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Paramedic's can not pronounce someone DOA?

Discussion in 'ALS Discussion' started by EMTCop86, Nov 23, 2008.

  1. EMTCop86

    EMTCop86 New Member

    Location:
    Riverside, CA
    I have always thought that paramedics were able to pronounce someone DOA but I have been recently told differently. Only a MD can pronounce someone DOA. Paramedic's can "refuse" treatment in certain cases when they know someone is dead but have to call an MD to officially pronounce it, but as far as paramedics actually pronouncing them DOA they are forbidden. Is this correct?
  2. akflightmedic

    akflightmedic Active Member

    No this is not entirely correct.

    You will find it varies from state to state, possibly even system to system as with everything else in EMS.

    In Alaska, we had the authority to pronounce dead as medics and EMT Basics were allowed to do it under extreme situations which were clearly defined so there was no misinterpretation.
  3. Melbourne MICA

    Melbourne MICA New Member

    That sounds right to me. Under licensure with the state, mandate for responsibility in all matters medical is assigned to the medical profession - that's not us.

    In aussie land determination of death is the province of the pts doctor or coronial office in his/her absence. The "State" takes a statutory interest in the death of every citizen (and their "life") but delegates responsibility to the "professional" most likely to make a judgement in keeping with medical practice, the views of the "state" - another way of saying the society taking into account minority religious and other interest groups needs - but the state still has privy over this issue. For example, the "state" may order an autopsy against the wishes of individuals or groups if believed warranted.

    Believe it or not their is even a stipulation as to what are the "absolute indicators" of death written into legislation - a kind of "death act". This is now being challenged by interpretations from many parties as to what constitutes death - you know the "brain dead" person etc and interestingly this parallels with how we view what constitutes "life" - when in starts etc.

    Previously the "absolute indicators" of death (here in Australia) were;

    1. Decapitation
    2. Significant visceral trans-section
    3. Putrefaction

    All other indicators are not so clear cut (pardon the pun) as they may mimic death and so do not fall into the first category. The waters get muddier the more equivocal indicators are that's why there is just one person making the final judgement at the behest of the "state".

    Fortunately for us, the state, through the decision makers of the medical profession have given us a much broader scope of decision making ability (within reason and often strict criteria) to make determinations of death - up to a point.

    This is all about what is "reasonable" to expect from a person with a certain level of medical training such as we Paras without fear of common law challenge. Most ambos who have served for a few years would be a better judge of when someone has died than most GP's - personally I've seen hundreds of very dead people.

    Unfortunately there are medico-legal and insurance factors (and economic costs as well) taken into account.

    The problem is less about when someone is dead and more about providing or withholding treatment (resus). The vast majority of court cases against ambos would certainly have been involving these issues.

    Still, it's a very sensitive issue with many stakeholders needs that have to be met.

    So in short - the chain of ultimate responsibility starts with the state and ends with the state or its delegated representative - the Doctor.

    It's actually a very interesting area of medicine -the whole death thing if I can so crudely put it.

    MM
  4. Sapphyre

    Sapphyre New Member

    Location:
    Los Angeles County, CA
    EMS Training:
    EMT-Basic
    I'll pull out the regs later if you want. Paramedics, and in some cases EMTs can presume death in my system in cases of extremely obvious death (decapitation being one of them). The medics still have to call med control to make it official.

    /rocking the parking lot, til 0700
  5. Here in the NWT to the best of my knowledge if the death is in a hospital or nursing home setting the MD can pronounce, but outside of those two settings the Coroner pronounces.
  6. Ridryder911

    Ridryder911 EMS Guru

    Usually pronouncement of death is only made by a licensed medical physician. This is the one signing the Death Certificate. Some areas still use elected officials with NO medical training called County Coroner.

    Paramedics and EMT's usually can declare death which is stating someone is dead. This is not the same legal term as pronounce of death. The same effect though.

    R/r 911
  7. Most of our Coroners here in the NWT don't have any formal medical training. Our Coroner's are appointed.
  8. EMTCop86

    EMTCop86 New Member

    Location:
    Riverside, CA
    Thanks for the answers guys clears things up quite a bit.
  9. akflightmedic

    akflightmedic Active Member

    In Alaska, a medic CAN sign the death certificate.

    My name is on one of these, my first and presumably the last one I will ever do.

    Typically, the doctor is willing to sign for your decision, however on occasion, they may ask the medic to do so. I imagine this procedure exists due to the remoteness of many of the villages.

    Usually when we pronounced in a remote village, if there were no suspicions to transport the body back to a larger town, we just left the body with the family so they could bury it and called in the death to the state police and the medical director. And this is how and why sometimes the medic had to sign the death certificate.
  10. KEVD18

    KEVD18 New Member

    Location:
    mass
    as R/r mentioned, the big diff is declare v. pronounce. we can declare them dead, and call the doc to pronounce. in some areas, you dont call olmc but go direct to the me/coroner and they do the pronouncement.
  11. tydek07

    tydek07 New Member

    EMS Training:
    EMT-Paramedic

    Ridryder hit it right on the nose!

    Take Care,
  12. Melbourne MICA

    Melbourne MICA New Member

    A nice clarification Ridders. Thank goodness the days of transporting and doing pointless resus on obviously dead people are (almost?) gone for Paramedics.

    Paramedics with years of experience and degree level university training should surely be able to make a reasoned and sensitive judegment over such things providing process is carefully followed and those "not absolute" indicators" of death I mentioned previously have been clincially addressed through thorough assessment.

    In the end its a kind of bureaucratic necessity that a licensed physician signs the paperwork to close the file if you like.

    In Aussie Land we can withhold resus on a number of types of cases and frequently do without problems from aggrieved relatives or bystanders.

    I would say our biggest problems come with NFR orders or lack thereof.

    Still, there hasn't been a civil suit against an ambo over a death/lack of resus dispute over here in years. And good thing too.

    MM
  13. ErinCooley

    ErinCooley New Member

    Location:
    Atlanta, Georgia
    EMS Training:
    EMT-Intermediate
    I'm pretty sure here in Ga, at least in my company, a paramedic can declare someone DOA however we cant call the coroner. Only the police can do that... figure that one out.
  14. Hal9000

    Hal9000 New Member

    We can declare someone dead, as Rid says. We have a "County Coroner" (Not elected and does have medical training.) that allows us to bypass going to an MD. We just used that avenue today with a patient, per request of medical control. The CC came, inspected, signed off, and then we made a stop by the funeral home on the way back to putting the rig in service.
  15. medicdan

    medicdan Active Member Premium Member

    Location:
    Northeast
    Isn't it illegal (or wasn't it at some point) for ambulance to transport dead bodies (outside of extreme need like MCIs)? Do you just turn up the AC in the back?
  16. ffemt8978

    ffemt8978 Forum Vice-Principal Community Leader

    Location:
    Zip code EIEIO
    EMS Training:
    EMT-Intermediate
    I would say that would vary by region. In some areas, it is the ambulance companies that transport corpses to the morgue for autopsy. In others, it is a funeral home or the county coroner.
  17. Ridryder911

    Ridryder911 EMS Guru

    No, in fact I know of EMS that loves to transport because they get a guaranteed amount of money. As we also charge for declaration of death (if they have insurance).
    Turn the A/C ? How cold do you think your unit will get?

    R/r 911
  18. Hal9000

    Hal9000 New Member

    And

    I think Rid is correct. In this case, the doctor "called it" while he was in the rig...we couldn't just chuck him once he was "dead." And when we parked for the coroner, we couldn't leave just him on the curb. We actually cut down on the time he would have been in there by taking him to the home.
  19. Here in Fort Smith the town's ambulance service picks up the bodies and transports to the morgue.
  20. Grady_emt

    Grady_emt New Member

    Location:
    Atlanta, where the players play, and we ride on th
    EMS Training:
    EMT-Intermediate
    Actually Erin, it varies by region within the state. Here in the Metro Area and other urban counties we have Medical Examiners not Coroners. As for who to call, that is agency dependent. Here we call APD who may call the ME, or we may also call the ME if APD has and extended ETA to the scene. Either way, for all field deaths the ME must be notified. The on call examiner takes a report from EMS and determines if they need to respond to the scene or not.

    There are still a few rural counties in south GA that have coroners, and for all autopsies they send the body to GBI HQ in DeKalb County.

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