated without a neurological deficit.
- EMS personnel do not pronounce death but rather determine death based on predetermined criteria.
- Field deaths not covered by this policy require assessment by an ambulance paramedic and consultation
with an on-line medical director for determination of death.
Criteria to Determine Death
- EMS personnel are not required to initiate resuscitative measures if any of the following exist:
c. Rigor Mortis
d. Dependent Lividity
f. Visual massive trauma to the brain or heart conclusively incompatible with life
g. Personnel are presented with a DNR Order - In these situations, refer to Do Not Resuscitate policy.
h. Advanced level units may discontinue resuscitation attempts for victims of blunt or penetrating
traumatic cardiac arrest if no EMS-witnessed signs of life were ever present AND the patient is
- With the exception of blunt traumatic arrest, an ECG strip is not required for any patient who meets any of the above criteria.
- EMS personnel are not obligated to continue resuscitation efforts initiated by other persons on the scene when the patient meets any of the above criteria. This includes telephone CPR initiated by the direction
of emergency medical dispatchers.
Once Death has been Determined
- Immediately notify the appropriate law enforcement agency and remain on scene until they arrive.
- Cover the body with a sheet or other suitable item.
- Do not remove any property from the body or the scene for any purpose.
- Leave the body at the scene in the care of the appropriate law enforcement agency.