Policy 9 — Criteria for Death/Withholding Resuscitation

Under what two circumstances may CPR and ALS treatments be withheld?

The patient is obviously dead per policy criteria, or a valid State of Texas DNR form is present

What alternative to a paper DNR form is considered equally valid and will be honored by responders?

A Texas Out of Hospital DNR bracelet or necklace found on the patient's body

What burn-related finding is an indication to withhold resuscitation?

Burns to the entire body

What finding involving separation of the head is an indication to withhold resuscitation?

Decapitation

What postmortem muscle finding is an indication to withhold resuscitation?

Rigor mortis

What penetrating injury finding, combined with a rhythm finding, is an indication to withhold resuscitation?

Penetrating injuries to the chest or head with asystole verified in two leads

What postmortem skin finding is an indication to withhold resuscitation?

Post-mortem lividity

What general injury severity finding is an indication to withhold resuscitation?

Injury incompatible with life

What head injury finding is an indication to withhold resuscitation?

Open head trauma

What specific mechanism-based head injury is an indication to withhold resuscitation?

Gunshot wound (GSW) to the head

What torso-transection finding is an indication to withhold resuscitation?

Hemicorporectomy

Under what family-related circumstance, absent a DNR, can resuscitation be withheld?

If no DNR is present but the family requests termination of efforts

For a death resulting from a vehicular or industrial accident, when is it acceptable to move the body?

Only if necessary to resuscitate a living person, or if the body will be significantly destroyed by fire, explosion, etc.

For a death resulting from a vehicular or industrial accident, what should be done regarding the body and scene?

Cover the body if appropriate or directed by law enforcement, preserve the accident scene as best as possible, and keep spectators away

For a death resulting from a vehicular or industrial accident, who must be notified?

The dispatcher as soon as possible, and law enforcement

For deaths occurring at home, whether natural or homicide, what should crews avoid doing at the scene?

Do not disturb anything

For deaths occurring at home, under what condition should crews reposition themselves?

If the scene is unstable, move to a position of safety

Who should be informed of any unusual or suspicious circumstances found at a death scene?

The first arriving officer, in addition to documenting all findings

What down-time threshold is a contraindication to withholding resuscitation, meaning resuscitation should be attempted?

Patient down time is less than 20 minutes

What circumstance regarding down time itself is a contraindication to withholding resuscitation?

Down time cannot be reliably determined

What ECG-related finding is a contraindication that prevents withholding resuscitation based on penetrating chest/head trauma?

Asystole cannot be verified in two leads

What environmental/physiologic condition is a contraindication to withholding resuscitation?

Hypothermia is present

What patient condition is a contraindication to withholding resuscitation regardless of other findings?

Pregnancy

What general principle serves as a catch-all contraindication to withholding resuscitation?

If any doubt exists