Peter Antevy explains when paramedics can stop resuscitation in the field: no pulse, no breathing, fixed pupils, and a flat heart monitor. He also covers finger thoracostomies, a quick chest decompression technique that can raise survival rates to 5-6% in adults and higher in children.
Questions this video answers
(1) Pulseless and apneic; (2) Fixed and dilated pupils; (3) Asystole on a monitor (unless there is an injury clearly incompatible with life).
Decapitation and massive crush injuries.
Roughly 5–6% neuro-intact survival for adults; speaker states higher rates for children.
Chapters
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So let's go over our trauma protocol, specifically as it relates to folks that we pronounce in the field from trauma related death. So the criteria, just so we're all clear on what that means, is you've got a patient who suffered trauma and you're being called to evaluate the patient and whether you're going to make a decision whether or not we can try to resuscitate these folks or if there's really no hope. I Our criteria for field termination is number one, the patient is pulseless and apneic, Number two, they've got fixed and dilated pupils and number three is you've put a monitor on them and the patient is asystolic. Now I've had a discussion with the trauma surgeons, obviously with the EMS medical directors and with our county's medical director, I'm sorry, medical examiner, and we all, all the clinicians agree that having a strip of asystole is one of the field criteria for that class of folks where you do not have an obvious injury that's incompatible with life, which is our other criteria, decapitation, massive crush injuries. Those folks, you don't necessarily need to get a monitor strip on. So the injuries are obviously incompatible with life. You don't need that. But for all others, you really want to get that strip of asystole. So now let's say that you put on the monitor and it's not asystole, it's something else. Well, now it doesn't really fit into our criteria for field termination. Now those of you, such as our EMS captains and perhaps our trauma hawk nurses, will be getting special training to do something called finger thoracostomies. It's basically a chest tube without the tube. So once you are granted privileges to do that because you've gone through the training, if you have somebody that sustains some sort of blunt or penetrating thoracic trauma before you consider terminating those folks, you're going to want to pop a couple holes in either side of the chest. Because what we found and was presented at Eagles this year is typically in the past, those folks would have zero or just about zero survival rate, but we can raise that up to 5, 6% neuro intact survival rate if they're adults and even higher if they're children. So we are going to go get some special training for our EMS captains and our trauma heart nurses so we can add that procedure to it.
