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 Laura McGaffey on September 6, 2010 at 2:46am

Hi Captain,

I haven't been an EMT since the early 80's but I have always remembered that we were taught that as EMTs we could be sued for NOT getting involved and/or for NOT taking command if we were senior in medical training at a scene. The Good Sam law did not apply to us. We had a legal obligation to help people with a medical crisis. Doctors and nurses could just drive or walk past people needing medical care, but not EMS personnel. If we walked on by, we could be sued. In fact, if we handed over a patient to someone we assumed was senior to us (like a veterinarian who said, "I'm a doctor, can I help?") we could be sued. We were required to confirm that anyone we turn out pts over to was senior to us in medical certification, not in rank in a fire or police dept.

If the law still requires EMS personnel to get involved and to make sure the senior most certified EMS person is in charge of the pt's care then I would conclude that a non-medically trained chief would have no legal authority to countermand an EMT's or paramedic's determination of the pt's medical status, including alive vs. dead.

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Permalink Reply by Laura McGaffey on September 6, 2010 at 5:21am

I haven't been an EMT since the early 80's but I remember being taught that we had a legal obligation to help people during a medical crisis. Doctors and nurses could just drive or walk on by, but not EMTs or Paramedics. If we walked on by, we risked being sued. In fact, if we handed over a pt to someone we assumed was senior to us but actually wasn’t (like a veterinarian or chiropractor saying, "I'm a doctor, can I help?") we risked being sued. If we turned a pt over to someone we KNEW was not senior to us in emergency medicine (with current certification) we were practically asking to be sued.

Before I posted my request for information, I spent quite some time searching the website of the Arizona Revised Statutes and found nothing about who has authority to declare deaths. Doing a Bing.com search resulted in just some general information on the subject. So, here I am turning to you for any information you could share. And you have all been gracious enough to respond.

Reading all your posts it sounds like the legal responsibilities I learned in 1978 are still being taught today all across the country.

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Permalink Reply by Firefighter Nation WebChief on September 6, 2010 at 2:14pm

Just a reminder gang, keep the threads on topic -- if you don't like someone's opinion so be it -- no need for name calling on either side. Thanks.

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Permalink Reply by John Crabbe on September 6, 2010 at 2:35pm

I remember being taught that we had a legal obligation to help people during a medical crisis. Doctors and nurses could just drive or walk on by, but not EMTs or Paramedics. If we walked on by, we risked being sued

First of all it depends upon the context of just walk on by. If you are on duty, then you would have a duty to act. If you are off duty, the decision is up to you. If you do render aid off duty, then one is typically covered by the Good Samaritan Act, so long as they don't try advanced interventions. So basically, if me, being a paramedic wearing an off duty fire shirt, sees a medical problem either in or outside my area, I can render aid, but when duty crews arrive I have no obligation to stick around. Even if the duty crew were EMT-B, I am not releasing to a lower care because I was off duty.

Doctors and nurses may not have the same level of obligation because of the vast differences of specialties and even degree of knowledge. Rarely would one see a doctor coming to render aid because they can be in charge of pt care. whereas I have often seen people identify themself as a nurse, but when you ask their level of nursing it could be a CNA, LPN, etc where many really don't know emergency care.

Typically if on duty and working a scene and a nurse or even doctor comes up, we politely tell them thanks but no thanks. Those who insist on being involved may get a more stern no thank you and please leave. We do have cards made up by a medical director for those doctors who insist on being involved, basically stating that "we are paramedics, working under med control and if the doctor insists on pt care they assume all obligations and liabilities of pt care". There have been a few incidents where a doc did take pt care.

In fact, if we handed over a pt to someone we assumed was senior to us but actually wasn’t (like a veterinarian or chiropractor saying, "I'm a doctor, can I help?") we risked being sued

Hence the reason to question the level. (A veterinarian though would be a stretch to taking pt care) A chiropractor could assume pt care if this is their pt, but would get "the card" mentioned above. If the doc rides in the ambulance to the ER etc, they can assume that care. Most would not when reading the liabilities etc.

If we turned a pt over to someone we KNEW was not senior to us in emergency medicine (with current certification) we were practically asking to be sued.

Which also does depend, because a release could be signed if the pt refuses EMS and is competant or parent/guardian assumes the liabilities. Then again we have responded many times to an urgent care type of setting and taken pt care from a doctor for transport to the ER. Basically, things just are not are that cut and dry.

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Permalink Reply by Laura McGaffey on September 6, 2010 at 3:10pm

Hi John,

Thanks for the info. Things have either gotten better all over or things are much different outside California. I hope it's better there too. We were under the gun all the time, not just on duty.

Thanks again.

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Permalink Reply by Ben Waller on September 6, 2010 at 8:04pm

Coroners are generally not MDs. Medical Examiners generally are. Some states don't have enough local doctors with ME qualifications, thus the coroner system in those states.

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Permalink Reply by John Crabbe on September 6, 2010 at 10:54pm

I'm a city-boy, so it would be very unusual to stop CPR in the field as a hospital was always relatively close. I'll grant that you could phone in to the hospital or medical control to stop a code, but when you do that, you are working on the doctor's orders remotely, so the same rules apply.

I'm a city boy too and we are close to 4 hospitals for transports and it is rare to have a long transport. However, there are cases were it doesn't pay to transport and there have been several times we did terminate a code in the field. Our protocols don't say we have to contact a doctor, but we generally do anyway.

When you say the ME or coroner also has authority to declare, aren't they usually MDs

As mentioned, they are not always MDs. As I mentioned previously where I work the county ME is a FF/paramedic on the dept. There are also several other FF/paramedics who work for him as deputy ME. They will do everything from scene investigations to autopsies. They do contract with a pathologist who is a MD for some cases. I can say it is nice when working with one of these guys because you don't really second guess yourself.

Usually we left the scene with the police, as it is technically a crime scene. At some later point, the ME would show up to declare the person dead. This may happen several hours later.

Similar here too. If this was an obvious DOA etc, we will leave the scene with PD. Sometimes we may wait around for the ME, but that is typically because we know most of them or there is a short response for them. It takes some time to get info and meds and so forth for the report so usually by the time we are ready to leave the ME is there.

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Permalink Reply by Brian Dumser on September 6, 2010 at 10:59pm

Is this serious? Hell no he's got no authority to declare/pronounce a death!

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Permalink Reply by John Crabbe on September 6, 2010 at 11:10pm

Is this serious? Hell no he's got no authority to declare/pronounce a death

Unless he really does Brian. However, this would mean he would have to be OK'd by the county coroner in order to do so and my bet is that didn't happen.

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Permalink Reply by Fireyladd - Retired Chief Sharp on September 6, 2010 at 11:24pm

Laura, as Chief he will get away with much unless his board or authority over him intervenes. Its sad when someone takes their authority to extremes an there is no checks or balances to oversee this. Your not alone Laura, these problems are all over our nation.