If there is any doubt about the following criteria or it is not obvious – commence resuscitation;
When recognising life extinct, a Determination of Death must be made with the following criteria:
Some pacemaker spiking activity may be observed for some time after death. If an AED is used, it must have ‘No Shock Advised’, especially if there is no screen on the device. Have a low threshold for seeking advice
from Clinical Support Desk where necessary.
Refer to Supplementary Notes for Deceased Persons if necessary
There may be circumstances where the commencement of resuscitation may be unwanted or very unlikely to reverse the situation favourably, unless there are compelling reasons or special circumstances. Determination of Death should be followed thereafter.
If there is any doubt about the following criteria or it is not obvious– commence resuscitation;
Expected Deaths / Advanced Directives;
Residential Care Facility patients who;
Patients in the Community with ALL the following
If the criteria for ROLE or Withholding resuscitation are subsequently met, then efforts for those patients may be terminated and Determination of Death can be made.
When Special Circumstances or Compelling Reasons to continue are identified, efforts should be extended (e.g. younger age, refractory VF/ recurrent arrest or timely access to ECMO.). Any decision to terminate should be made very cautiously and discussed with Clinical Support Desk and / or ASMA.
In other cases, maximally directed resuscitation must be continued. However, it is recognised there will be occasions when resuscitation efforts may be considered futile.
Sound clinical judgement and reasoning should always apply and take into consideration many factors and prognostic indicators.
Termination of Resuscitation may apply if;
If in doubt, contact the Clinical Support Desk. Volunteer Crews should have a low threshold to do so.
Refer to Supplementary Notes for Deceased Persons if necessary
The decision to terminate resuscitation efforts requires sound judgement. Determining the likely cause of the cardiac arrest and good background history is important. There is no specific or absolute time for a decision to be made as each case will be different.
|C||Cause / Special circumstances / compelling reasons– e,g, Sudden collapse of presumed cardiac origin, overdose, asphyxia, drowning, pregnancy etc. – would all favour prolonged resuscitation / transport to ED|
|R||Resuscitative Effectiveness – e.g. Good CPR quality measured via feedback device, CPR induced femoral pulses, EtCO2 fluctuations, Refractory or Recurrent VF – would all favour prolonged resuscitation|
|A||Ask and include the team|
|F||Futile features – e.g. Time in arrest, unresponsive to resuscitation, poor EtCO2, slow PEA or agonal activity, co-morbidities, neurological functional status, frailty / physiological reserve to recover and ICU admission likelihood – would favour termination|
|T||Transport, Time and Handling risks – e.g. Is it feasible and safe to move and transport the patient? Consider bariatric features, location and time to ED, public place, etc.|
|E||Explain and engage with family or other necessary parties – Families should not necessarily be asked whether efforts should cease as they are often unprepared. Be empathetic, tactful and honest. Provide support to them in their time of loss|
|D||Document rationale for decisions clearly and fully|
|Less Favourable||More Favourable|
|Prolonged down time||Shorter down time|
|Non-Shockable presentation||Shockable presentation|
|No bystander CPR||Bystander CPR|
|No AED Shock||AED Shock|
|EtCO2 values falling||Normal / High EtCO2|
|Wide Complex PEA||Narrow Complex PEA|
|Advanced Frailty||Low Frailty|
|Older (> 80 y/o) less likely to admit ICU||Younger more likely to admit ICU|
|Significant Co-Morbidities||Less significant Co-Morbidities|
A Medical Practitioner may certify Life Extinct. They may also issue a Cause of Death Certificate where they believe the death had a known cause and the deceased is known to them.
Ambulance Officers may certify Life Extinct under the provisions of the Coroner. A Life Extinct Form, electronic or paper, is required for any deceased patient that SJA attends.
In Voluntary Assisted Dying cases:
Reportable Deaths: Deaths in these categories require notification to the coroner.
(*) The term “person held in care” means a person held:
An important point to understand is that once the decision has been made to report the death to the Coroner, all evidence of medical intervention in the deceased must remained untouched. This means that all tubes, intravenous lines and other aspects of medical intervention must be left in situ as these could be examined in detail. In the case of children, the endotracheal tube may be cut off at the lips if there is to be a viewing of the body.
This is the only category in which Police Officers may/will issue a Life Extinct form.
Suspicious deaths may include criminal acts, suicides, stabbings, shootings, overdoses or where the information gathered does not make sense. Where Officers suspect a suspicious death Police need to be called immediately and the scene secured. Documentation is important and any details you gather should be included. This is evidence and may be required by a court. Patient care to others should not be delayed. If CPR is stopped please leave the scene as is. Should this happen Officers need to be aware that they will contribute to evidence at the scene and may inadvertently contaminate the scene. In cases of a hanging; the knot used to form a noose should be left tied and the rope cut away from the knot where possible. Do not cut down the deceased if there is an obvious death and CPR is not considered.
Non Suspicious Deaths:
Non suspicious circumstances may include deaths at home of natural causes. If there are no suspicious circumstances, the Medical Practitioner may be phoned and once given the circumstances surrounding the death asked if a Cause of Death Certificate will be forthcoming. If so there is no need to contact Police. The relatives may then be advised to contact a funeral service of their choice and make all further arrangements. The name of the Medical Practitioner and time contacted must be documented. Should the deceased’s Medical Practitioner be unavailable or a Death Certificate is not forthcoming, then the Police must be called and advised of the situation. Officers may be required to take the deceased to the mortuary on request of police.
Wellbeing and Support Services:
Officers who attend these deaths might find themselves reacting to these potentially traumatic events and may need to contact Wellbeing and Support. This service is available to all frontline staff, 24 hours per day.
Many people, especially relatives, may also require some support. They should be signposted, based on the situation, to the St John WA bystander card (available at depots) and/or to their GP for additional support.
Complete list of Support & Resources available here.
Wellbeing and Support:
 There will be occasions where some activity of a dying heart can be observed. These are most commonly defined as very wide, disorganised and extremely slow complexes. Wait for this to deteriorate to Asystole. This may take several minutes and Determination of Death can be made thereafter.
 These do not have to be in writing, and can be communicated to St John staff verbally as long as it is from a trusted / credible source. Refer to the Guardianship and Administration Act 1990.
 This is an end of life event. These patients may be in a shockable rhythm but all have extremely poor outcomes regardless of presenting rhythm.