Guidelines for withholding or termination of resuscitation in prehospital traumatic cardiopulmonary arrest: a joint position paper from the National Association of EMS Physicians Standards and Clinical Practice Committee and the American College of Surgeons Committee on Trauma.

1. Resuscitation efforts may be withheld in any blunt trauma patient who, based on out-ofhospital personnel’s thorough primary patient assessment, is found apneic, pulseless, and without organized electrocardiographic (ECG) activity upon the arrival of emergency medical services (EMS) at the scene. 2. Victims of penetrating trauma found apneic and pulseless by EMS, based on their patient assessment, should be rapidly assessed for the presence of other signs of life, such as pupillary reflexes, spontaneous movement, or organized ECG activity. If any of these signs are present, the patient should have resuscitation performed and be transported to the nearest emergency department (ED) or trauma center. If these signs of life are absent, resuscitation efforts may be withheld. 3. Resuscitation efforts should be withheld in victims of penetrating or blunt trauma with injuries obviously incompatible with life, such as decapitation or hemicorporectomy. 4. Resuscitation efforts should be withheld in victims of penetrating or blunt trauma with evidence of a significance time lapse since pulselessness, including dependent lividity, rigor mortis, and decomposition. 5. Cardiopulmonary arrest patients in whom the mechanism of injury does not correlate with clinical condition, suggesting a nontraumatic cause of the arrest, should have standard resuscitation initiated. 6. Termination of resuscitation efforts should be considered in trauma patients with EMSwitnessed cardiopulmonary arrest and 15 minutes of unsuccessful resuscitation and cardiopulmonary resuscitation (CPR). 7. Traumatic cardiopulmonary arrest patients with a transport time to an ED or trauma center of more than 15 minutes after the arrest is identified may be considered nonsalvageable, and termination of resuscitation should be considered. GUIDELINES FOR WITHHOLDING OR TERMINATION OF RESUSCITATION IN PREHOSPITAL TRAUMATIC CARDIOPULMONARY ARREST: