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S-402 Prehospital Determination of Death A (Obvious death/traumatic arrest)

A. When the patient is determined to be obviously dead, no basic or advanced life support shall be initiated or continued.

1. The obviously dead are victims who, in addition to absence of respiration and cardiac activity, have suffered one or more of the following:
a. Decapitation
b. Evisceration of heart or brain
c. Incineration
d. Rigor Mortis
e. Decomposition

2. Adult traumatic cardiac arrest, with ALL of the following:
a. No visible signs of life (no spontaneous movement, apneic, pulseless.)
b. Cardiac rhythm of asystole
c. Mechanism of injury consistent with injuries

3. Prehospital personnel shall describe the incident and victim's condition on the Prehospital Patient Record, clearly stating the reason that life support measures were not initiated or were discontinued.


S-412 Definition of "Emergency Patient"

Any person for whom the EMS/9-1-1 system has been activated and who meets the following criteria:

1. Has a chief complete or suspected illness or injury.
2. Is not oriented to person, place, time, or event.
3. Requires or requests field treatment or transport.
4. Is a minor who is not accompanied by a parent or legal guardian and is ill or injured, or appears to be ill or injured.


S-412 Documentation for AMA

A. Who activated 9-1-1 and the reason for the call.
B. All circumstances pertaining to consent issues during a patient encounter.
C. The presence or absence of any impairment of the patient/DDM, such as by alcohol or drugs.
D. The ability of the patient/DDM to comprehend and demonstrate an understanding of his/her illness or injury.
E. The patient/DDM has had the risks and potential outcome of non-treatment or non-transport explained fully by the EMT or Paramedic such that the patient/DDM can verbalize understanding this information.
F. The reasons for the AMA, the alternate plan, if any, of the patient/DDM and the presence of any on scene support system (family, neighbor, or friend (state which)).
G. That the patient/DDM has been informed that they may re-access 9-1-1 if necessary.
H. The signature of the patient/DDM on the AMA form, or, if the prehospital personnel are unable to have an AMA form signed, the reason why a signed form was not obtained.
I. Consideration should be given to having patient/family recite information listed in Sections III.B.5.d-g above to the MICN/BHP over the radio or telephone.


S-101 Terms (ALTE/BRUE)

Apparent Life Threatening Event (ALTE)/Brief Resolved Unexplained Event (BRUE):
An episode involving an infant less than 12 months of age which is frightening to the observer and is characterized by one or more of the following:
1. Apnea (central or obstructive)
2. Color change (cyanosis, pallor, erythema)
3. Marked change in muscle tone
4. Unexplained choking or gagging


S-101 Terms (Shock, Adult)

>/= 15 years :
Systolic BP <80mmHg **OR**
Systolic BP <90mmHg *AND* exhibiting any of the following signs of inadequate perfusion:

A. Altered mental status (decreased LOC, confusion, agitation)
B. Tachycardia
C. Pallor
D. Diaphoresis


S-101 Terms (Shock, Pediatric)

<15 years:
Exhibiting any of the following signs of inadequate perfusion:
A. Altered mental status (decreased LOC, confusion, agitation)
B. Tachycardia (<5yrs >/= 180bpm, >/= 5yrs >/= 160bpm)
C. Pallor, mottling, or cyanosis
D. Diaphoresis
E. Comparison (difference) of peripheral vs. central pulses
F. Delayed capillary refill
G. Systolic BP < [70+(2 x age)]