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.

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Permalink Reply by Oldman on September 8, 2010 at 1:12pm

Laws and SOP's aside, lets look at this logically.

The pronouncement of death is not something which requires a degree in quantum physics, or even a degree in underwater basket weaving. No pulse = death.

In my first responder and EMT classes, I tell my students that I can take a 3 year old chimpanzee, and show them how to do most anything we do on the street. They might be able to do it, but they won't have a clue about why they are doing it. That same chimpanzee can feel for a pulse, not find one, and declare death. The problem is, he wouldn't have a clue of whether or not that person is viable.

In Texas, the only persons who may legally pronounce death are physicians, or the Texas version of the afore-mentioned primate, called the Justice of the Peace. Paramedics are delegated the authority in many areas under their services protocols and Medical Director's license. Otherwise, the JP comes out and will look at the victim, and then ask the medic what they observed as to breathing and pulses before pronouncing death.

Now I am not calling that Chief a primate, but...

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Permalink Reply by Gareth on February 19, 2011 at 2:46pm

Well an interesting topic... Sadly i'm across the pond in the UK so in all fairness I couldn't say if it's legal or not for the Chief to be able to confirm death or not... but it did prompt the question, "What if the Chief dropped dead"? Not that i'm wishing it, but surely it'd be a little problematic if no one else could confirm he'd passed away ? ;-)

Thankfully here in the UK we can diagnose death ourselves and even stop ALS after several cycles if we get no effort back from our patient and call it.

Even for us though, once we have called it or diagnosed death, it's still down to an MD to sign the death certificate following our efforts (sometimes following a coroners investigation to establish the actual cause of death).

It'd still be interesting to find out the outcome of your situation tho.

Gareth UK