Episode 21 - Field Termination and DOA

Field Termination and DOA


May 2024


John Hill

Scott Wildenheim

Ray Pace


Dr. Donald Spaner, MD

Episode Videos

Part 1

Part 2

Part 3

Part 4 LIVE!

Episode Audio

Show Notes

National News recently ran a story about EMS and field termination. This is not the only case, but the most recent.

The summary of what happened was this.

Remember, in the state of Ohio, paramedics do not pronounce patients in the field. It is completed with medial direction at the hospital in concert with the doctor.

When calling the hospital, remember to have information for the doctor ready to go. Things like



Do not resuscitate patients should be talked about. Sits almost between DOA and field termination. Therefore, we have to understand that we have two different types of DNR orders in Ohio. DNRCC is active now, and DNRCCA has all interventions up until the point where their heart stops beating. DNR does not mean do nothing. That is important to remember, CPAP, and oxygen are both okay in the orders. You would not be putting them on monitors and such.

Remember how important Co2. Do not forget Capnography, if you have been working on the patient for twenty minutes and see levels around 40. That happens when you have metabolism, so you will be told to transport the patient to the ED.

How do we pivot extra considerations for crime scenes? Survivability always trumps crime. We try to minimize disturbing the scene while maximizing patient care. In addition, if you determine the patient is salvageable, treat the patient and do not forget good documentation. Having police with bodycams on helps. It will prove what took place.

With the use of ultrasound becoming more allowable in the EMS field, would that benefit the ER doctor? The answer would be yes, once it is within protocol. The ability to send a doctor an image of no heart movement would help with a DOA diagnosis.

Blunt and penetrating trauma cases and field terminations. How do we help the provider wrap their heads around when it is appropriate to resuscitate trauma? Getting a history helps with these decisions. In addition, talking with the ER doctor with a good history and information about the incident will make that field termination easier.

The Protocols

From The Episode

Dr Spaner discusses what gets done for DNR CCA patients in the hospital

Ray describes was to make the EMS report to the hospital meaningful

Dr. Hill works through the relationship between EMS and the Coroner

Scott agrees with the points being discussed regarding field termination