Loki said:
How can we be sure there's no way of restoring pulse and respiration? First-aid states that you have to continue performing CPR until a doctor proclaims death (unless it's absolutely obvious like in the case of a severed head or a body gone stiff after suicide by hanging). What methods does the doctor use to confirm resuscitation isn't possible?
You are correct....in the sense that is the directions given to first aid, which is training for the layman. EMS personell, however, often make the determination that there is nothing else they can do.
Specifically, they make that determination when the following are present
- There are no spontaneous movements.
- There is no respiratory effort.
- There are no heart sounds or palpable pulses.
- There is an absence of reflexes including corneal, gag and vestibulo- ocular reflexes (spinal reflexes may persist for a time).
- The pupils are fixed and dilated.
(State of Missouri Homicide Investigation Handbook)
In Missouri, for example, 2 people are qualified to certify death. A doctor and a coroner.
Usually, if the person dies on scene, the coroner is called and they come and certify death. If they are transported to the hospital, the doctor does. The law does allow a sheriff to certify death in the absence of a coroner.
It should be noted that EMS personnell usually cease efforts to resuscitate when they determine there exists no shockable rhythm. That would be information only available from running an ECG. It would not be something knowable by someone trained in basic first aid. So, the information given to you in basic first aid applies to you and other first aid users.
In other words, one should continue administering CPR until a more qualified person takes over, unless one of those obvious signs of death (i.e. decapitation) is present. One last note, EMS personnell have a saying "No one is dead until they are warm and dead", meaning, under certain cold conditions, people can be resuscitated long after they would normally be irretrievable.