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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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Ben,
Thank you for all your posts. I greatly appreciate your taking the time to respond and to find the information about the Arizona law online.
As the TLP, I can assure you that my original post was not "slanted". The facts in my first paragraph are public knowledge: The chief's claim about his legal authority to declare deaths as well as his demands for a raise and the reason for it were stated by him during a publicly open meeting of the board of the fire district. His command vehicle used to carry medical equipment, oxygen, and an AED. However, he announced that he would remove all of this from the vehicle and then did so because he was allegedly ordered to by the medical community that oversees the EMS services provided by his fire department. He said that they had told him HE was NOT qualified to use the equipment even though NFPA requires an AED on all fire vehicles.
Beyond these facts, none of us, including the EMS staff of the department, can get any further information from him about his actions. Therefore, in good faith I posted to try to find out if there's anything I'm missing that someone could share with me.
Once again, thank you for writing. You have given me several good ideas for research into this matter.
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Permalink Reply by 55 TRUCK on
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You should check with your state EMS commision and your Medical Director. The Coroner comes in after the fact. Here in Indiana a non medical person can't declare someone dead. Except in extreme cases as defined by medical protocol. A non medical officer has command of the over all scene not PT care. All Officers on my dept are Emts or Paramedics. A Officer on scene who is a emt cannot over ride a Pvt. who is a Paramedic. The Medic is the higher medical authority on scene.
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Permalink Reply by Paul Montpetit on
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He cannot do so...unless he is in some bizarre state that has strange laws on the books....you may want to contact your State health Department or your county Emergency Coordinator on this one......Sounds like someone has an authority/ego problem....I should be careful here...if he sees this he might "declare" me dead...then what would I do.....? LOL
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Permalink Reply by John Crabbe on
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new chief of a small fire district near us has declared himself the only one legally authorized to declare deaths.
A declarition doesn't make it so. The person would have to be OK'd to do so by the medical examiner of the county.
Since you state he is not certified in a medical capacity (EMT, Paramedic, nurse, DR?) then his responding to EMS calls seems micromanaging at best. If he is not medically qualified on the scene the senior most medically qualified person IS in charge of the scene/ pt care. That means if the chief gets on scene, he can not dictate the treatments/actions of the medical responders.
As for declaring death, such a thing is left up to the medical examiner or rep, or DR, etc as you mentioned. Someone just can't declare themselves the one legally aurthorized to make such a decision unless they are OK'd by the Medical Examiner. As mentioned there are signs of obvious death where an EMT can make the call, like rigor, lividity, obvious injuries, type of thing. In such cases a call should could still be made to the medical director at the ER, describe the situation and they can OK it.
For us, if we respond to a PNB and it is obvious death, we will still confirm asystole. Unknown downtime, unwitnessed arrest, and asystole in 3 leads is enough for us to call for the ME. In some cases we will leave the scene with PD if the ME is going to be awhile. We also have the luxury of having the Med Examiner for the county as a member of the fire dept and several other FF/paramedics work for the ME.
In one situation we had a PNB. We get on scene, unknown downtime, unwitnessed arrest, cancer Hx, etc, etc. Eyes are dry, no pulse, no breathing, asystole, etc. Family was quite distraught and we were awaiting the ME and did have PD on scene. We let the pump return. While waiting for the ME, the pt starts foaming at the mouth, this is after awhile of not being touched, worked, anything. I made a call to one of the guys on my shift who works for the ME and described this. He said the foaming is pulmonary edema releasing and is a sign of a narcotic OD. He said as long as the bubbles are going out and not in, you're fine. Turns out that is what the cause of death was narcotic OD in conjunction with her med Hx.
What I learned there is that one should still cover the bases. In this case, I would NOT listen to an unmedically trained chief who declares himself the authority to declare death (barring of course unless he was OK'd by the ME). As a paramedic or even an EMT, it is YOUR license on the line to make the right call. If this means checking asystole, doing an exam, notify med control, then do so.
However, if the chief insist on this being his role. DOCUMENT, DOCUMENT, DOCUMENT, make it clear that the person who called the person deceased was the chief. If he makes the call and doesn't let you check the pt, document that and so forth. The responsibility lies with him then and if something were to happen, like the person really alive, faint pulse etc, and you couldn't check the pt because they were declared dead, then it is he that has to answer. However, if that is the case, there would be a good chance you would be questioned as well. Again it is YOUR license, why chance it with someone unmedically trained making the calls?
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Permalink Reply by Michael A. Pimental on
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in mass I know that police can cancle you for a doa and assume all responsibility but rearely done. but as soon as your on scene it is now your responsibility as an EMT to declare obvious signs of death. EMT's can not announce a time of death that is only the rn's and doctors that can do that. there is a case going on now where emt's showed up on scene the police said the pt was dead and the they would not allow the emt's into the crime scene. Now those emt are fighting to keep there tickets because they never checked the pt out while on scene. So becareful and all state laws will vary. sorry about spelling in a hurry today
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Permalink Reply by Ben Waller on
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Interesting that someone would order an AED removed from a fire department vehicle, since AEDs are intended for use by people who actually don't have any medical training.
I disagree that your post was not slanted. Even if it is completely accurate, your post was slanted in complete opposition to the fire chief's actions. A non-slanted post would have included more than one perspective on the issues. I'm not saying that your opinion is wrong, because I don't know. I'm just saying that there are possibilities that you didn't consider. I'm not saying that you had any bad intent - I don't think you did. You can have a slanted opinion with good intent, and that seems to be the case here.
There is also a HUGE difference between being qualified to do patient care and being able to legally determine death. Don't confuse the two as being the same thing - they are two different issues.
The way to resolve this issue is to get the facts.
As for "However, he announced that he would remove all of this from the vehicle and then did so because he was allegedly ordered to by the medical community that oversees the EMS services provided by his fire department." ...I'd question the medical oversight's authority to determine what equipment is carried on what fire department vehicles. That would seem to be squarely in the realm of "Fire Chief's perogative".
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Permalink Reply by Vic Silverfish on
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You guys are over thinking this. The chief is just making a play to give himself a raise. Only a doctor can declare a patient dead, but just about anyone can decide to not start care on an obvious DOA. Let's look to some hypotheticals:
1) You show up to an obvious DOA: does the new rule mean you work the patient anyway until the chief shows up?
2) 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.
this is all madness. Your guy is gunning for overtime, operationally nothing will change, but he will rack up a ton of hours responding to every potentially serious medical call.
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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.
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.
My post had two distinct paragraphs.
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.
The second paragraph was my questioning of the legality of the chief's behaviors. Yes, my concern was evident, but SO WHAT?
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? Can we do so without the condescending attitude? Slanting your posts with your defensiveness for a fellow chief is not helpful.
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Hi Vic,
Yes, many others and I believe this is all about money. Unfortunately, the problems with this new chief don't end there.
He responds to structure fires in off-the-rack bermuda shorts!
The Arizona Forestry (aka Wildlands) no longer calls the department for support at wildlands fires if this chief is on duty. They will only allow the department to respond if someone else is in charge. Note 1: the department and personnel receive monetary compensation from the state if they are called up. Note 2: I do not belong to their department, therefore have no monetary interest of my own in what he does. (I have no personal axe to grind.)
The department has a one year old pumper and an ancient brush truck (among other vehicles). He recently announced at a training session that the pumper, with twenty or so dials, has only one setting and therefore they were forced to resort to using the brush truck at structure fires. Even his deputy chief tried to show him how to change the settings on the new pumper during the training session, but the chief bellowed out that he had made his decision and that was that! Why does this really matter? It is a very small department in a very rural community and the cost of that new pumper was probably a quarter of the yearly budget! (I live in the district though I work for another agency.)
He has called for air support for a three acre brush fire. During fire season there are a number of these small fires and for years they have been dealt with by two or three brush trucks and five to ten firefighters.
During one brush fire of less than three acres, he put out a countywide call for mutual aid. Our county is sparsely populated but very large. The cavalry was coming from over 50 miles away. They were, of course, cancelled, long before they arrived when his people handled the fire just fine.
On the opposite end of the spectrum, there was a structure fire about twelve miles away from the station and as per his SOP he ordered two firefighters to respond with a brush truck while he followed in his completely unequipped command pickup; i.e. he didn't even take a fire truck that could fight the blaze. Within thirty seconds the brush truck was empty. Back at the station were pumpers and other brush trucks and within a half mile radius were former volunteer firefighters with many years of service who could have responded. But, he has changed the department into a paid only department and all but three of the paid employees live at least twenty miles away from the station. So, the fire department equipment stood idle while he watched the store burn to the ground and he waited for mutual aid. The next closest department is over twenty five miles away and they were unable to get there for almost an hour. Needless to say, the store was gone long before they got there.
There are firefighters in his department who no longer wear their ball caps in public because they are so embarrassed to be associated with him.
It is a well-known fact within the state, county and local fire fighting communities, that he and his department are a joke.
These are just a few of the incidents that are public knowledge. If Ben wishes to declare this is all "slanted" against this new chief, well, so be it. He has the right to his opinion. Sometimes, though, there just isn't anything to "balance" the scales. Sometimes, the best you can say about someone is that at least he proves the Peter Principle is correct.
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Hi Ralph,
I'm going to call the county coroner first. The EMS at the department (I don't work there, I just live in the district and work at another agency) is associated with one of the hospitals in Tucson. I'm going to find out which one and contact them too.
Thanks for responding. This is a great website and everyone has given me such good advice on this forum.
I'll keep you informed about what I find out.
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Permalink Reply by Dave on
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ok.. why is a chief officer doing medical runs?? Also, as a paramedic I cannot declare anyone dead! we have a protocal for OBVIOUS DEATH, but can not just stop efforts. Is this Chief using the obvious death guidelines?? Example....decap of head, rigor...ect ect.
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Hi Dave,
Good questions. First, I believe he's doing the medical runs to get overtime pay. He recently demanded publicly a 20% raise, claiming he was doing more than he had agreed to when he took the job. However, no other chief before him went on medical runs.
We have a very small community here - 2000 to 2000 souls. (I live in the district but work at another agency.) In 2008 we voted to change from a Chief and Sec/Treas to a Fire Board of five civilians. This is the third chief the board has hired and fired since Dec 2008. They are all civilians with NO fire or EMS experience or knowledge. They have consistently done whatever the current chief tells them to do. At the monthly public board meetings they bring up issues that are on the agenda, turn to the chief to tell them what to do and then vote unanimously (without discussion) to follow his orders. One board member even announced during a meeting that the board existed to "support the chief", which was contrary to the reason given for why we needed to change to a board in the first place - i.e. oversight of the chief and department.
Second, 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. I've heard the EMS personnel griping about him taking on the declaration of death role. I believe they are too concerned about losing their jobs in this economy to challenge him. This is what I'm hearing.
My understanding is that he's going beyond obvious death guidelines. I'm told he decides whether someone is worth starting CPR on, no matter what the EMS personnel on scene advise.
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