MOD F TECH 41 Suspected death and dying Flashcards
Recognition of Life Extinct (ROLE)
In patients with cardio-pulmonary arrest, vigorous resuscitation attempts must be undertaken whenever there is a chance of survival, however remote
Nevertheless, it is possible to identify patients in whom there is no chance of survival and where resuscitation would be both futile and distressing to relatives
There are a number of conditions where resuscitation should not be attempted because they are unequivocally associated with death, in ALL age groups these are:
- Massive cranial and cerebral destruction
- Hemicorporectomy
- Massive truncal injury incompatible with life, including decapitation
- Decomposition/putrefaction
- Incineration
- Hypostasis (post-mortem staining)
- Rigor mortis
- In the newborn, foetal maceration is a contraindication to attempted resuscitation.
The Ambulance Technician is not permitted to diagnose the fact of death, however, they should still not commence resuscitation in conditions unequivocally associated with death
In the following conditions resuscitation can be discontinued
•The presence of a DNACPR (DNR/DNAR) order or an Advanced Directive (Living Will)
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•When the patients death is due to terminal illness
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•Submersion for longer than 90 mins
Efforts would be futile if ALL of the following exist together:
•15 mins since the onset of collapse
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•No bystander CPR prior to the arrival of the ambulance
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•The absence of any of the exclusion factors on the flowchart (JRCALC)
–Drowning, hypothermia, poisoning or overdose, pregnancy
•Asystole for >30 secs on the ECG monitor screen (Print Strip)
EMAS Diagnosis of Death Procedure
1st February 2016 Conditions Unequivocally Associated with Death (Paramedics, Technicians, Trainee technicians, ECA’s) No ECG evidence required.
- Massive Cranial and cerebral destruction
- Hemicorporectomy or similar massive injury
- Decomposition/ putrefaction
- Incineration
- Hypostasis
- Rigor Mortis
- Foetal Maceration
EMAS Diagnosis of Death Procedure
1st February
Clinical Diagnosis of Death
Conditions Requiring ECG Evidence of Asystole
2016
Patients recognised as life extinct who have received no consistent and concerted resuscitation attempts within 15 minutes following collapse and are now presenting in an asystolic rhythm (pacing spikes do not demonstrate a complex or a rhythm and in this context may be disregarded), with no pulse or respirations on arrival of the ambulance clinicians. This may be carried out by Paramedics, Nurses and Ambulance Technicians.
Termination of resuscitation attempts may take place if continuous asystole is present (pacing spikes do not demonstrate a complex or a rhythm and in this context may be disregarded), despite ADVANCED LIFE SUPPORT attempts, including IV/IO drug therapy, for more than 20 minutes in a normothermic patient. This may be carried out by Paramedics and Nurses.
Clinical Diagnosis of Death
Conditions Requiring ECG Evidence of Asystole
Patients who have been submerged for more than 90 minutes (this applies to both normothermic and hypothermic patients), with the exception of patients in the following circumstances:
- All those where there is a possibility of being able to breathe from a pocket of air whilst underwater.
- Anyone showing signs of life on initial rescue
- Those whose airway has only been intermittently submerged for the duration of their immersion, e.g. this wearing lifejackets but in whom the airway is being intermittently submerged, provided they still have a reasonably fresh appearance.
This may be carried out by Paramedic, Nurses and Ambulance Technicians.
Reporting the fact of Death
Throughout EMAS, the police must be informed in the following circumstances:
- Suspicious circumstances
- Deceased is under 18 yrs old
- Identity cant be confirmed
- Death didn’t occur in home of the deceased or relative of the deceased
- No known GP for deceased
- Relative/other responsible person not easily contactable
- Obvious physical signs of trauma/deliberate violence
- Premises is insecure/signs of forced entry
- Deaths resulting from fires
- Deaths which may result in criminal charges
- Industrial/agricultural accidents & work related deaths
- Suicides
- Drug related deaths
- Drowning/diving deaths
- Deaths in custody
- Deceased subject to a deprivation of liberty order
- Deaths on the railway
- Deaths at MOD establishments
Fatal RTC’s
Reporting the fact of Death – throughout EMAS
- The Diagnosis of Death Form must be completed by the crew member pronouncing the fact of death and (with the exception of Northamptonshire) faxed to the EOC appropriate to your area at the earliest opportunity and in every case before the end of the shift. The form must be fully and clearly completed, as EOC will scan and email the form to the relevant Coroner on receipt. It is essential that all sections are fully completed.
- If a Coroners Officer or Police Officer is at the scene, the Diagnosis of Death Form can be handed to them as an alternative to fax transmission to EMAS EOC. However, this should be documented on the patient record.
- A Diagnosis of Death Form should be completed on ALL occasions. Including when a patient is transported to the Emergency Department and the attending hospital clinician determines that resuscitation attempts should be ceased, whilst the patient still remains in the ambulance. In turn allowing transportation of the deceased to the mortuary.
Approach to Bereavement
The SADA Cycle
Informing a Relative or Friend
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Avoid euphemisms
- Do not give false hope
- Consider your voice tone
- Control your own emotions!!??
- Avoid patronising comments like:
–I know how you feel, no you don’t!!
- Leave time to grieve
- Try to concentrate on practical issues
- Use simplistic terms
- Body language; how do you stand, it can have an influence on the situation
- Do you sit down or stand up
- Are you chewing gum !!
- Ensure you look at the recipient of the bad news
- How important is it to respectfully lay the deceased body out before you leave the scene, will this help the grieving process
•Her Majesty’s Coroner is appointed by the crown to hold inquests into cases of sudden death in order to determine the cause
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•They are assisted by Coroner’s Officers, usually police officers.
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•You may be consulted from time-to-time with matters relating to ‘continuity of evidence’
In cases of sudden death the police may need to be involved particularly if the circumstances:
- Indicate that the death was due to unnatural causes
- Give reason to suspect a crime of some sort
- Are unusual in any other way
- Removal and inventory of all clothing, valuables and effects will be carried out by mortuary staff; you will be asked to agree the list and sign a personal property and effects form
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•The mortuary attendant will the countersign the form and hand a copy to you as a receipt; attach this copy to your daily work sheet and hand it in on return to base
Mortuary procedures
Follow local protocols, which determine whether you take a body to the mortuary once certified and to which mortuary
In the interest of both ambulance and mortuary staff, the procedure generally followed is:
•Hand over the body to mortuary staff with brief details of:
–Circumstances of death
–Who confirmed the death
–Where the body was found
The identity of the body
Ethnic and religious groups
•Custom and practice surrounding death and the handling of bodies will differ among different ethnic groups and communities.. The wishes of the family will sometimes conflict with accepted procedures
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- Family wishes should be respected as far as possible bearing in mind legal and service procedures
- In some circumstances, compromise may be the only alternative to cause the family least distress
