Massachusetts OEMS BLS Protocols Practice Exam 2026 - Complete Prep Guide

In deciding when to withhold resuscitation in a patient with lividity or rigor, you don’t rely on a single finding. The decision is based on evaluating multiple factors together. The statement that four criteria must be met reflects that approach: you assess (1) absence of pulse and no effective breathing, (2) unresponsive state, (3) signs that death is irreparable—such as rigor mortis, dependent lividity, visible decomposition, or obvious fatal injury—and (4) a valid directive or legal order (like a Do Not Resuscitate or other advance directive). If all four criteria are present, resuscitation is withheld. If any one of these is not clearly established, resuscitation should generally be started or continued until further guidance is obtained. This emphasizes that lividity or rigor alone isn’t the sole determinant; they are part of a broader assessment to determine non-viability in accordance with protocol.