DEAD ON SCENE PROCEDURE

DEAD ON SCENE PROCEDURE

In order for Medical Control to fulfill their medical and legal obligations in the determination of patient death at the scene of an emergency, the responding EMS providers must gain access to the patient and perform a specific sequence of procedures, as outlined below. (See also Resuscitation Policy)

Care must be taken to cooperate with law enforcement in the security of a crime scene and for preservation of evidence. The number of EMS providers having access to the patient should be limited to one or two persons at a time. This will allow the first responders access to determine if there is a need for resuscitation measures to be implemented and, if not, then to transfer responsibility for further documentation to ALS personnel upon their arrival.

Always be aware that in situations of hypothermia, acute drug overdose, hypoglycemia, and some poisonings the patient may appear clinically dead but may be resuscitated.

The following procedures are to be followed for documenting a patient dead on scene:

1. Affix cardiac monitor and confirm asystole in two leads.

2. Contact a licensed physician at Medical Control.

3. Describe the history involved, i.e., auto accident, overdose, penetrating injury, heart attack, etc.

4. Provide an impression as to whether the death appeared natural, accidental, or deliberate.

5 Give a verbal report of the negative vital signs, i.e. blood pressure 0/0, pulse absent, no respirations, pupils fixed and dilated.

6. Describe body temperature and evidence of lividity and/or rigor mortis.

7. If applicable, present additional history such as cancer, heart disease, diabetes, etc.

8. The licensed physician may then provide the decision to pronounce the patient dead.

9. The Medical Control physician may decide that the patient meets the criteria for notification of the medical examiner.

10. If the first responders determine that the patient is non-salvageable and does not require resuscitation efforts, they may contact the responding ALS unit and advise them to reduce their level of emergency response. This policy will provide for safer driving conditions for both the ALS responders and the public. The ALS unit will continue to the call to document patient death. If the patient meets obvious death criteria, the ALS unit may be cancelled by the Medical First Responder. After notifying the ALS unit, the first responder will immediately contact Medical Control to provide a history of the incident and a verbal report.

11. Once CPR has been initiated by any trained person at the scene, it must be continued until either an on-scene physician (see on-scene physician policy) or an on-line physician from Medical Control (734 241-1386) pronounces the patient dead-on-scene. Even if obvious signs of death are noted after CPR has been initiated, CPR can only be terminated after pronouncement by an appropriate physician.
CRITERIA FOR DEAD-ON-SCENE

OBVIOUS DEATH

- Decapitation or gross dismemberment of the body

- Bodily Decay/Putrification

- Open head trauma with exposed brain tissue

- Severe open chest or abdominal trauma

EVIDENCE OF DEATH

- Asystole for greater than 20 minutes without CPR

- Rigor Mortis (involving more than just joint rigidity)

- Lividity

- Cold skin (in absence of low environmental temperatures)

- Extensive full thickness burns with charring of the body and face and with loss of limbs.

- Drowning victim submersed greater than one hour

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