A-41
Appendices: Do Not Resuscitate Guidelines
Lt Col John McAtee, USAF, BSC
- Do NOT resuscitate (DNR) casualties under the following circumstances:
a. Combat (direct fire) situations:
- Patient with no pulse, regardless of cause.
- Patient with a pulse but no respirations, who cannot be resuscitated without
endangering the lives of care givers and/or rescuers.
b. Non-combat situations: Clear the decision not to resuscitate with medical consultants
if possible. If it is not possible, do not resuscitate the following casualties:
- Victim is obviously dead, characterized by signs such as:
i. Obvious decomposition (bloating, etc.)
ii. Body partially consumed by scavengers
iii. Skin over dependent areas is mottled (dependent lividity)
iv. Rigor mortis (may resemble severe hypothermia, so check body core
temperature)
- Victim is decapitated
- Victim partially decapitated with no pulse present
- Victim is dismembered, or body is fragmented
- Victim has an open head injury, with brain matter exposed and no pulse present
- Victim has an injury to the trunk with chest contents exposed, and no pulse present
- Hypothermia victim ‘frozen’, e.g., ice formation in the airway
- Hypothermia victim with frozen, incompressible chest
- Victim has total body burns or body carbonization, no pulse present
- Victim has suffered massive blunt trauma (e.g., fall of over 100 feet, etc) and has
no pulse
- Decisions to not initiate resuscitation must be completely documented, including time/date
of decision, reason for decision, name of medical consultant (if able to contact), and location of victim
(GPS coordinates if possible).
- NOTE: The decision not to initiate resuscitation IS NOT a legal declaration of death, unless a
qualified physician declares the patient dead.
- In a combat situation, body recovery should be attempted unless the attempt exposes the rescue team to
undue danger. If the body cannot be safely recovered, the location should be noted as accurately as
possible (GPS coordinates preferred) for later recovery efforts. If the body has a set of ID tags that can
be safely recovered, one should be left with the body, and one should be secured.
- In non-combat situations, attempt body recovery only if it can be accomplished with a minimum of risk to
the rescue team. If there is any suspicion of death as a result of foul play or other forensic circumstances
(suicide, homicide, neglect, accident, etc.), the body and the area around it should be undisturbed until law
enforcement authorities have had an opportunity to examine the scene.
- In the event of a military aircraft crash, do not disturb the scene except to assess and resuscitate any
casualties which are not dead (see above). If the casualties must be moved to perform medical treatment,
every attempt should be made to record the exact location where the patient was found, and his/her
exact position (photographs from multiple angles are helpful). Body recovery may be the responsibility
of local law enforcement or military authority, depending on the circumstances and location of the mishap.
In most circumstances, it is best to leave the body or bodies in position until investigating authorities
arrive and survey the site.
