Policy 11 — DNR and Advanced Directives

Who may discontinue unsuccessful CPR and ALS interventions in the field?

An EMS paramedic

What must a paramedic do if one or more adult family members requests continued resuscitation or transport, when discontinuation is otherwise being considered?

Honor the request if safe to do so, and contact medical control for assistance if needed

What must be documented regarding CPR quality to allow discontinuation?

Adequate CPR has been administered with recorded ETCO2 readings

What airway management devices are acceptable to satisfy the airway criterion for discontinuation?

Endotracheal intubation, an advanced airway (King Airway), or a cricothyrotomy

What type of vascular access must be established to allow discontinuation?

IV or IO access

What treatment category, besides airway and access, must have been administered per protocol before discontinuation?

Rhythm-appropriate medications and defibrillation (if indicated)

What rhythm findings support discontinuation of resuscitation?

Persistent asystole or a pulseless agonal rhythm below 20 bpm

What is the minimum duration of resuscitation required before discontinuation can be considered?

25 minutes

How must the final rhythm be confirmed before discontinuing resuscitation?

Confirmed in at least two leads and documented in the patient care report

What agreement among personnel is required to discontinue resuscitation?

All EMS and first responder personnel involved in the patient's care must agree discontinuation is appropriate

What ROSC-related criterion must be true to discontinue resuscitation?

No ROSC was achieved at any point during resuscitation

For a patient who required defibrillation, what rhythm duration criterion must be met to discontinue?

Persistent asystole for at least 20 minutes

What should EMS do if any of the discontinuation criteria are not met, but discontinuation is possibly indicated or desired?

Contact Medical Control

What is EMS's transport obligation for a patient where discontinuation of resuscitation has been elected and all criteria met?

EMS will not transport that patient