Dead on arrival

Dead on arrival or DOA is a term used to indicate that a patient was found to be dead upon the arrival of professional medical assistance, often in the form of first responders such as emergency medical technicians, paramedics, or police. In some jurisdictions, first responders must first consult with an online physician before officially pronouncing a patient deceased, but once cardiopulmonary resuscitation is initiated, it must be continued until a physician can pronounce the patient dead.

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DOA is also frequently used as slang to indicate that a new item was received broken, or that an idea or concept has no chance.

Medical DOA

When presented with a pulseless patient, medical professionals are required to perform CPR unless specific conditions are met which allow them to pronounce the patient as deceased:

• Injuries not compatible with life. These include but are not necessarily limited to decapitation, incineration, severed body, and injuries that do not permit effective administration of CPR. If a patient is presenting with any of these conditions, it should be intuitively obvious that the patient is non-viable.
• Rigor mortis, indicating that the patient has been dead for at least a few hours. Rigor mortis can sometimes be difficult to determine, so it is often used reported along with other determining factors.
• Obvious decomposition.
• Lividity, indicating that the body has been pulseless and in the same position long enough for blood to sink and collect within the body, creating purplish discolorations at the lowest points of the body (with respect to gravity).
• Stillbirth. If it can be determined without a doubt that an infant died prior to birth, as indicated by skin blisters, an unusually soft head, and an extremely offensive odor, resuscitation should not be attempted. If there is even the slightest hope that the infant is viable, CPR should be initiated; some jurisdictions maintain that life-saving efforts should be attempted on all infants to assure parents that all possible actions were performed to save their child, futile as the medical professionals may have known them to be.
• Identification of valid Do Not Resuscitate orders.

(Note that the above list may not be a comprehensive picture of medical practice in all jurisdictions or conditions. For example, it may not represent the standard of care for patients with terminal diseases such as advanced cancer. In addition, jurisdictions such as Texas permit withdrawal of medical care from indigent patients who are deemed unlikely to recover.)

Further information: Texas Futile Care Law

Regardless of the patient, pronouncement of death must always be made with absolute certainty and only after it has been determined that the patient is not a candidate for resuscitation. This type of decision is rather sensitive, and can be difficult to make.

Legal definitions of death vary from place to place, for example irreversible brain death, prolonged clinical death, etc.

Popular usage

Colloquially, anything which is received in a non-operational (broken) state can be called DOA or dead on arrival. If a new product, such as a computer, arrives "DOA" then it is likely that the recipient will call the supplier to get a Return Merchandise Authorization (RMA), a transaction that acknowledges that (apparently defective) goods will be returned to the supplier for refund, replacement or credit. Sometimes it is difficult to actually detect a defective or DOA product. With computers, for instance, it might require a boot image to be installed and run through a test suite to detect any failed parts.

When, as with computers, product complexity is high and diagnostics are involved, the medical metaphor is perhaps appropriate, as complex diagnostics might be required to determine if the product "is really dead".

• D.O.A. is the title of a 1950 movie regarded as a classic film noir.

• It features in the lyrics of The Rembrandts' song "I'll Be There For You" (perhaps better known as the theme to Friends): "Your job's a joke, you're broke, your love life's DOA."

• Dead On Arrival is a New York heavy metal band founded by drummer Rick Ferrusi, and is sometimes abbreviated as D.O.A.

• The Bloodrock song "D.O.A." is told from the point of view of a man dying of injuries suffered in a plane crash, lying in an ambulance with the paramedic standing over him and announcing "there's no hope for you".

• It is a hit song by the Foo Fighters on their album In Your Honor.

• It is also the name of a Fall Out Boy song on Take This To Your Grave.

• In the popular 2004 video game True Crime: Streets of L.A., one of the main character's quotes is "Mess with the EOD, end up DOA.

References

Michael F. O'Keefe [et. al]. Brady Emergency Care, (8th ed.). Prentice Hall. Upper Saddle River, New Jersey: 1998; p.818.