Deceased Pt Standard

Question 1

Who is a deceased pt?

Answer 1

• obviously dead
• subject to a medical certificate of death
• VSA with a DNR
• VSA with a TOR
• VSA with a Withhold Resus Order given by a BHP.

Question 2

What is an expected death?

Answer 2

A death that was imminently anticipated generally as a result of a progressive end stage terminal illness.

Question 3

What counts as obviously dead?

Answer 3

1. decapitation, transection, visible decomposition, putrefaction; or
2. absence of vital signs and:
   * a grossly charred body;
   * an open head or torso wound with gross outpouring of cranial or visceral contents;
   * gross rigor mortiso; or
   * dependent lividity

Question 4

Who is a responsible person as per the deceased pt standard?

Answer 4

An adult who (in the reasonable belief of the paramedic) is capable to remain with the deceased pt and assume responsiblity for them.

Question 5

What is an unexpected death?

Answer 5

A death that was not imminently anticipated (traumatic deaths, deaths related to the environment, accidental deaths, and apparently natural deaths that are sudden and unexpected)

Question 6

What should we do whenever anyone dies?

Answer 6

1. Confirm the pt is dead;
2. ensure the deceased is treated with dignity;
3. consider the needs of family members and provide compassion informed decision making;
4. in cases of suspected foul play, follow the Police Notification Standard;
5. if applicable, listen to the coroner or person appointed/delegated by the coroner;
6. if TOR enroute to a health care facility, advise CACC/ACS to contact coroner and continue to destination unless otherwise directed by CACC/ACS;
7. for cases of obvious death, note and document the time at which the paramedic confirms pt is deceased.

Question 7

What do we do in cases of unexpected death?

Answer 7

1. in absence of police or coroner on scene, advise CACC/ACS of the death and they’ll notify them;
2. if coroner advises they’ll attend the scene we remain until they’ve arrived to assume custody of the body. If they won’t be attending the scene, we remain until a person delegated/appointed by the coroner arrives;
3. if police are attending and secured the scene though, we can leave as soon as our paperwork is done or we’re assigned to another call.
4. If at any time we haven’t received further direction from CACC/ACS, we shall ask that they seek direction from the coroner concerning our responsibilities, including whether we can leave the scene.

Question 8

If the death is viewed as unexepected from the perspective of the person reporting it does this mean the coroner will be investigating?

Answer 8

Not necessarily.

Question 9

What do we do in cases of expected deaths?

Answer 9

1. Advise CACC/ACS of the death;
2. make a request of a responsible person (if present) to notify the primary care practitioner or member of palliative care team of the patient and request their attendance at the scene;
3. if responsible person is unable to provide that notice, advise CACC/ACS and they’ll attempt to request the same attendance;
4. if after that contact the practitioner says they’ll attend the scene, we wait until their arrival at scene,
5. unless there’s a responsible person that we think will stay until the practitioner arrives. Then we can leave once our paperwork is done or we’re assigned to a new call. Also, if the police are there we can leave;
6. if the practitioner can’t be contacted or won’t attend or there’s no responsible person on scene we advise CACC/ACS and they notify the police or coroner of the death and that there’s no one to take responsibility for the body;
7. if requested by coroner, provide them the circumstances of the death; then we’ll either be released from the scene or instructed to remain with the body until they or a person they’ve delegated to or a responsible person can attend the scene and assume responsibility for the body.