Nobody dies in an ambulance?

[Aidey]

We can declare also. The issue at my agency is specifically declaring in the back of the amb.

 

[Tigger]

I can't figure out why anyone would be declared deceased in the physical confines of an ambulance. If we find someone in arrest and choose not to work it or call efforts after a rescuitation attempt, the body would be left there. If they arrest in the ambulance, they are going to be worked (pending DNR status). I suppose if you pulled over to work the code and then decided efforts were futile you would be pronouncing them dead in the ambulance, but really how common is that?

 

[DesertMedic66]

I can't figure out why anyone would be declared deceased in the physical confines of an ambulance. If we find someone in arrest and choose not to work it or call efforts after a rescuitation attempt, the body would be left there. If they arrest in the ambulance, they are going to be worked (pending DNR status). I suppose if you pulled over to work the code and then decided efforts were futile you would be pronouncing them dead in the ambulance, but really how common is that?

So if you have a DNR patient who codes while enroute to the hospital do you not declare them deceased while in the ambulance?

 

[Tigger]

So if you have a DNR patient who codes while enroute to the hospital do you not declare them deceased while in the ambulance?

Sorry I meant to add outside of DNR situations. And for what it's worth no one on my truck will be declared dead since we are 99% of the time straight BLS.

 

[medicdan]

Its worth noting that many states have statutes making it illegal for dead bodies to be transported by an ambulance-- except in the case of extreme public health emergencies. Be sure to note these laws, if you plan on transporting a corpse.

 

[fortsmithman]

True story. No one dies in an ambulance. They had a pulse until the second you walked through the door of the building.

Otherwise the ambulance has to park and stay out of service until the medical examiner, coroner or mortuary can get around to taking care of the body. It isn't a pretty situation.

With my service we are responsible for body pickup. If someone passes away during transport they are taken to the morgue directly. My services chief is also a Coroner.

 

[Handsome Robb]

People aren't arguing whether EMS can declare or not, it's whether patients are declared in the ambulance. From the sounds of it it varies from system to system, like most things.

So if you have a DNR patient who codes while enroute to the hospital do you not declare them deceased while in the ambulance?

Absolutely not.

Unless you want to explain to my supervisor, for me, why I'm out of service for 5+ hours waiting on the coroner

I've never been put in the situation before but everyone has told me the same thing Aidey said.

"They lost their pulse as we were unloading, their a DNR, sorry :-/ "

 

[firecoins]

DNR takes presedence. If they die while enroute to the ER and they code, thats it! We don't work it. We inform the receiving facility MD. ER receives the body. No waiting for a cornoner.

We don't pick up dead bodies so if its an obvious death, we dont transport unless its in public or the police say so. We go to the ER with it.

Everyone else who codes enroute is worked up.

 

[leoemt]

True story. No one dies in an ambulance. They had a pulse until the second you walked through the door of the building.

Otherwise the ambulance has to park and stay out of service until the medical examiner, coroner or mortuary can get around to taking care of the body. It isn't a pretty situation.

I had to babysit a body last month because Medics pronounced a death in the back of their rig and had a 2 hour eta from the ME's office. Had the pronounced him on the ground the PD would have babysat him but nope had to do it in the back of their rig.

Since I am BLS and can't pronounce death (except very obvious like decapitation) noone dies in my rig. Got to get them in the ER for them to die.

In the case of a DNR - if I have the DNR in my possession then I will honor it. If its not in my possession or is invalid then they are treated like anyone else and all efforts will be made. It doesn't matter if they tell me they have a DNR or POLST I have to have it in my hand and it needs to be valid.

 

[DesertMedic66]

Per our county or company policy (can't remember which one) we are supposed to pull over to a safe spot and contact the Corner and then follow his/her directions.

The "he coded as we were unloading" won't work in our system. Sometimes the hospital will let us put the gurney into a closed room and wait but the body stays on the gurney.

 

[med51fl]

People aren't arguing whether EMS can declare or not, it's whether patients are declared in the ambulance. From the sounds of it it varies from system to system, like most things. "

:deadhorse:

 

[VirginiaEMT]

Its worth noting that many states have statutes making it illegal for dead bodies to be transported by an ambulance-- except in the case of extreme public health emergencies. Be sure to note these laws, if you plan on transporting a corpse.

I wish that applied to us. What a tremendous waste of time for EMS providers and takes away our ability to respond to another emergency if called upon. We will transport to the morgue or even the funeral home if requested to do so. Most time the funeral home personnel comes to the location to get the body.

 

[Christopher]

Its worth noting that many states have statutes making it illegal for dead bodies to be transported by an ambulance-- except in the case of extreme public health emergencies. Be sure to note these laws, if you plan on transporting a corpse.

We transport them all the time (which I find silly...we're an ALS ambulance...).

 

[Kevinf]

Since I am BLS and can't pronounce death (except very obvious like decapitation...

Head falls off in the rig... should have held c-spine!

 

[Jon]

I've always made it a goal to have a life-neutral ambulance. They don't die in the truck, and they damn sure aren't born in the truck (that's a MESS). I've been successful on the 2nd half, anyway - so far.

As for "what to do when the DNR patient dies" - If you're doing these runs with a valid DNR, that should be discussed and understood. Options include diverting to the closest ED, returning to sending facility, proceeding to destination, or even going to a different facility (like an ED close to the intended destination).

For example, I did a hospice discharge to home a few weeks ago for a VAD patient w/ a valid out-of-hospital DNR. Plan was to divert to closest appropriate ED, and I had phone numbers for the CRNP that was overseeing that patient's care to consult if I had a issue. He made it home OK, if you're wondering.

In the end, even with a DNR, someone has to fill out the death certificate. If the ME/Coroner has to do it - they need to do some type of investigation. If patient's primary doc is willing/able to sign the death certificate, then the ME might not need to do ANY investigation. These things are best discussed with your management and the sending facility staff BEFORE doing the run. In my case above, I had several names and numbers written on the back of my paperwork envelope, just in case. I didn't need any of them.

I would say that the concept of lying and saying the patient "just stopped breathing" is a bad idea. Your PCR is legal documentation, etc, etc, etc. Should the death be investigated, it might come out that they had been dead for some time on arrival at the facility (my trip referenced earlier was ~90 minutes due to traffic). That would make the whole thing much MORE suspicious than just saying "uh, he seems to have died"

 

[WuLabsWuTecH]

People die in the ambulance. Only idiots claim otherwise. That t-shirt no one dies in the ambulance along with the emts save paramedics t -shirt need to all be piled up together and burned and never mentioned or seen again.

If you are doing CPR they are dead. If you are doing CPR while ambulance is rolling you are doing crappy CPR and your system is archaic for allowing it.

Um... Auto-Pulse? And you can actually do pretty decent CPR in the back of the medic depending on what kind of roads you are on. But seeing as how in 2012 I had at least 3 codes that ROSC'ed while doing CPR/ACLS in the back of the medic I think that there are appropriate times and places for it.

They are declared frequently on board ambulances. No issues. Wheel the corpse out and into the hospital or the morgue or move onto funeral homes cot, etc and go back into service just like any other call.

We can declare also. The issue at my agency is specifically declaring in the back of the amb.

I can't figure out why anyone would be declared deceased in the physical confines of an ambulance. If we find someone in arrest and choose not to work it or call efforts after a rescuitation attempt, the body would be left there. If they arrest in the ambulance, they are going to be worked (pending DNR status). I suppose if you pulled over to work the code and then decided efforts were futile you would be pronouncing them dead in the ambulance, but really how common is that?

This. I can't figure out why anyone would pronounce in the back of the medic either. If they are DNR, you call them on scene or call the coroner on scene. If you work them on scene for the required amount of time (in our case 20 minutes) then you make a transport decision. IF you decide to call it, you call it right there. If you decide to transport, you are committed. In our protocol, as in most, if they have a spontaneous pulse at any time while the crew is present, they are worked all the way to the hospital. The only exception I can think of is a DNR patient who walked onto the ambulance and then coded enroute to the hospital. In our system, they still get sent to the hospital to be pronounced.

Well, of course. If they're dead in a bus you're screwing up the entire bus route and inconveniencing hundreds of people.

...now what about dead in an ambulance?

 

[medic417]

The only time a patient is worked in the ambulance is if they code in the ambulance. The ambulance stops. Code is worked in non moving ambulance because despite anecdotal statements science actually backs working them when not moving. When pronounced we either drop them at the hospital if near it or we meet the funeral home van and move the body over to them.

If they code before we get in ambulance they are worked on scene. Body turned over to funeral home.

 

[medictinysc]

head falls off in the rig... Should have held c-spine!

rofl. Lmbo

 

[medictinysc]

The only time a patient is worked in the ambulance is if they code in the ambulance. The ambulance stops. Code is worked in non moving ambulance because despite anecdotal statements science actually backs working them when not moving. When pronounced we either drop them at the hospital if near it or we meet the funeral home van and move the body over to them.



If they code before we get in ambulance they are worked on scene. Body turned over to funeral home.

That is a great idea but in my system it wouldn't work. We have a LUCAS for compressions enroute. I personally don't drive a true cardiac arrest in code but they are people in my system that do. It's left up to the individual medic. We get to use our brains instead of a cookbook.

 

[Brandon O]

Clearly this is 100% different everywhere.

I love when people assume that everything they do in their system, no matter how major or minor, is clearly the only way to do it...