Paramedic Resuscitation: When to Stop Life-Saving Efforts

Paramedics follow standardized protocols (e.g., AHA, NAEMSP, local medical direction) to determine when to withhold or terminate resuscitation. Common criteria include:

Definitive Criteria (Do Not Start / Stop Immediately)

• Valid DNR/POLST/MOLST order presented and verified.
• Obvious signs of irreversible death: Decapitation, decomposition, rigor mortis, dependent lividity, transected torso.
• Physician declaration of death (via telemetry/online medical control).

Termination After Initiated Resuscitation

• No ROSC after 20+ minutes of high-quality ACLS with:
  • Asystole or PEA throughout
  • No reversible causes identified/treated (Hs & Ts)
  • EtCO₂ < 10 mmHg persistently
• Terminal illness with family request to stop (aligned with goals of care).
• Futility determined by medical control—prolonged effort with no clinical improvement.

Special Considerations

• Hypothermia / drowning: Longer resuscitation may be warranted ("no one is dead until warm and dead").
• Pediatric arrests: Often receive prolonged efforts.
• Scene safety / mass casualty: Resource allocation may limit efforts.

Documentation of time, interventions, rhythm strips, EtCO₂, and medical control communication is mandatory.