You respond to a major motor vehicle crash. The driver is severely entrapped, unresponsive, not breathing, and has no carotid pulse. What is the recommended action?

• A. ventilate the patient for 5 minutes and then stop if there is no response.
• B. have your partner check for a pulse to confirm that the patient is deceased.
• C. stop any active bleeding and advise dispatch to send a paramedic crew.
• D. request the fire department to extricate the patient so you can begin CPR.

Answer: (B)

In a severely injured patient who is entrapped, unresponsive, not breathing, and without a carotid pulse, the priority at the scene is to determine whether resuscitation is indicated or if death should be presumed. A quick, second opinion on the absence of a pulse helps avoid starting futile resuscitation or continuing efforts when death is certain due to the injuries and circumstances. That’s why having your partner check for a pulse to confirm that the patient is deceased is the best action in this scenario. If the pulse were present, you would immediately begin appropriate life-saving measures; if it’s clearly absent, resources can be redirected toward safe extrication and notification of the proper medical direction.