Dead on arrival

Dead on Arrival

Dead on arrival (often abbreviated as DOA), also known in some contexts as dead in the field or brought in dead (BID), denotes a situation where a patient is found to be clinically dead upon the arrival of professional medical assistance. This usually involves first responders such as emergency medical technicians, paramedics, or police.

Pronouncement Protocols

While first responders are trained to provide emergency care, in many jurisdictions, they need to verbally consult with a physician to officially pronounce a patient deceased. If cardiopulmonary resuscitation (CPR) is started, it must generally continue until a physician can declare the patient dead.

Medical Criteria for DOA

When medical professionals encounter a potential DOA patient, they are typically mandated to initiate CPR unless certain conditions are met:

• Injuries incompatible with life: This can range from decapitation and catastrophic brain trauma to injuries that make effective CPR administration impossible.
• Rigor mortis: A clear sign that the patient has been dead for several hours, though it can sometimes be difficult to ascertain and may be used in conjunction with other indicators.
• Obvious decomposition: A sign that death occurred quite some time ago.
• Livor mortis (lividity): Indicates that the body has been pulseless for a significant duration, leading to blood pooling and creating purplish discolorations at the body's lowest points.
• Stillbirth: If it's unmistakably determined that an infant died before birth (evidenced by skin blisters, an unusually soft head, and a strong offensive odor), resuscitation might not be attempted. Some jurisdictions, however, advocate for CPR on all infants to assure parents of exhaustive life-saving attempts.
• Valid do not resuscitate orders: These legal directives indicate a patient's wish to avoid resuscitation.

These criteria might not encompass every situation or jurisdiction. For instance, they might not apply to patients with terminal illnesses like advanced cancer. Some areas, such as Texas, even allow medical care to be withdrawn from patients unlikely to recover. Further details on Texas's policy can be found here.

In all circumstances, death should be pronounced with utmost certainty, after ensuring the patient isn't a resuscitation candidate. These decisions can be emotionally charged and challenging.

Legal Definitions

The legal definition of death can vary widely between jurisdictions. Some consider irreversible brain-stem death as the criterion, while others might require prolonged clinical death.

Colloquial Usage

Outside of its medical context, the term "dead on arrival" has found its way into everyday language:

• In tech and product diagnostics, a complex device, like a computer, that fails to operate might be deemed "DOA", requiring intricate diagnostics to confirm its non-functionality.
• More broadly, "dead on arrival" can describe any idea or product perceived as fundamentally flawed from its inception, destined for failure.

See Also

• Out-of-box failure
• Emergency department
• Morgue

Dead on arrival Resources
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