Withholding and/or Ceasing Pre-hospital Resuscitation (All Pts) |
Circumstances where resuscitation efforts may be withheld |
| Likely risk to Paramedic health and safety |
| Clear evidence of prolonged cardiac arrest (e.g. rigor mortis, decomposition, postmortem lividity) |
| Injuries incompatible with life (e.g. decapitation) |
| Inadequate resources to deal with all Pts (e.g. multi-casualty incidents) |
| Death declared by Medical Officer who is, or has been, at the scene |
| An adult (18 years or older), where a Refusal of Treatment Certificate has been completed for a current condition which most likely caused the cardiac arrest |
| A child (< 18 years), where a Court Order is provided to the attending Ambulance crew indicating that Cardiopulmonary Resuscitation is not to be commenced |
| An adult (18 years or older) whose initial cardiac rhythm is asystole (over a minimum 30 sec. period), provided the time interval between the onset of cardiac arrest, i.e. collapse, and arrival of the crew at the Pt has exceeded 10min. and there are no compelling reasons to continue, such as suspected hypothermia, suspected drug overdose, a child (< 18 years) or family/bystander requests continued efforts |
Circumstances where resuscitation efforts may be ceased |
| An adult (18 years or older) who, after 30min. of Advanced Life Support resuscitation (including advanced airway management, defibrillation and/or Adrenaline) has no return of spontaneous circulation, is not in VF or VT, has no other signs of life present such as gasps or pupil reaction and hypothermia or drug overdose are not suspected. |
Special Notes |
A Refusal of Treatment Certificate may be completed by: - a person aged 18 years or older; - an agent, where a person aged 18 years or older has completed an Enduring Power of Attorney (Medical Treatment) - a guardian appointed by the Victorian Civil and Administrative Tribunal (VCAT) |
| A Refusal of Treatment Certificate may be sighted by the attending Ambulance crew, or they may accept in good faith the advice of those present at the scene. If there is any doubt about the application of a certificate the default position of resuscitation should be adopted. |
| A Refusal of Treatment Certificate may only be completed in relation to a current condition. When ceasing or withholding resuscitative efforts in these circumstances the attending Ambulance or MICA Paramedic needs to be satisfied that the Pt’s cardiac arrest is most likely due to this current condition. |
| Ambulance crews must clearly record full details of the information given to them and the basis for their decision regarding resuscitation on the PCR. This is particularly important in circumstances where a copy of the Refusal of Treatment Certificate has not been sighted as it will serve if necessary as evidence of their good faith. |
| Under the Medical Treatment Act 1988 a person acting under the direction of a Registered Medical Practitioner who, in good faith and in reliance on a Refusal of Treatment Certificate, refuses to perform or continue medical treatment is not guilty of professional misconduct or guilty of an offence or liable in any civil proceedings because of the failure to perform or continue that treatment. |