# paramedics and death



## AVPU (Jul 21, 2010)

Two questions, mainly for my curiosity:

1. Can paramedics declare someone dead, or does a physician need to do that? If so,

2. Does that physician need to be on-scene? (assuming this is an out-of-hospital scenario)

Thanks!


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## emtstudent04 (Jul 21, 2010)

Medics CANNOT declare someone dead a physican has to. The physician does not have to be on scene its over the radio.

Thats what they did when i went on a call for a Pt that had coded we did CPR for a lengthy period of time they finally got on the radio contacted the base hospital and the physician pronounced the Pt.


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## medic417 (Jul 21, 2010)

Depends on service, city, state, and country.  

Here I stop all efforts or decide not to start efforts.  Yet we wait for a judge or doctor to make it official.  I have had all efforts stopped for more than 2 hours before judge could be contacted, so patient time of death per that judge was 2 hours after all efforts ceased.  Other judges will ask what time it was when we stopped and they list that time.  Can be in person or on phone.


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## akflightmedic (Jul 21, 2010)

emtstudent04 said:


> Medics CANNOT declare someone dead a physican has to. The physician does not have to be on scene its over the radio.
> 
> Thats what they did when i went on a call for a Pt that had coded we did CPR for a lengthy period of time they finally got on the radio contacted the base hospital and the physician pronounced the Pt.



I suggest you spend some time in EMS before making such matter of fact statements.

It varies by region as someone already said...state, service, county, medical director. It does not have to be over the radio or phone, it can be done without ever speaking to a doctor.

We can choose to not start resuscitation, we can choose to end resuscitation efforts after we have begun if allowed by whatever authority we happen to be in at that time. It all depends, but the short answer is Yes, paramedics can declare someone dead.


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## emtstudent04 (Jul 21, 2010)

Well im sorry i said that im just going from what i was told. I was told you can stop CPR under certain circumstances or withhold CPR under certain circustances regarding local protocols. I was told you can refrain from any resuscitation to obvious signs of death. Never did i hear or read that Medics can declare death in a Pt. unless it's obvious. I was under the impression once resuscitation has been initiated you can stop, but to declare a Pt you must make BH contact for a physician. If im wrong i stand corrected. I know i still have a lot to learn.


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## clibb (Jul 21, 2010)

This is what I've heard.
In Colorado, Paramedics are allowed to declared someone dead if they show Asystole on a 6 second strip.


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## vienessewaltzer (Jul 21, 2010)

I would suggest reading your local protocol to find out what to do in any particular situation.  In NY, the medical examiner/investigator gets contacted and dispatched for DOA's.  Basically, your state's protocol will provide a much more granular answer.


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## AtalantaAsh (Jul 21, 2010)

I was under the same impression, that only a physician or JP can pronounce a PT. dead, but I agree that it is different from city, service, state, or even country.


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## Sassafras (Jul 21, 2010)

I've only had one call where death was called.  Medic pushed drugs, we pumped the chest and did rescue breaths, after a while of trying to get a shockable rythm to no avail the medic contacted medical control who gave permission to stop efforts.  They then told me the EMT-B to call it and I said "no thanks" so the medic did it.  Not sure the last bit was permissable or not, and I wasn't comfortable with calling it so I shirked responsibility to the medic.


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## emtstudent04 (Jul 21, 2010)

Well then i wasnt a 100% wrong. I agree as well that it is different everywhere you go. I was just going off of what i was told and what i somewhat know due to the lack of experiance i have.


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## medic417 (Jul 21, 2010)

emtstudent04 said:


> Well then i wasnt a 100% wrong. I agree as well that it is different everywhere you go. I was just going off of what i was told and what i somewhat know due to the lack of experiance i have.



That's why it is important to explain this is per my local areas policy or this is what my instructor told me.  The way stated it was like it was the absolute final answer.  We're all guilty of doing that at times so don't sweat it just learn from it so people can understand more fully what you are saying.


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## emtstudent04 (Jul 21, 2010)

medic417 said:


> That's why it is important to explain this is per my local areas policy or this is what my instructor told me.  The way stated it was like it was the absolute final answer.  We're all guilty of doing that at times so don't sweat it just learn from it so people can understand more fully what you are saying.



That is very true good point and will do.


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## jjesusfreak01 (Jul 21, 2010)

Sassafras said:


> I've only had one call where death was called.  Medic pushed drugs, we pumped the chest and did rescue breaths, after a while of trying to get a shockable rythm to no avail the medic contacted medical control who gave permission to stop efforts.  They then told me the EMT-B to call it and I said "no thanks" so the medic did it.  Not sure the last bit was permissable or not, and I wasn't comfortable with calling it so I shirked responsibility to the medic.



Thats interesting. I know it varies by region, but I find it slightly difficult to believe that they would let an EMT-B call it. Maybe they just wanted someone to say it out loud.


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## Shishkabob (Jul 21, 2010)

emtstudent04 said:


> Medics CANNOT declare someone dead a physican has to. The physician does not have to be on scene its over the radio.



No.



Depending on where you work, Paramedics, and sometimes even EMTs, can cease resuscitation efforts, or even refuse to start, without contacting a higher authority.


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## emtstudent04 (Jul 21, 2010)

How can you refuse to start resuscitation on a Pt unless there are obvious signs of death or DNR? Wouldnt that be considered negligence on your part?
I'm aware now that it's different everywhere, but that doesn't make any sense to me??


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## ExpatMedic0 (Jul 21, 2010)

emtstudent04 said:


> How can you refuse to start resuscitation on a Pt unless there are obvious signs of death or DNR? Wouldnt that be considered negligence on your part?
> I'm aware now that it's different everywhere, but that doesn't make any sense to me??



death secondary to trauma would be an example


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## emtstudent04 (Jul 21, 2010)

schulz said:


> death secondary to trauma would be an example



Ok well i can see that. What about if it's a medical pt?


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## rescue99 (Jul 21, 2010)

AVPU said:


> Two questions, mainly for my curiosity:
> 
> 1. Can paramedics declare someone dead, or does a physician need to do that? If so,
> 
> ...



No and No.


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## ExpatMedic0 (Jul 21, 2010)

emtstudent04 said:


> Ok well i can see that. What about if it's a medical pt?


Local protocols.  Last time we had a patient expire the only M.D. we called was the medical examiner. Just waited with the body for almost 2 hours before he showed up.


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## LondonMedic (Jul 21, 2010)

emtstudent04 said:


> Ok well i can see that. What about if it's a medical pt?


Purple.


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## emtstudent04 (Jul 21, 2010)

Dang 2 hours? That's a long time.


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## MMiz (Jul 21, 2010)

My protocols state that I can not start CPR based on certain indications, and I can stop ACLS based on certain indications, but "Physician or registered nurse on the scene pronounces patient legally dead."


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## ExpatMedic0 (Jul 21, 2010)

emtstudent04 said:


> Dang 2 hours? That's a long time.


Yeah try waiting the back of the ambulance for that long with an intubated body in the summer heat. It starts making weird sounds, and a pretty nasty organic  cocktail starts slowly coming up the ET tube.


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## CAOX3 (Jul 21, 2010)

Here we do not have to initiate CPR if certain criteria is met at basic or ALS level and we dont have to contact anyone but the cops, at the ALS level they they can withold resus. efforts or cease them if deemed appropriate.


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## emtstudent04 (Jul 21, 2010)

schulz said:


> Yeah try waiting the back of the ambulance for that long with an intubated body in the summer heat. It starts making weird sounds, and a pretty nasty organic  cocktail starts slowly coming up the ET tube.



Thats a little crazy or weird for that matter.


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## Sassafras (Jul 22, 2010)

jjesusfreak01 said:


> Thats interesting. I know it varies by region, but I find it slightly difficult to believe that they would let an EMT-B call it. Maybe they just wanted someone to say it out loud.



I think that's exactly what it was.  Really it was just me, the medic, the crew chief and a FR there.  The crew chief is always trying to get me to speak up, so that may be why it was said.  Medical command had already gotten off the line by that point so it's not like anyone would have known WHO called it then I guess?  I dunno.  I said no thanks so it doesn't really matter LOL.


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## Akulahawk (Jul 22, 2010)

I can determine death, but in my County, a Sheriff's Deputy can pronounce it... 

There's a specific determination of death protocol and one for ceasing resuscitation efforts in the field, but for an actual pronouncement of death, a Sheriff's Deputy can do it. Of course the elected Sheriff is also the Coroner, and therefore runs both offices/departments. If I happened to be "lucky" enough to have a physician along in the field, then the Doc gets to do the pronouncement. 

As to running a strip, the two counties I've worked in most require a full 60 second printed strip showing at least two leads. Only a few years ago, the monitors used in those Counties could only print one lead at a time... so you'd actually print 2 minutes of a strip.


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## Dominion (Jul 22, 2010)

AVPU said:


> Two questions, mainly for my curiosity:
> 
> 1. Can paramedics declare someone dead, or does a physician need to do that? If so,
> 
> ...



In Kentucky medics can declare death but you must meet certain requirements.  If those aren't met you're missing one you can call OLMC and ask permission to cease efforts and declare.


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## MagicTyler (Jul 22, 2010)

In AZ the law states that ANYONE can pernouce someone dead... My girlfriends mom is a hospice nurse and I know they're company will use family/ caregiver to pernounce at times.


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## mcdonl (Jul 22, 2010)

Here in Maine - You do not even need to pronounce someone dead.

http://www.maine.gov/dps/ems/documents/2008MEMSProcotols.pdf (Gray 5)

But, in the case of a DNR when resuscitation had begun, only OLMC or the patients physician can order the stop of resuscitation.


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## Jinkx (Jul 22, 2010)

InTexas its Protocol driven. More predominent in rural EMS.


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## EMT11KDL (Jul 22, 2010)

In my area, we have to call the doctor and tell them what we see.  if its obvious death, like decap or something like that, than we dont have to call the dr. but if its something medical, we call the doc, send a 12 lead and have him tell us yes bring the pt or no call the coroner


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## somePerson (Jul 22, 2010)

emtstudent04 said:


> Medics CANNOT declare someone dead a physican has to. The physician does not have to be on scene its over the radio.
> 
> Thats what they did when i went on a call for a Pt that had coded we did CPR for a lengthy period of time they finally got on the radio contacted the base hospital and the physician pronounced the Pt.



I live in San Diego also, I suggest you look at the back the policy section of the SD county protocol booklet or buy one


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## johnrsemt (Jul 24, 2010)

When I worked in Indiana    EMT-Basics could call them dead,  without contacting the hospital in 5 signs:

1:  Transection

2:  Decapitation

3:  Heavy charring of body,  down to deep muscle or bone,  with NO respratory effort

4:  Lividity

5:  Rigor Mortis


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## Melclin (Jul 24, 2010)

Confused about terminology.

When you all say 'pronounce', we're not talking about death certificates right?

Anyways, 

Here, a paramedic or a nurse can make a *"verification of death"*. This officially constitutes the end of a person's life, time wise (TOD etc), and involves ceasing or not initiating resuscitation. The body can be moved and collected by undertakers or the coroner as appropriate. 

A patient must have obvious signs of death (lividity, injuries incompatible with life, etc) or be pulseless; have no breath or heart sounds on auscultation for 2 mins; pupils fixed and dilated; and no response to central or peripheral painful stimuli. An asystolic rhythm strip is nice to have but not compulsory. We then make notes in the charts (nurses and sometimes for medics if they're at a nursing home, supported accommodation etc). Otherwise, we have toe tags on which we fill out the relevant information (our name, title, date, time, clinical criteria for death, circumstances and location). Obviously none of this requires online medical control because we don't have online medical control.

This is applies unless the pt's death fulfills the criteria for being a 'reportable death', in which case its a police matter.

*Certification of death* ie the filling out of a death certificate, requires that a cause of death be recorded, that the pt's body be examined and that the doctor have a "detailed knowledge of the circumstance of the death". Its the paperwork end of the deal and can only be done by a medical doctor within 48 hours of the death.


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## Cliff (Dec 15, 2015)

AVPU said:


> Two questions, mainly for my curiosity:
> 
> 1. Can paramedics declare someone dead, or does a physician need to do that? If so,
> 
> ...



Paramedics can and do declare death all the time. It is mostly dependent on the system and the advising physician. I have declared 4 people dead in one day. We worked 3 of them and the forth one was in the early stages of rigor mortis, way into al gore mortis.

We never call a physician to do that. We do call the Medical Examiners office to get the death recorded and we call police in to do the same.

Most of the time the deceased doesn't even go to the ME's office and goes directly to the funeral home if they have one chosen.

If we suspect a crime scene/foul play we restrict entry to the scene and call in police and tell the ME they will be needed at the scene. In 30 years I have declared a lot of people dead. This is the case for most states. In most states RN's cannot pronounce death because the operate under doctors orders. Paramedics operate under protocols that are written for them to follow and those protocols have a section that details what determines death in the field. You can so a Google search for "death in the field protocol" and get a lot of information.


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## akflightmedic (Dec 15, 2015)

Nice job Cliff. Too bad you did not declare death on this thread which was almost 6 years dead...


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## Cliff (Dec 15, 2015)

akflightmedic said:


> Nice job Cliff. Too bad you did not declare death on this thread which was almost 6 years dead...



Yea, I just wanted to make sure that folks got the right message. I see too many folks that think that only doctors can do that. I was actually doing a search on death in the field over that lady that went to the funeral home where they found she had been stabbed. Whoops. Who determined that there was no foul play? My guess is that they will get a talking to over that one.


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## ExpatMedic0 (Dec 15, 2015)

akflightmedic said:


> Nice job Cliff. Too bad you did not declare death on this thread which was almost 6 years dead...


I was hardly out of my mid 20s when I replied to this, now I'm 33....


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## Cliff (Dec 16, 2015)

So you guys are saying that I can't/shouldn't respond to this thread? Nice to know.

They really need to put an expiration date on this stuff or make it go away all together.

I will cancel my account right away. This doesn't seem to be a very friendly place to visit.


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## chaz90 (Dec 16, 2015)

Cliff said:


> So you guys are saying that I can't/shouldn't respond to this thread? Nice to know.
> 
> They really need to put an expiration date on this stuff or make it go away all together.
> 
> I will cancel my account right away. This doesn't seem to be a very friendly place to visit.


You're more than welcome to respond to old threads if you have something new or constructive to add. As long as it's on topic we don't mind. That's why we don't lock threads after a certain amount of time. 

Most of the time though, if a thread has laid dormant without any replies for over five years, it's buried deep under more recent conversations. Resurrecting long dead threads tends to bother some people as it clutters the recent feed with information that is years old. 

Hopefully you'll stick around and take a look around the forum a bit more. We're happy to have you here and contributing.


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## akflightmedic (Dec 16, 2015)

And no sense of humor...I mean seriously? I put a smiley face and obviously the next comment was just as fun...


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## TransportJockey (Dec 16, 2015)

Cliff said:


> So you guys are saying that I can't/shouldn't respond to this thread? Nice to know.
> 
> They really need to put an expiration date on this stuff or make it go away all together.
> 
> I will cancel my account right away. This doesn't seem to be a very friendly place to visit.


*waves*


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## ExpatMedic0 (Dec 17, 2015)

Cliff said:


> So you guys are saying that I can't/shouldn't respond to this thread? Nice to know.
> 
> They really need to put an expiration date on this stuff or make it go away all together.
> 
> I will cancel my account right away. This doesn't seem to be a very friendly place to visit.



Just giving you a hard time man ;-) no hard feelings.


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## AtlasFlyer (Dec 17, 2015)

The biggest issue with responding to very old threads is that information can be very dated. Our protocols change every year, so in 5 years a LOT can change. Someone reading the thread may not know that there is a 5 year time difference between the original post and the most current post. If a post is quoted, asking a question about an old post, that poster may not even be a currently-posting member anymore and won't see it. 

Just my opinion... nothing to get upset or offended about. Just that a lot can change in the 5 years since the thread was started.  Sometimes (not always but sometimes) it's better to start a new thread, maybe putting a link to the old thread in the new post, to discuss a subject.


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## GloriousGabe (Dec 22, 2015)

Where I work we call it in on the radio and the hospital will either tell us to work it or stop.


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