Resuscitation with signs of obvious death

Can you please provide direction on what would be the most appropriate action for situations involving the initiation of cardiopulmonary resuscitation by first responders, prior to Paramedic arrival, who is then deemed to meet the obvious death criteria under the BLS PCS.

Thank you for the question. In order to provide an answer we need to consider a couple different potential scenarios for when this would apply. The first situation is where resuscitation efforts have been initiated by an Emergency First Response Team (EFRT) or Fire Rescue personnel prior to Paramedic arrival. If, in this situation, the paramedic’s patient assessment/physical exam reveals signs of obvious death, the expectation is that they would explain their clinical findings and rational to any first responders involved and then discontinue any and all resuscitation efforts. This authority is based on the grounds that Paramedics hold BLS certification and are generally considered the highest medical authority on scene. The second example involves a situation by which resuscitation efforts have been initiated by a Paramedic crew and a second crew arrives to provide assistance. In this situation, if the second crew discovers signs of obvious death, that may have been initially overlooked, they would need to communicate those findings to the first crew. If both Paramedic crews are in agreement with the clinical findings, resuscitation efforts may be immediately discontinued. If however, no consensus can be made between crews, it is recommended that resuscitation efforts continue and a BHP patch be immediately initiated for medical consultation. This direction applies regardless of the certification levels of either crew (PCP/ACP). In either situation, the NWRPCP would like to stress the importance of using professional communication when interacting with family members, bystanders and allied agencies. Keep them informed and involved in the decision making process. We are also in support of utilizing a BHP patch in order to avoid potential confrontation/disagreements in this sort of situation. Finally, it is important to remember that it is the Paramedics responsibility to document the details of the event within the Remarks section of the Ambulance Call Report and submit a Base Hospital Self Report Form per NWRPCP policy.