Nobody dies in an ambulance?

[exodus]

Pretty much anywhere in the country, BLS must divert to ER to confirm the death. As far as I know in pretty much any system, pulseless, apenic, unresponsive, isn't an obvious sign of death and may not be called by a BLS crew.

Divert to ER, say you're transporting a patient with a DNR, who appears to be pulseless and apenic, but you are unable to verify this due to the lack of an EKG. You are transporting to the ER to confirm your suspicion. For all you know, the pt has gone into V-Tach and may convert himself out of it.

 

[DesertMedic66]

Pretty much anywhere in the country, BLS must divert to ER to confirm the death. As far as I know in pretty much any system, pulseless, apenic, unresponsive, isn't an obvious sign of death and may not be called by a BLS crew.

Divert to ER, say you're transporting a patient with a DNR, who appears to be pulseless and apenic, but you are unable to verify this due to the lack of an EKG. You are transporting to the ER to confirm your suspicion. For all you know, the pt has gone into V-Tach and may convert himself out of it.

A Pt. who is pulseless, apneic, and with a DNR is enough for EMTs in our county to determine death. I highly doubt there is a hospital that would let us hand over the patient to them.

County protocol (when transporting a patient who passes away during transport is to stop at a safe location, contact the coroners office, give a report to them, and follow their directions.

 

[exodus]

A Pt. who is pulseless, apneic, and with a DNR is enough for EMTs in our county to determine death. I highly doubt there is a hospital that would let us hand over the patient to them.

County protocol (when transporting a patient who passes away during transport is to stop at a safe location, contact the coroners office, give a report to them, and follow their directions.

REMS Policy 5620.6:
http://remsa.us/policy/2011/5620.pdf

In the event the patient expires en route, the following should be considered:
6.1 Unless specifically requested, the patient should not be returned to a private residence or skilled nursing facility.
6.2 Continue to the destination hospital or return to the originating hospital if the time is not excessive.
6.3 If transport time would be excessive, divert to the closest hospital.
6.4 In remote areas, transporting agencies should make advance agreements with the Coroner’s Office for mutually acceptable rendezvous locations where the patient may be taken.
6.5 Do not cross county lines if the patient expires en route.

 

[DesertMedic66]

REMS Policy 5620.6:
http://remsa.us/policy/2011/5620.pdf

That policy/protocol is from 2008 (So its a little outdated). The protocols we have been using are different from '08.

http://www.remsa.us/policy/

Policy 4203:

When the decision not to attempt / to discontinue resuscitation has been made during transport:
1. Stop in a safe location without crossing county lines
2. Comfort and care for any survivors present
3. Contact the County of Riverside Coroner's Office, give report, and answer all applicable questions
4. Follow the Coroner's directions for:
a. Diposition
b. Notification of local law enforcement
5. Complete ePCR/PCR as described above

 

[exodus]

Huh that's weird, I used the search policy option at the bottom and that's the first one that it brought up. Ah well. I guess we sit out of service for hours!

 

[Ironman]

Interesting.

 

[dixie_flatline]

The only time a patient is worked in the ambulance is if they code in the ambulance. The ambulance stops. Code is worked in non moving ambulance because despite anecdotal statements science actually backs working them when not moving. When pronounced we either drop them at the hospital if near it or we meet the funeral home van and move the body over to them.

If they code before we get in ambulance they are worked on scene. Body turned over to funeral home.

Are you a 911 service? There's no way we are allowed to offload a body to a funeral home.

 

[lilith88]

ummm

hmmmm that's a good question lol

 

[unleashedfury]

Are you a 911 service? There's no way we are allowed to offload a body to a funeral home.

Good question I know we are not allowed to turn a body over to the funeral home, it must go to the county coroner first since it was an out of hospital death, Similar is if you are admitted to the hospital and die within the first 24 hours of admit. must go to a coroner first.

 

[mycrofft]

In the recent case of the young lady who died and her parents are keeping her on life support nonetheless, the hospital where she was declared had to process it through their coroner's office before theory would or could release the remains/patient for transport to another medical facility.

Back to the initial title: no, people die in ambos every day, but they are usually declared in the receiving facility. They don't die in convalescent homes because they are slid into an ambulance just before their last breaths.

 

[Akulahawk]

I forget which county it's in, but one of the counties where I used to work has a policy where DNR patients can be transported directly to a funeral home if the patient dies during transport. However, such arrangements must be known ahead of time which funeral home we were to go to. I don't think I've ever heard of that being done in practice. If that info wasn't known (never was) we were to divert to the nearest receiving facility. Those facilities were supposed to determine also that the patient was actually dead and then the body would be moved to their morgue. The county did things that way because they didn't want too many ambulances out of service while they waited for the coroner's crew. The patient care report was to be completed so that it could be turned over to the Coroner's Office with the body for their investigative purposes.

 

[mycrofft]

I forget which county it's in, but one of the counties where I used to work has a policy where DNR patients can be transported directly to a funeral home if the patient dies during transport. However, such arrangements must be known ahead of time which funeral home we were to go to. I don't think I've ever heard of that being done in practice. If that info wasn't known (never was) we were to divert to the nearest receiving facility. Those facilities were supposed to determine also that the patient was actually dead and then the body would be moved to their morgue. The county did things that way because they didn't want too many ambulances out of service while they waited for the coroner's crew. The patient care report was to be completed so that it could be turned over to the Coroner's Office with the body for their investigative purposes.

Sort of flattering to be considered like a physician as far as the "unattended death" thing goes, but also really scary.

http://www.emtlife.com/showthread.php?t=36595

 

[ZombieEMT]

Huh that's weird, I used the search policy option at the bottom and that's the first one that it brought up. Ah well. I guess we sit out of service for hours!

Absolutely. Crap happens. Nobody wants to sit out of service with a dead body for hours, but crap happens. Mutual aid exists for a reason. Also have the option of contacting a supervisor to babysit or switch out crew. Its not as bad as it seems.

 

[ZombieEMT]

I do not know if there is applicable state laws, but in all three departments that I work with, we pull over and contact police. The hospitals are reserved for living patients, not dead. Many local hospitals do not have a morgue unit and have to be transported elsewhere when they die in the hospital.

Normally the steps in a DNR patient who dies in route.

1. Pull ambulance over to safe location.
2. Contact on duty supervisor and/or medical director.
3. Contact police department.
4. Contact patient's PCP, county medical examiner or hospice care physician.
5. Contact county coroner.

(If death occurs on an EMS call, ALS can perform a pronouncement after contacting medical command.)

 

[mycrofft]

I do not know if there is applicable state laws, but in all three departments that I work with, we pull over and contact police. The hospitals are reserved for living patients, not dead. Many local hospitals do not have a morgue unit and have to be transported elsewhere when they die in the hospital.

Normally the steps in a DNR patient who dies in route.

1. Pull ambulance over to safe location.
2. Contact on duty supervisor and/or medical director.
3. Contact police department.
4. Contact patient's PCP, county medical examiner or hospice care physician.
5. Contact county coroner.

(If death occurs on an EMS call, ALS can perform a pronouncement after contacting medical command.)

Here in central CA, just call the office and see if they will make the call to law enforcement. I bet the supervisor will want to do the notifications and document them.