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Fischer, F. T.; Kutschka, I.; Kunz, S. N.; Grove, C. and Lochner, S. J. (2016): Todesfeststellung und Reanimationsabbruch im Notarztdienst. In: Rechtsmedizin, Vol. 26, No. 6: pp. 489-498

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Background. Emergency physicians and ambulance personnel are regularly confronted with critical and closely linked problems in resuscitation, termination of resuscitation and confirmation of death. Decisions for or against resuscitation, on abortion of resuscitation and confirmation of death belong to a fringe area of medicine, which also includes medicolegal aspects. Objective. The aim of the study was to as certain which criteria are used in emergency medical services to determine when death has occurred or when resuscitation attempts are terminated and how the documentation of the diagnosis and the treatment decisions is carried out. Material and methods. Data were obtained from the files of the district attorneys office in Munich concerning unnatural and unexplained fatalities in the period from January to October 2015. Results. In the majority of cases death was correctly determined by sure signs of death;however, in a relatively large number of cases no certain signs of death were documented in detail. In the justification for termination of resuscitation measures it was noticeable that the duration of resuscitation was frequently given but was precisely documented in only approximately half of the cases. It was also frequently not documented whether sure signs of death appeared after termination of resuscitation attempts. In association with advance patient directives, the constellations of neglected measures and justifications found are in need of substantial improvement. Conclusion. Within the framework of this retrospective study several problematic aspects were uncovered, which from a prospective viewpoint should be handled better in the emergency medical services. They affect the importance of early bystander resuscitation to reduce the interval prior to treatment, the necessity for improvement in documentation of sure signs of death and handling of advance patient directives.

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