Criteria for Death




  • CPR and ALS treatment are to be withheld only if the patient is obviously dead or a valid South Carolina Do Not Resuscitate form is present (see Deceased Persons Protocol).




  • To honor those who have obviously expired prior to EMS arrival.




  • If a patient is in complete cardiopulmonary arrest (clinically dead) and meets one or more of the criteria below, CPR and ALS therapy need not be initiated:
  • Body decomposition.
  • Rigor mortis.
  • Dependent lividity.
  • Traumatic arrest in asystole or PEA <30.
  • Injury not compatible with life (i.e., decapitation, burned beyond recognition, massive open or penetrating trauma to the head or chest with obvious organ destruction).
  • Extended downtime or un-witnessed arrest with asystole on the EKG in two leads.




  • If a bystander or first responder has initiated CPR or automated defibrillation prior to an EMS Paramedic’s arrival and any of the above criteria (signs of obvious death) are present, the Paramedic may discontinue CPR and ALS therapy. All other EMS personnel levels must communicate with Medical Control prior to discontinuation of the resuscitative efforts.
  • If doubt exists, start resuscitation immediately. Once resuscitation is initiated, continue resuscitation efforts until either:
    • Resuscitation efforts meet the criteria for implementing the Discontinuation of Prehospital Resuscitation Policy.
    • Patient care responsibilities are transferred to the destination hospital staff.
    • Orders to terminate resuscitation are received by Medical Control.