OMG! *I* cannot pronounce death but a paramedic can????

Specialties Geriatric

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Oh wowwww....forgive me for FREAKING OUT, but I know some (or ALL??) :yes: of my fellow nurses will understand my stress, shock and amazement!!! I experienced my FIRST death of a resident withOUT a DNR tonight and I still can NOT believe this!!! First, I have to explain, his death was SOOO unexpected, NO warning signs, etc!!!!!!!!

To make a long story short (I'll TRY....LOL!!!)......I knew he was definitely DEAD, and as I called my DON to report it, she said we HAD to begin CPR since there was no DNR. Trust me, I did already (kind of) know this, and I've talked to SOOOO many experienced LTC nurses about this, and many explained the term "slow code", etc.....Co-workers (I wasn't there!) recently had a HORRIBLE experience with an emaciated, cancer-riddled resident who refused to sign a DNR, and a new grad was absolutely traumatized when she heard ribs cracking during the CPR, when the resident was CLEARLY already dead. She said the paramedics wanted to cease the CPR, but she yelled at them and said she was NOT losing her license over it, so I'm pretty sure the paramedics took over.....Why didn't they just pronounce the resident dead like the paramedic who did that for us tonitght?? can EMTs also pronounce?

ANyway, as we waited for the paramedics, the other nurse and I totally agreed that starting CPR was LUDICROUS.....but we started placing the board, setting up suction, etc. Thank Goodness the police officer who arrived WAY before the paramedics totally understood why we were NOT actually going to dishonor this sweet person's body by

starting compressions and breaths. I was SO torn on what the RIGHT thing to do was.....I figured legally, in a courtroom, I / we could get in HUGE trouble if we never actually did CPR.????? (could we?)

The paramedics arrive, and they pronounce him. I had NO idea paramedics could do that!?!"!?!???!!! And not the two of us LICENSED NURSES can do that????? (I'm an RN, my coworker an LPN).........

Aside from all the emotions and my stress level---again, this was my FIRST death, so.....it was kiiiiiinda stressful!!!.......It ticks me OFF that a police officer and THREE Paramedics/ EMTs had to waste their time, wear and tear on their vehichle, gas, etc....when if I or my coworker could've just prounouned him, call the doc, call the fam, do post-mortem care, call the funeral home, etc......WHY make the paramedics/ EMTs come out???? What if someone else needed them WAY more than this resident did?

I'm just blown away....and, hate to say it, but the waste of our time with all the PAPERWORK that the Paramedics need?!!???? They're not even taking him with them......also, legally, if WE had to start CPR, why didn't they have to continue?

My other concern and I'm also so curious........**IF** we had actually done CPR, his body would be so bruised, ribs possibly broken, etc. How on earth does the mortician handle all of that for viewings (if that's what the resident wanted?) What if the ambu bag broke some of the bones on his face? I know they do all kinds of makeup and have prosthetic implants to make the cheeks / neck, etc look nice if they;re traumatized by CPR, etc.....? How do they get the hands to look folded and peaceful if CPR was done and the arms are bent out to the side, etc? Rigor Mortis had already begun in this man's jaw when the paramedic pronounced him----can you imagine what damage the ambu bag would've done???

I appreciate stories/ experiences/ thoughts/ etc.......Also curious ( I know things vary by STATE!!!), where you work, does the doctor require you to tell them WHO pronounced them dead? Does it always have to be a paramedic? What if we'd found him even later and there was more rigor mortus? Do they still require us legally to begin CPR since there's no DNR? Seriously????

Can an LPN/ RN pronounce death where you work and avoid the WASTE of time having the paramedics and poilce come out? Does a police officer always have to be at a death? Thanks! ***oh em gee, wonder if I'll EVER get to sleep!!!****:no:

Where I live RNs are allowed to pronounce. If a person is not a DNR you should be starting CPR. I don't believe an Ambu bag would cause damage to the persons face.

You state the patient was 56 and the death was unexpected. To me, not performing CPR was disrespectful and neglectful. My parents are in their 50s and I would be very upset if someone disregarded their personal choice. I know the odds of successful resuscitation but I also know it is not my choice. Performing CPR on a 56 year vs an 86 year old is very different.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
EMT-Ps (paramedics) have education that is specific to medicine on the street. They are taught how to survive outside a hospital environment with the supplies that they have on hand. Their education, however, does not supercede that of an RN's, and I have also always been of the opinion that if an EMT-P was able and educated enough to pronounce a death, an RN (especially an ER RN) should be able to do the same. The only reason they can't, in my opinion, is because there are docs in the ER that can call the patient. Out on the streets, that authority gets transfered to the EMT-P.

Remember the EMT-P are in constant communication with the EDMD by radio and follow strict state approved protocols. They discuss the case with the medical control and receive direct communication on what they are deciding from the EDMD/medical control. They do not ever sign the death certificate. There may still be states that don't allow the medic to "call a code". I know Where I used to live over 20 years ago...if someone started CPR they had to continue until they reached the emergency department to have the code called by the ED MD....there were many inappropriate transports to the ED which are costly.

I remember a motorcycle accident that a by stander started CPR that should have never left the scene.....the victim had burst into flames on impact.....today's regulations would allow the medics to decide with the EDMD/medical control the the patient is deceased and has unsurvivable injuries and any further resuscitative measure would be futile. There by saving the family a ton of grief, anguish, and anxiety

Don't be a quitter.

You can still ventilate the stump. You just take a firm grasp of the trachea with your thumbs and forefinger, purse your lips, and inflate like an air mattress.

OMG, I really almost never literally Laugh Out Loud, but the image of blowing up a patient's headless corpse like some kind of gothic inflatable toy got me. Ha!!

Specializes in ER, Addictions, Geriatrics.

Don't be a quitter.

You can still ventilate the stump. You just take a firm grasp of the trachea with your thumbs and forefinger, purse your lips, and inflate like an air mattress.

I just got a wild visual of what that would look like bahah.

At my facility/state, an RN can pronounce for a DNR patient, but Full Code status still means Full Code. We did have a case recently where the EMTs, in radio consultation with the ER doc, stopped a code on a full code (but obviously dead) patient while still in the facility with no MD present.

Keep in mind that lumping EMT-B in with Paramedics is similar to lumping together CNAs and RNs in terms of level of training.

Don't be a quitter.

You can still ventilate the stump. You just take a firm grasp of the trachea with your thumbs and forefinger, purse your lips, and inflate like an air mattress.

It will truly be the easiest intubation, ever.

Whether or not the Paramedic can call a code on scene varies vastly in what their protocols state. Not only does it vary state to state, it varies district to district. To an even finer point, it will vary from Paramedic to Paramedic, depending on the trust level and reputation of that Paramedic within their system.

Should an RN be able to call a code? I think it depends on the situation, circumstances and location.

When I have had a DNR death, I notified the doctor, he "pronounced" over the phone, I called the Coroner, who, through a list of specifics questions determined that they would allow release of the body to the mortuary. I also notified the POA.

With our Full Cor's, we call 911 and initiate CPR.

Yes, I really want someone without even the basic concept of grammar, punctuation or sentence structure to be able to pronounce death. And slow code? Man, they really scraped the bottom of the talent barrel at your facility.

Specializes in CICU.

I think there are plenty of people that do not realize that EMS providers do not operate independently - there are protocols and standing orders and a medical director involved.

Many years ago, I had to get a 5" three-ring binder to hold my copy of the state protocols...

I believe, under ACLS, the team (in the absence of a physician) can decide to stop resuscitation. Not sure on that, and believe-you-me, if it ever came to that, I will be getting a doc on the phone to give that order if I had to call the Top Dog myself.

Where I am, In cases of an expected death (hospice, comfort-care, etc) two RNs verify absence of vital signs. Doc is notified and asked if OK to remove lines and release body. I also ask if they will sign the death certificate.

Specializes in Geriatrics, Transplant, Education.

In my experience working in LTC/SubAcute in Massachusetts, we would receive orders for RN Pronouncement of Death & May Release Body to Funeral Home for residents with a DNR who expired and it was expected (i.e. they were actively dying, on hospice and the like). I would have to chart that the resident was found unresponsive, unable to obtain vital signs and with no apical pulse. I filled out a form with the resident's information that served as verification they had expired, included my license number, etc. In MA this can only be done by a RN. The physician later filled out the death certificate. Hope this helps.

Specializes in Transitional Nursing.
Right, but on 3rd shift there is no physician. Sometimes not even a RN. LPNs are often the ones who have to verify that the pt has no VS.

Maybe we're not the one's officially pronouncing, but we're defiantly the ones calling it.

Or is this one of those "I Don't really assess, I just gather data" things?

Yeah I think it kind of is. The doc's will just call and verify the pt has no vitals, come in and do whatever it is they do. I don't get it.

Specializes in Managed Care/Advisory Services/Transition Planning.

Look up your state regulations on your scope of practice as an RN. In Washington state, RN's can pronounce death, but LPN's cannot. EMT's may not pronounce in my state either, the paramedics generally call the medical director on call for the area and tell them the signs of death and he pronounces over the phone. But, not sure about paramedics in my state, though I believe they can. This is one of the many reasons I dread deaths for those that are not already on hospice or have no code status in place.

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