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Old 11-23-2008, 03:24 AM   #1
EMTCop86
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Paramedic's can not pronounce someone DOA?


I have always thought that paramedics were able to pronounce someone DOA but I have been recently told differently. Only a MD can pronounce someone DOA. Paramedic's can "refuse" treatment in certain cases when they know someone is dead but have to call an MD to officially pronounce it, but as far as paramedics actually pronouncing them DOA they are forbidden. Is this correct?


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Old 11-23-2008, 03:51 AM   #2
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No this is not entirely correct.

You will find it varies from state to state, possibly even system to system as with everything else in EMS.

In Alaska, we had the authority to pronounce dead as medics and EMT Basics were allowed to do it under extreme situations which were clearly defined so there was no misinterpretation.
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Old 11-23-2008, 04:16 AM   #3
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Originally Posted by EMTCop86 View Post
I have always thought that paramedics were able to pronounce someone DOA but I have been recently told differently. Only a MD can pronounce someone DOA. Paramedic's can "refuse" treatment in certain cases when they know someone is dead but have to call an MD to officially pronounce it, but as far as paramedics actually pronouncing them DOA they are forbidden. Is this correct?
That sounds right to me. Under licensure with the state, mandate for responsibility in all matters medical is assigned to the medical profession - that's not us.

In aussie land determination of death is the province of the pts doctor or coronial office in his/her absence. The "State" takes a statutory interest in the death of every citizen (and their "life") but delegates responsibility to the "professional" most likely to make a judgement in keeping with medical practice, the views of the "state" - another way of saying the society taking into account minority religious and other interest groups needs - but the state still has privy over this issue. For example, the "state" may order an autopsy against the wishes of individuals or groups if believed warranted.

Believe it or not their is even a stipulation as to what are the "absolute indicators" of death written into legislation - a kind of "death act". This is now being challenged by interpretations from many parties as to what constitutes death - you know the "brain dead" person etc and interestingly this parallels with how we view what constitutes "life" - when in starts etc.

Previously the "absolute indicators" of death (here in Australia) were;

1. Decapitation
2. Significant visceral trans-section
3. Putrefaction

All other indicators are not so clear cut (pardon the pun) as they may mimic death and so do not fall into the first category. The waters get muddier the more equivocal indicators are that's why there is just one person making the final judgement at the behest of the "state".

Fortunately for us, the state, through the decision makers of the medical profession have given us a much broader scope of decision making ability (within reason and often strict criteria) to make determinations of death - up to a point.

This is all about what is "reasonable" to expect from a person with a certain level of medical training such as we Paras without fear of common law challenge. Most ambos who have served for a few years would be a better judge of when someone has died than most GP's - personally I've seen hundreds of very dead people.

Unfortunately there are medico-legal and insurance factors (and economic costs as well) taken into account.

The problem is less about when someone is dead and more about providing or withholding treatment (resus). The vast majority of court cases against ambos would certainly have been involving these issues.

Still, it's a very sensitive issue with many stakeholders needs that have to be met.

So in short - the chain of ultimate responsibility starts with the state and ends with the state or its delegated representative - the Doctor.

It's actually a very interesting area of medicine -the whole death thing if I can so crudely put it.

MM
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Old 11-23-2008, 04:40 AM   #4
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I'll pull out the regs later if you want. Paramedics, and in some cases EMTs can presume death in my system in cases of extremely obvious death (decapitation being one of them). The medics still have to call med control to make it official.

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Old 11-23-2008, 07:07 AM   #5
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Here in the NWT to the best of my knowledge if the death is in a hospital or nursing home setting the MD can pronounce, but outside of those two settings the Coroner pronounces.
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Old 11-23-2008, 07:09 AM   #6
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Usually pronouncement of death is only made by a licensed medical physician. This is the one signing the Death Certificate. Some areas still use elected officials with NO medical training called County Coroner.

Paramedics and EMT's usually can declare death which is stating someone is dead. This is not the same legal term as pronounce of death. The same effect though.

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Old 11-23-2008, 07:11 AM   #7
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Usually pronouncement of death is only made by a licensed medical physician. This is the one signing the Death Certificate. Some areas still use elected officials with NO medical training called County Coroner.

Paramedics and EMT's usually can declare death which is stating someone is dead. This is not the same legal term as pronounce of death. The same effect though.

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Most of our Coroners here in the NWT don't have any formal medical training. Our Coroner's are appointed.
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Old 11-23-2008, 07:55 AM   #8
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Thanks for the answers guys clears things up quite a bit.
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Old 11-23-2008, 11:44 AM   #9
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In Alaska, a medic CAN sign the death certificate.

My name is on one of these, my first and presumably the last one I will ever do.

Typically, the doctor is willing to sign for your decision, however on occasion, they may ask the medic to do so. I imagine this procedure exists due to the remoteness of many of the villages.

Usually when we pronounced in a remote village, if there were no suspicions to transport the body back to a larger town, we just left the body with the family so they could bury it and called in the death to the state police and the medical director. And this is how and why sometimes the medic had to sign the death certificate.
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Old 11-23-2008, 12:00 PM   #10
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as R/r mentioned, the big diff is declare v. pronounce. we can declare them dead, and call the doc to pronounce. in some areas, you dont call olmc but go direct to the me/coroner and they do the pronouncement.
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