paramedics and death

[emtstudent04]

Dang 2 hours? That's a long time.

 

[MMiz]

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."

 

[ExpatMedic0]

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.

 

[CAOX3]

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.

 

[emtstudent04]

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.

 

[Sassafras]

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.

 

[Akulahawk]

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.

 

[Dominion]

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!

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.

 

[MagicTyler]

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.

 

[mcdonl]

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.

 

[Jinkx]

InTexas its Protocol driven. More predominent in rural EMS.

 

[EMT11KDL]

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

 

[somePerson]

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

 

[johnrsemt]

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

 

[Melclin]

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.

 

[Cliff]

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!

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.

 

[akflightmedic]

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

 

[Cliff]

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.

 

[ExpatMedic0]

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....

 

[Cliff]

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.