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Declaring Death
I have learned that the new chief of a small fire district near us has declared himself the only one legally authorized to declare deaths. This sounds suspicious. First, he is not certified in any EMS capacity; not an EMT, paramedic, nurse. Second, shortly before he made this procedural change in his district/department he demanded a raise, claiming that he was working many more hours than expected due to his responding to all EMS calls in his "command vehicle" (a pickup truck with logo, lights, siren but NO medical or firefighting equipment).
My question is: How can he get away with this? Can a non-medically trained Fire Chief give himself such power? I certainly don't want him checking me out and deciding whether I'm worth doing CPR on! Looking this up online, the only individuals I found who are legally authorized to declare death are medical doctors, or nurses caring for end of life patients in hospices.
My question is: How can he get away with this? Can a non-medically trained Fire Chief give himself such power? I certainly don't want him checking me out and deciding whether I'm worth doing CPR on! Looking this up online, the only individuals I found who are legally authorized to declare death are medical doctors, or nurses caring for end of life patients in hospices.
Replies to This Discussion
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Permalink Reply by Laura McGaffey on
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No problem.
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Further info I just learned:
Transportation by helicopter to the hospital in Tucson nearly 100 miles away is so common that our little community of about 2000 souls is begging for donations and grants to build a heliport.
But, the chief in question has assumed the authority to determine which patients are viable for transport and decides when to call in the helicopter. The EMS personnel are in radio contact with the medical personnel at the hospital in Tucson. But, the chief now overrides their advice and has cancelled calls for the helicopter. In other words, he is making medical decisions for live patients.
I'm very grateful for all the advice and ideas offered. I will be investigating further and will let you know what I find out.
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Permalink Reply by John Crabbe on
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Only a doctor can declare a patient dead,
Or a coroner/ medical examiner or a rep of the ME. Also n some cases a nurse in a hospice type of situation.
Once you've started CPR, does the chief really have the authority to tell you to stop? I haven't looked up the law in a while, but I thought only a doctor can stop CPR once it's started.
If CPR is in progress, it is up to the senior medically trained person on scene to make the call, not an untrained chief (barring of course unless he is certified to do so). However, there have been changes to CPR and ACLS where a code can be stopped in the field without a doctor's presence. A call can be made to medical control and the scenario can be described and the ER doc can make the call to stop working the code without bringing a pt in.
We have had incidents where an engine/truck crew with EMT-B's got on scene and started CPR, after working the code for a bit paramedics have called in to cease working the code. It used to be that once CPR was started, you brought the pt in to the ER. Now with new guidelines you are seeing more and more field terminations of CPR. Unknown downtime, unwitnessed arrest and so forth are big factors in such determination. Some services will do a round of meds etc and then call it, whereas some just need to confirm asystole. Basically, you see more of a turn to field decisions and medicine because realistically when it comes to a code, there isn't much more a hospital will do that can't be done in the field.
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I concur, Ralph
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Permalink Reply by M.J. 6821 on
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If this is the case its not going to be if someone gets killed bc of him its when is it going to happen, and Im pretty sure there will be a lawsuit. The fire board had better wake up soon.
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he does not actually "do" medical runs as an EMT or paramedic. He just follows the ambulance every time they go out. What I've heard is that he does the triage at all scenes and orders the EMS personnel around
Triage at all scenes, even for a single pt? Sounds like a huge ego trip and seriously when it comes to pt care, it is the senior most medically trained person's call, despite if they are lower than the chief. If the chief is not medically certified then he really has no say in pt care, nor in ordering the medically trained folks in what to do.
the chief in question has assumed the authority to determine which patients are viable for transport and decides when to call in the helicopter. The EMS personnel are in radio contact with the medical personnel at the hospital in Tucson. But, the chief now overrides their advice and has cancelled calls for the helicopter.
Not his call here either. Again it is the medically trained personnel to make the call. Although with helo ops, the chief can have a say regarding an LZ and staff to set up something like that.
Problem I se here is you are forwarding gripes about another service's chief and his actions. You and your service are limited in making your say here. There are ways to address the issues, but an outside agancy doesn't have much to go on, unless you were personally affected by the actions of this chief. A call to the county coroner can be made about the chief declaring himself authorized to declare death, since it would be the county/city coroner's job to OK someone to do so. As for him telling EMTs what to do on a medical scene, it should be the EMT's going to the medical director about this. Although the difficulty is with the chain of command. It is best to get information regarding his actions, in documentation of run reports, talking with med control and so forth to present the info to his supervisors. Really, there is no reason for the chief to be on medical runs, especially if he isn't medically certified.
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Hi John,
"doing triage at all scenes" does sound ridiculous, doesn't it? Regarding triage, I meant at scenes with multiple pts. I was picturing auto accidents, etc.
I see how it may sound like I'm just "forwarding gripes about another service's chief". However, what I've apparently not made clear, is that I LIVE in the district where this gentleman is the chief. I've even held the elected position of Secretary/Treasurer of the district. In our very small unincorporated community in a very rural area, what this chief does is of serious concern to all 2000 or so of us who pay taxes to run the department and vote for the elected board members. I understand that the confusion is my fault in that I opened my original post by referring to a "small district near us". Chalk it up to my trying to write briefly and get to the point quickly. (My current involvement in emergency services is as a volunteer with my company's ERT. My company is located within the district in which I live and near the station.)
Thank you for pointing out the confusion.
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Hmmmm. Can't tell whether you're pro- or anti- illegal alien. Can't tell if you think we're a bunch of racists down here or if you agree with our governor. But, it's funny. You should send it to Jay Leno.
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I have to thank John Crabbe for a post that illuminated some confusion in my posts.
I wrote about a new chief of a small fire district "near us". This needs clarification.
Actually I LIVE and WORK in the district. I have even served in the elected position of Secretary-Treasurer of the district.
When I say "work in the district" I am referring to my business, which resides in the district, and to my career as a computer engineer as well as to my involvement with my company's Emergency Response Team.
In 2008 we voted to change the district's organizational structure from a Chief/Sec-Treas to a 5-person Fire Board. This is in a small, rural, unincorporated community of about 2000 souls. The change was to install oversight over the chief in particular and the department in general. Since Dec 2008, the board has hired and fired three chiefs. The board is made up of 5 elected civilians who have no training or experience in fire or emergency medical services.
So, though the organizational change was to install oversight, the board relies entirely on the chief to tell them what to do, what to buy, etc. At their legally mandated monthly meetings, the board rushes through the agenda and votes unanimously (remember, this is all public record) to follow the chief's lead. They hold no discussion or debate and usually hear about what they will vote on mere moments before doing so.
My goal of this thread is to find out if anyone knows of any conditions under which this chief may legally, unilaterally decide that as chief he has the final say in how far his authority goes in medical matters. I do not go into battle unprepared. If I bring this up to the Fire Board, I will know all the pertinent laws and regulations about who has the authority to do what. To that end, you have all been extremely kind to share your knowledge and opinions with me.
This is a great website and I thank you all for all the great ideas and advice as well as for your dedication to the firefighting and EMS professions.
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Permalink Reply by Chris Weber on
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Definitely sounds like an ego trip,but thats from reading this from a Pennsylvania perspective.As Captain 4 noted we have pretty strict guidelines as to who can and can't and how to go about it.Even the worst chief we have had (who had a MAJOR ego problem)would have done that.Sounds like a major dept. liability problem.Hope everything works out for the best.
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Permalink Reply by Ben Waller on
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Dave, in small departments it is a matter of routine for the chief to do medical runs.
In some states (like mine) a paramedic can declare death. The paramedic just can't sign the death certificate - a physician or coroner has to do that.
The rules that apply in this case are Arizona's, which as with most states, has rules slightly different from many other states.
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Laura, I'll respond point by point, but it appears that you've misunderstood a lot of what I said...
"Ben,
I am a COMPUTER ENGINEER by profession. I have held various volunteer positions in Fire Service, including Secretary/Treasurer in a district run by the Chief and Sec/Treas (no "fire board"). I was originally certified as an EMT in 1978 although I am not currently certified. I am also an author and columnist."
What do being a computer engineer, author, and columnist have to do with this discussion?
My Random House dictionary software defining "slant":
Definition 4 - "to distort (information) by rendering it unfaithfully or incompletely, esp. in order to reflect a particular viewpoint. He slanted the news story to discredit the Administration."
Definition 12 - "Also called angle. Journalism, the particular mood or vein in which something is written, edited, or published. His column always has a humorous slant."
"Of course I have an opinion. But, don't confuse giving an opinion with slanting (distorting) a reporting of data."
Since you were the only source of the data in the TLP and your data (opinion) didn't have any data to support any conclusion other than the one you postulated when you said "How can he get away with this?'
"My post had two distinct paragraphs." No condescention there, right??
The first paragraph was a simple recounting of the facts I know. (If you think it is "interesting" that the chief removed an AED from the command vehicle, you would be shocked by some of the other well-known, publicly observed behaviors I could share about the chief in question. I'll share just one - showing up at structure fires wearing bermuda shorts.) BTW, the district in question is run by a board of five members, all civilians who have no fire department experience. They are not even retired firefighters or EMS personnel and during their monthly public meetings just do whatever the chief says to do. This is public knowledge, not my opinion."
Since that "public knowledge isn't available here, I guess we'll just have to take your word for it? And...while we're at it, when you say that this chief responds to fires wearing Bermuda shorts, I guess that's not "slanted", either??? If it was intended to show him in a bad light, then it is indeed slanted, even if it is true.
"The second paragraph was my questioning of the legality of the chief's behaviors. Yes, my concern was evident, but SO WHAT?"
Therin lies the rub...you started out with the opinion that the chief's behavior was bad and then you questioned its legality. You may well be right, but there are other possibilities that apparently didn't occur to you. That tells me that you had made up your mind that the chief's actions were a) bad and b) of questionable legality - before you posted here. That exactly equals "slant".
"Instead of arguing about writing technique, can we get back to my original purpose in posting; i.e. the gathering of information from others who may know more about the legality of the issues?"
Apparently you forgot the link to Arizona law that I posted? I'm trying to determine just how I can help you more with your request about "legality of the issues" than to post a link to your state's law on those issues???
"Can we do so without the condescending attitude?" What condescending attitude? The one that started with "I am a COMPUTER ENGINEER by profession."Oh, wait, I didn't post that, you did. Nowhere did I condescend. I just pointed out some facts that you apparently didn't think of for yourself, which was your stated reason for posting in your second TLP paragraph.
"Slanting your posts with your defensiveness for a fellow chief is not helpful."Excuse moi? I wasn't defensive, and my post was an attempt to get you the information you sought. The fact that we're discussing a chief officer - that I don't know - has nothing to do with it. You seemingly had made up your mind that the chief didn't have the legal right to make the decisions you're complaining about. That's quite possible. However, before you go spouting about how bad it is, you need to rule out other possibilities - like the possibility that he's gotten himself appointed as a death investigator and that what he's doing could be legal if that's the case.
I'll also refer you to my quote to Derek above where I said "That doesn't make it smart, but it may very well make it legal." How is questioning the intelligence of the actions in question "...defensiveness for a fellow chief...?"
And Laura, if you want to label me in this discussion, I'd prefer you'd label me as a paramedic, since I am one, and in a state where paramedics routinely pronounce death as well as administering ALS.
Nowhere did I question the accuracy of your claims. I just offered an alternative that needed to be ruled out in order to be sure. Since you asked for facts, can we do without the speculation and get back to the facts?
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