Obvious Death Standard

Question 1

What does a deceased patient mean?

Answer 1

1. Obviously dead
2. the subject of a medical certificate of death, presented to the paramedic crew, in the form that is prescribed by the Vital Statistics Act (Ontario) and that appears on its face to be completed and signed in accordance with that act
3. without vital signs and the subject of an MOH DNR Conformation Form
4. without vital signs and the subject of a TOR Order given by a Base Hospital Physician; or
5. without vital signs and the subject of a Withhold Resuscitation Order given by a Base Hospital Physician

Question 2

What does Expected Death mean?

Answer 2

• means a death that was imminently anticipated generally as a result of a progressive end stage terminal illness

Question 3

What does Obviously Dead mean?

Answer 3

• means death has occurred if gross signs of death are obvious, including by reason of:

1. Decapitation, transection, visible decomposition, putrefaction ; or
2. absence of vital signs and:
   a. a grossly charred body
   b. an open head or torso wound with gross outpouring of cranial or visceral contents
   c. gross rigor mortis (ex. limbs and/or body stiff, posturing of limbs or body); or
   d. dependent lividity (ex. fixed, non-blanching purple or black discolouration of skin in dependent area of body).

Question 4

What is palliative care?

Answer 4

• means a team of health care professionals who provide palliative care to a terminally ill pt

Question 5

What is responsible person?

Answer 5

• means an adult who, in the reasonable belief of the paramedic, is capable to remain with the Deceased Pt and assume responsibility for the Deceased Pt

Question 6

What is Termination of Resuscitation (TOR) Order?

Answer 6

• means an order given by a Base Hospital Physician to a paramedic to stop resuscitation measures

Question 7

What is unexpected death?

Answer 7

• means a death that was not imminently anticipated (ex. traumatic deaths, deaths related to the environment, accidental deaths, and apparently natural deaths that are sudden and unexpected).

Question 8

What is Withhold Resuscitation Order?

Answer 8

• means an order given by a Base Hospital Physician to a paramedic to not initiate resuscitation measures

Question 9

In all cases of death, the paramedic shall:

Answer 9

1. confirm the patient is deceased as per the Definitions above
2. ensure that the Deceased Pt is treated with respect and dignity
3. consider the needs of family members of the decedent and provide compassion-informed decision-making;
4. in cases of suspected foul play, follow the direction set out in the Police Notification Standard
5. if applicable, follow all directions issued by a coroner or a person appointed by a coroner or to whom a coroner has delegated any powers of authority pursuant to the Coroners Act (Ontario)
6. if TOR occurs in the ambulance en route to a health care facility, advise CACC/ACS to contact the coroner, and cont. to the destination unless otherwise directed by CACC/ACS; and
7. for cases of obvious death, not and document the time at which the paramedic conforms the patient was deceased as per the standards

Question 10

In cases of unexpected death:

Answer 10

1. in the absence of police or a coroner on-scene, the paramedic shall advise CACC/ACS of the death, in which case CACC/ACS shall notify the police or coroner;
2. if a coroner indicates that he/she will attend at the scene, the paramedic shall remain at the scene until the coroner arrives and assumes custody of the Deceased Pt. If the coroner indicates that he/she will not attend at the scene, the paramedic shall remain on the scene until the arrival of a person appointed by a coroner or to whom a coroner has delegated any powers or authority pursuant to the Coroners Act (Ontario)
3. notwithstanding paragraph 2 above, if police are present and have secured the scene, the paramedic may depart as soon as documentation has been completed or he/she is assigned to another call; and
4. where at any time the paramedic has not received any further direction from CACC/ACS, the paramedic shall request that CACC/ACS seek direction from the coroner concerning his/her responsibilities, including whether he/she may leave the scene

*Although a death may be viewed as “unexpected” from the perspective of the person reporting the death (paramedic, family members), this does not necessarily imply that the death requires investigation by a coroner under the Coroners Act (Ontario)