Who declares time of death?

[TeaPlease]

I've worked in a LTC facility for about four years. We've experienced four codes in the last several months. The standard protocol was observed: call Code Blue, start CPR and call 911. Our local EMS team is very familiar with our facility.

I heard that the night shift recently had a code and the staff followed the normal protocol BUT that the resident was pronounced dead at the scene by the EMS team and that the MD confirmed time of death over the phone. Resident was full code. I'm a little puzzled. Is this a normal procedure in your area?

[brownbook]

Last I heard it is acceptable for an EMS service to have an arrangement or agreement with local MD's or ER physicians for them, the EMS personnel, to declare time of death.

[TeaPlease]

Interesting! I'd never heard of this before and was a little surprised that EMS could do that. Most of the staff not involved in the code were a bit curious today. Thanks!

[brownbook]

Thanks for your thanks, but I hope others reply. My knowledge is old and may be out of date?

[AJJKRN]

At my hospital, any two RN's can pronounce together after ruling out signs of life and the attending MD signs the death certificate.

[NurseGirl525, ASN, RN]

Well, who pronounces death on say the scene of an MVA? I'm sure it differs state-to-state on the laws, but I would think EMS could.

[TeaPlease]

This is in a nursing home setting. We've had several codes in the last month (compared to ZERO codes in the four years I've been there). We don't have nurses with the authority to pronounce on full codes...just follow protocol and get EMS in there. Considering that 5 out of 5 residents that coded had fairly similar comorbidities I thought it was interesting that EMS used whatever their protocol was to pronounce on this particular code.

NurseGirl525, you've got a point, but when massive injuries are involved in an MVA there are different protocols for EMS, I'd think.

[TheCommuter, BSN, RN]

When I worked in the nursing home setting in Texas, RNs were permitted to make pronouncements of death and determine the time it occurred.

This may vary from state to state.

[lindseylpn]

The same thing happened to me once, patient was a full code and passed. We started cpr and when ems arrived they called the er doc and pronounced death and the Dr gave orders to send the patient to the mortuary. We all thought it was weird but, followed the Drs orders. The Dr and ems ended up getting in trouble with the state, our facility was not cited but, we were told to never let it happen again. An RN could pronounce if the patient was a DNR, all full codes were to be pronounced by a Dr. This was years ago so, things may have changed since then and it varies from state to state.