Paramedic's can not pronounce someone DOA?

Here in Mississippi, you have to call the coroner. You still have to make sure the person is dead, so that you don't have to provide medical interventions. If someone dies at a car wreck, we call the coroner and then transport to the hospital in a body bag. I have never put a dead body in a body bag yet, so I am not sure how tough that is going to be. If they die at home, usually the family has the funeral home come get the body.
 
Here in my area of GA we declare death in the field and call for coroner ( we can call) our coroners go to coroner level 1 & 2, And are pretty medically inclined people.
 
Call command

In PA, we cannot pronounce, but if there are obvious signs of death in a trauma we don't need medical command. I've had two medical DOA's in the last three days. I get on scene, confirm aystole in three leads, get the history, check for rigor, check pupils, call command and he gives orders not to start working it. Then we call the coroner.
 
rhan101277 said:
I have never put a dead body in a body bag yet, so I am not sure how tough that is going to be.
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The first time is kinda freaky. After the second or third, it's as routine as putting a patient on oxygen.
 
Death in Melbourne

We use to get tied up transporting deceased pts but no more. On rare occasions such as a traummatic paeds death in a public place we might take care of the body but even then only until the coroners wagon arrives. Deaths at home are never transported by Melbourne ambulance crews.

We are allowed to make a determination of death following assessment including ECG and can withhold treatment/resus without any need to call command or anybody else if the pts situation meets certain criteria including obvious death, asystole with prolonged downtime and no CPR etc.

We arrange for a GP to do certification if at a residence or the coroners if out in public such as road deaths or if the pts GP or Locum is unavailable.

The Police and their traffic investigation unit take command at road deaths after we inform them of our findings.

We also have the option to consult with family about resus where exiting NFR orders are available at scene or in a nursing home situation - clear documentation is the best scenario for all of us in NFR type situations.

As for "rigor" - this doesn't happen till about the three hour mark after death so you will never see it in road trauma. Post mortem lividity is a better indicator for assessment of death and is easy to document in your paperwork.

Its all about common sense and sticking to process so there are no unnecessary repercussions. Australia is somewhat less inclined to litigation than the US so I can understand stiffer controls over US ambos.

MM
 
In Pennsylvania, if the patient is of an older age and has a known medical history that appears to be a contributing factor in the death, we always attempt to contact the family physician first to ascertain if they are willing to sign the death certificate. If they are, then we coordinate and assist the family with contacting a funeral home and remain with the deceased until the funeral home takes possession.

If the family physician is not comfortable signing a death certificate, then we have to request the county coroner to respond. And in certain cases, its an automatic call for the coroner.. instances such as suicides, MVC, patients of a young age, etc.

Technically speaking, we are not allowed to legally pronounce since we cant fill out and sign a death certificate, but in reality we do pronounce when we make the decision not to initiate resuscitation.
 
Tying up ambos

ResTech said:
In Pennsylvania, if the patient is of an older age and has a known medical history that appears to be a contributing factor in the death, we always attempt to contact the family physician first to ascertain if they are willing to sign the death certificate. If they are, then we coordinate and assist the family with contacting a funeral home and remain with the deceased until the funeral home takes possession.

If the family physician is not comfortable signing a death certificate, then we have to request the county coroner to respond. And in certain cases, its an automatic call for the coroner.. instances such as suicides, MVC, patients of a young age, etc.

Technically speaking, we are not allowed to legally pronounce since we cant fill out and sign a death certificate, but in reality we do pronounce when we make the decision not to initiate resuscitation.
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I think the situation is similar for most ambos no matter where given your last couple of paragraphs but how are your resourcing levels given you get tied up with the funeral home arrangements? That's must take hours on occasions. Doesn't seem like the best way to resource ambos but I can understand the sensitivities for families of the deceased.

MM
 
? Even EMRs (EMT-Bs) can do it here. Of course, that requires obvious signs of death or "injuries inconsistent with life" (decapitation, putrefaction, rigor mortis, and the like). I am not sure if EMTs (EMT-Is) can use other, less obvious signs, I'll ask my EMT-I partner at work.
 
how are your resourcing levels given you get tied up with the funeral home arrangements?
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Legally, in PA at least, we must remain with the body until it is transferred to the funeral home, coroner, or law enforcement takes custody of it (instance of a crime scene). So we aid the family in calling the funeral home since they usually have no idea of the process or what to say and it makes it easier on them. Its not a frequent occurrence so it doesn't effect out resources at all with having a second ambulance and mutual aid.
 
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