Standard Operating Procedures

Chapter IV Death Scenes

 

Policy

 

  • Greenville County EMS 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 on death scenes.

 

    • The Greenville County Coroner authorizes EMS personnel to declare and pronounce a patient dead.
    • EMS related medical practices and procedures used during patient assessment shall conform to EMS-authorized medical practices as outlined in the Greenville County EMS Protocols, Standards of Care and Standing Orders, and the EMS Division, SCDHEC.
    • This Policy and remaining procedures are intended to direct EMS personnel with death and death scene management Patients with terminal illnesses may be managed under the guidance of the standard of care and/or within the parameters of the DHEC DNR/POST Orders.

 

EMS Declaration of Death

 

  • A patient may be declared dead if the patient presents with all of the following:

 

    • No response to painful stimuli
    • Makes no respiratory effort
    • No evidence of heart action as evidenced by no palpable pulses and no electrical heart activity documented in at least two limb leads on a functioning cardiac monitor
    • Patients who are obviously dead presenting with decomposition, large body part dismemberment, and burned beyond recognition are exempt from this requirement.
    • When determining death, use caution if the inspection of the scene and/or surrounding area is warranted as part of the determination of a death scene or to gather information. Move the patient and/or articles (furniture, etc.) as little as necessary to accomplish the task at hand.

 

Natural Death Scenes

 

    • Natural death scenes are defined as scenes where there is reasonable evidence that the person died of natural causes (i.e. illness, old age, etc.). If at any time, there is any question as to the death/scene being a questionable scene, stop inspection and secure the scene immediately and notify the Coroner's Office.
    • Upon confirming death, the paramedic shall contact the physician (or on-call physician), if known, of the deceased. The Paramedic shall confirm that the physician will sign the death certificate and certify the death.
    • 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.
    • If, for any reason, a physician cannot be contacted or is unwilling to sign the death certificate, notify the Coroner's Office and follow their instructions.
    • Advise the Coroner’s Office of all known facts of the call, and follow their instructions.
    • If the coroner determines the death is of natural causes, a physician has agreed to sign the death certificate, and the family has determined a funeral home, the appropriate funeral home will be contacted by EMS personnel to transport the body.
    • If a physician is not available to sign the death certificate or a funeral home designation cannot be determined, EMS will follow the request of the On-Duty Coroner.
    • In the event that the On-Duty Coroner responds to the scene, then he/she will contact the private contract company for body transport services to transport the body.
    • In cases in which the body is transported by a funeral home or the privately contracted body transport service, EMS should seek to return to service and depart the scene as quickly as possible in order to be available for an emergency call.
    • Complete documentation per the current reporting standards.

 

Unnatural or Questionable Deaths and Death Scenes

 

    • Unnatural or questionable deaths are death scenes defined as any death or death scene outside the definition of a natural death.

 

  • These deaths/scenes include (but are not limited to):
    • involving violence
    • trauma
    • drugs or drug paraphernalia
    • hemorrhage
    • OB
    • pediatrics
    • It also includes any death or death scene where there is questionable of insufficient information to identify the deceased and/or possible causes of death.

 

  • If signs of an unnatural or questionable death are present, or if the paramedic is uncertain of the mode of death, the paramedic shall:
    • Leave the immediate area of the scene while not disturbing the scene, the surrounding area, or the articles related to the scene.
    • Not move or reposition the body after initial assessment (if movement is necessary to determine death).
    • Secure the scene as much as practical
    • Request that the Coroner’s Office and Law Enforcement personnel be dispatched.
    • 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.)
    • Follow the directions of law enforcement officers and/or Coroner’s Office personnel on the scene.

 

Coroner Notification for High Morbidity Cases

  • In cases in which EMS personnel believe that patient death may be imminent as a result of unnatural causes, the Coroner’s Office shall be notified. This notification should be accomplished as soon as reasonably possible.  It is the responsibility of the EMS Paramedic to communicate the patient condition to the EMS Communications Center in order that the Communications Staff can notify the On-Duty Coroner.
  • Situations that should prompt EMS personnel to notify the On-Duty Coroner include, but are not limited to the following patient conditions that are outlined below:
    • Priority One Trauma
    • Patients in whom the trauma team has been alerted
    • Patient with an Revised Trauma Score of 6
    • Electrocution involving 440 Volts or higher
    • Burns that have a high percentage of body surface area of patient or full-thickness burns
    • Drowning, to include immediate notification if it is presumed that a victim is still in the water.
    • Pediatric Cardiac Arrest
    • Stillbirths and/or fetal deaths
    • EMS pronounces death
    • Patients that meet the above guidelines and are transported to the hospital by an air transport unit
    • When death is suspected and the patient doesn't meet the above guidelines.

 

Call Documentation

  • All deaths and death scenes shall be fully documented according to current Greenville County EMS Policy and Procedures.

 

The Paramedic shall:

  • Complete a PCR in EMS Charts
  • Upload a rhythm strip that shows at least two recorded leads into EMS Charts and attach to the patient care report.
  • A Death Scene Report for the Greenville County Coroner’s Office shall be completed by the on-scene EMS crew.
  • The Death Scene Report shall be scanned and uploaded into the PCR on EMS Charts.
  • Any additional supplemental reports requested by the Coroner’s Office or Law Enforcement personnel investigating the scene.

 

Hospice Notification

  • If the deceased was being cared for by Hospice, follow the procedure outlined in Chapter IV Field Operations, Sections J, DNR Orders, Sub-section 4.4.2.

 

Non-refereed body transport.

  • In many cases, the disposition of deceased will be facilitated by either a funeral home or by the County’s contracted private body transport company. In some instances, however, it may be more appropriate for Greenville County Emergency Medical Service to handle the transportation. GCEMS will facilitate transportation of deceased as the EMS system status permits, and when it is quicker to transport from an uncomplicated scene (i.e. no unnatural or questionable death circumstances) than to wait for the County’s contracted body transport service.
  • Often the contracted body transport service will be used for unnatural or questionable death scenes that require extensive, lengthy on-scene investigations by law enforcement, forensics, and the Coroner’s Office and/or during times when the EMS system workload will not permit an ambulance to be held on scene and utilized for a non-emergent transport. Use of the private service will enable EMS to return to emergent duty as quickly as possible and be available for an emergency call.
  • In these cases, once the patient has been determined to be deceased, and a lengthy scene time is anticipated, the EMS crew will collaborate with the on-duty Coroner. Once it is determined that EMS will not be able to facilitate transport, the responding on-duty Coroner shall notify the private company for body transport services, usually through the EMS Communications Center.