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**Resuscitation & DNR**

**SPECIAL NOTES**

**Adult Trauma:**
- BEMS initiates resuscitative measures on pulseless trauma patients only in very limited cases (see protocol "Traumatic Cardiac Arrest"). We will not discontinue resuscitative measures in trauma cases.

Resuscitation may be discontinued at any time in all cases regardless of the status of resuscitative measures when the following criteria are identified/found:

a) Multi-casualty incidents, per MCI Triage protocol or decapitation
b) Decomposition or incineration
c) Rigor mortis
d) Dependent lividity
e) Visible trauma to the head or cardiovascular system clearly incompatible with life
f) Valid "Do Not Resuscitate" directives as defined in the "Resuscitation and DNAR" rationale

Consideration should be given to family or patient representative's wishes. If the family or patient representative wishes efforts to be continued or their wishes remain unclear, in the informed setting, resuscitative efforts should continue. If there is no family or patient representative present, resuscitative efforts should continue.

Consideration should also be given to logistic factors including patient location (e.g., public place), weather, and/or the safety of the crew and/or public.

Chaplain services contact should be considered early in the resuscitation if termination is anticipated. Having pastoral care on scene prior to the termination of efforts is optimal.

Answer :

Final Answer:

Continued resuscitation unless specific criteria or patient wishes indicate otherwise, with consideration for safety.

Explanation:

The protocol outlined emphasizes the importance of continuing resuscitative measures in trauma cases, except when certain criteria are met, such as decapitation, decomposition, or valid Do Not Resuscitate directives. This ensures that efforts are appropriately directed based on medical necessity and patient preferences. Family or patient representative input is crucial in decision-making, and in cases where their wishes are unknown, efforts should continue until clarity is achieved. Additionally, logistic factors and safety considerations play a role in determining the continuation of resuscitative efforts, highlighting the need for a comprehensive approach to patient care in traumatic situations.

In accordance with the provided protocol, resuscitation measures will not be discontinued in trauma cases, except under specific circumstances such as multi-casualty incidents, severe trauma incompatible with life, or valid Do Not Resuscitate directives. Family or patient representative wishes should be considered, and if unclear, resuscitative efforts should continue.

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Rewritten by : Barada

Final answer:

In cases of resuscitation, efforts may be discontinued under specific circumstances outlined in the protocol, including multi-casualty incidents, decapitation, decomposition, or valid "Do Not Resuscitate" directives. Consideration of family wishes, logistical factors, and chaplain services are integral parts of the decision-making process.

The main answer:

The resuscitation protocol outlines specific criteria under which resuscitative efforts may be discontinued, such as in cases of multi-casualty incidents, decapitation, decomposition, or clear signs of death like rigor mortis or dependent lividity. Additionally, the presence of valid "Do Not Resuscitate" directives must be respected. However, family or patient representative wishes should also be considered, and if unclear or absent, resuscitative efforts should continue in an informed setting. Moreover, logistical factors such as patient location and crew safety play a role in decision-making. It's essential to involve chaplain services early in the process, especially if termination of efforts is anticipated, to provide support and guidance to both the medical team and the patient's loved ones.