If an EMS provider finds that the patient is pulseless and non-breathing, resuscitation must be attempted UNLESS:

1. The patient has obvious signs of biological death which are rigor mortis, dependent lividity, or injuries which are incompatible with life (i.e., decapitation, massive head injuries, transected torso, incineration, etc.).
2. The patient has a valid DO NOT RESUSCITATE Order.
3. The patient's physician is at the scene, assumes Medical Control and orders that resuscitative efforts not be initiated.
4. The Medical Control Physician orders resuscitation efforts to be discontinued.

B. Guidelines for determining resuscitation efforts or ceasing efforts:

1. Begin CPR, if indicated.
2. Contact the Medical Control Physician. Transmit as much pertinent history as possible (age, vital signs, EKG, pupil status, length of time since onset of cardiac arrest) and receive resuscitation instructions or cease effort orders.
3. Transport the patient to the hospital. If on-site resuscitation is not successful, continue CPR and transport.

C. No signs of life present, signs of death not notably evident (i.e., no blood pressure, pulse, respirations, EKG is asystole, patient down time is unknown, body temperature warm):

1. Initiate CPR
2. Initiate Field Treatment Protocols as appropriate
3. Contact Medical Control
4. Continue resuscitative measures as directed

D. Signs of death are notably evident:

1. Confirm no Blood Pressure, respirations, or EKG activity
2. Contact Medical Control
3. Receive direction to notify Coroner

E. Upon EMS arrival, CPR is in progress:

1. Continue CPR
2. Determine if life signs are present
3. Contact Medical Control
4. Continue resuscitative measures as directed

F. Special circumstance where prolonged resuscitation efforts are indicated:

1. Hypothermia
2. Pediatric patients
3. Treatable contributing factors

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