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?
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
