History:

 

• Person encountered by EMS who meets criteria for obvious death
• Patient with a valid DNR who is pulseless and apneic
• Patient with other approved advanced directive requiring no CPR be administered who is pulseless and apneic
• Patient for whom resuscitative efforts are ceased on scene
• Name of primary care physician
• Known medical conditions
• Last time known to be alive
• Fetal death

 

Definitions:

 

• Natural death scenes:
  • scenes where there is reasonable evidence that the person died of natural causes (i.e., illness, old age, etc.)
• Unnatural or questionable death scenes:
  • scenes outside the definition of a natural death (i.e., violence, trauma, drugs or drug paraphernalia, hemorrhage, fetal death and/or products of conception, pediatrics, questionable or insufficient information to identify cause of death, patients <60 years old without an extensive medical history, etc.)
• High morbidity cases:
  • cases in which EMS personnel believe that patient death may be imminent as a result of unnatural causes (i.e., fetal death, pediatric cardiac arrests, trauma with RTS <6, priority one trauma, high percentage burn, high voltage electrocution, drowning, etc.)

 

Patient meets criteria for discontinuation or has injuries incompatible with life ?

 

• No

 

• • Continue with resuscitation per appropriate protocol

 

• Yes

 

Natural death scene ?

 

• Yes

 

• • Contact primary care physician
  • Contact Coroner

 

Patient released by Coroner ?

 

• No

 

• • Follow (Unnatural, questionable or traumatic death scene protocol)

 

• Yes

 

• • Contact funeral home

 

Unnatural, questionable or traumatic death scene ?

 

1. Contact Coroner and Law Enforcement
2. Leave the immediate area without disturbing the scene
3. Do not move or reposition the body after the initial assessment
4. Secure the scene as much as practical

 

• Complete Death Scene Report

 

PEARLS:

 

• If at any time there is a question as to the death scene being a questionable scene, stop inspection and secure the scene immediately and notify the Coroner's office.
• For all high morbidity cases contact the Coroner.
• Contact the patient's primary care physician to certify death and sign the death certificate.
• Greenville County Paramedics may declare a person dead on the scene or during EMS transport. Paramedics are expected to use reasonable judgment, coupled with compassion, when declaring death and/or interacting with the public and other agencies.
• Fetal death includes abortion, stillbirth, miscarriage, and products of conception, etc.
• In the case of natural death, contact the patient's primary care physician to certify death and sign the death certificate.  It is acceptable to transfer information through a nurse or other licensed personnel at the physician's office if the physician is unable to come to the phone to certify the death.
• If a physician cannot be contacted or is unwilling to sign the death certificate, notify the Coroner.
• Do not re-enter the scene or immediate area of the scene during the investigation unless requested to do so by the Coroner on-scene.
• Leave in place any and all disposable medical equipment used to assess and/or treat the patient (i.e. monitor pads, inserted airways and IV setups, etc.) until the patient is released by the Coroner.
• When determining death, use caution and move the patient and/or articles (i.e., furniture, etc.) as little as necessary to accomplish the task at hand.
• Patients can be covered if the scene is in view of the public.