Non-Paramedics determining Obvious Death

Question#: 688

Question:

I have; over the years, been on scene with VSA patients who the first responding Fire Departments have termed Code 5. Sometimes there are certified Paramedics within the FD on scene and sometimes there are no Paramedics on scene. Let it be known that I harbor no ill will toward firefighters or departments; however, I am looking for definitive answers to clear up confusion and possible liability:

Can a non emca firefighter call a patient Code 5?

Can an emca certified firefighter working as a firefighter call a pt Code 5?

I have yet to find any literature to support this ability. Some FD services have emca medics working for them who have "trained" them to deem pts Code 5, but is this enough, since it is a delegated medical act. Again, I ask this question for a definitive answer for a situation that happens more times than we think it might. I also ask to possibly avert a potential life altering event based on faulty information or confusion.

Answer:

In order to answer this question, we approached our Associate Medical Director, Dr. Mark Froats, who is also an investigating coroner in Hastings County.

The pronouncement of death, or determining that someone is obviously dead, is not a medical or legal act, and can be performed by anyone in Ontario. It is simply the act of determining that someone is not alive. Family members (of palliative patients for example), police officers (performing a well-being check and finding a decomposing body for example) and nursing home staff, all routinely pronounce death. Firefighters are able to do so as well. Of course, if it is isn't clear if someone is dead, then this determination will typically fall to healthcare providers. There is no provincial standard of care for firefighters in Ontario, and training and comfort in pronouncing death may vary among fire departments.

Paramedics are bound to follow the Deceased Patient Standard in the BLS-PCS, and there is specific criteria to evaluate before determining obvious death. This is to ensure there are no mishaps like what you are eluding to (pronouncing someone dead who might still be viable).

In the scenario where firefighters are on scene ahead of paramedics, and state that a patient is obviously dead (rigor mortis and/or lividity), it is still incumbent upon the paramedics to personally assess for obvious death criteria to the best of their ability, document this assessment, and to not rely on the word of a firefighter or other person on scene.

Pronouncement of death should not be confused with certification of death, which is a legal act that involves identifying the deceased, indicating the date of death, and attesting to the cause and manner of death. From a coroner standpoint, only a physician, and Advanced Practice Nurses (APN) with specialized training, can certify death, which requires a review of medical records, incident history, physical exam, and any additional investigation to determine the probable cause and manner of death.