disclaimer this is an informational slide for instructors and not intended to be shown. every...

DisclaimerDisclaimer

This is an informational slide for instructors and not intended to be shown.This is an informational slide for instructors and not intended to be shown. Every attempt has been made to ensure the accuracy of these materials. However, Every attempt has been made to ensure the accuracy of these materials. However,

statutes and regulations do change and the person using these slides should be familiar statutes and regulations do change and the person using these slides should be familiar with Alaska’s statutes and regulations related to emergency medical care. In the event with Alaska’s statutes and regulations related to emergency medical care. In the event that discrepancies are found, the statutes and regulations published by the State of Alaska that discrepancies are found, the statutes and regulations published by the State of Alaska have primacy.have primacy.

Users are encouraged to customize these slides to make them more aesthetic and useful Users are encouraged to customize these slides to make them more aesthetic and useful for particular audiences. Again, care must be taken to ensure consistency with the for particular audiences. Again, care must be taken to ensure consistency with the statutes and regulations.statutes and regulations.

Medicolegal IssuesMedicolegal Issues

Prepared by the:

Section of Community Health and Emergency Medical Services

Division of Public Health

Department of Health and Social Services

Juneau, Alaska

DefinitionsDefinitions

Medicine: The science and art of Medicine: The science and art of diagnosing, treating, and preventing disease. diagnosing, treating, and preventing disease.

Law: A system that provides for rights Law: A system that provides for rights between parties.between parties.Civil Law concerns disputes among private Civil Law concerns disputes among private

parties (individuals, businesses, corporations).parties (individuals, businesses, corporations).Criminal law concerns enforcement of societal Criminal law concerns enforcement of societal

rules against individuals.rules against individuals.

Sources of LawSources of Law

ConstitutionConstitution Statutory Statutory CommonCommon AdministrativeAdministrative

Areas of VulnerabilityAreas of Vulnerability

Emergency Vehicle OperationsEmergency Vehicle Operations Confrontation, Lack of RapportConfrontation, Lack of Rapport Patients Who Refuse TreatmentPatients Who Refuse Treatment

Liability Litigation (1987 - 1992)Liability Litigation (1987 - 1992)

National Retrospective Computer StudyNational Retrospective Computer Study 76 cases met inclusion criteria76 cases met inclusion criteria

Half of cases involved ambulance collisionsHalf of cases involved ambulance collisionsHalf of cases involved patient careHalf of cases involved patient care

In almost half of cases, EMT was named as In almost half of cases, EMT was named as codefendantcodefendant

Average of 1 claim per 25,000 patient Average of 1 claim per 25,000 patient encountersencounters

Ambulance Collision CasesAmbulance Collision Cases

Plaintiffs Plaintiffs Motor Vehicle Operator (30)Motor Vehicle Operator (30) EMS Patient (5)EMS Patient (5) Other (3)Other (3)

SettlementsSettlements $0 - 39.5%$0 - 39.5% $1 - $10,000 - 26.3%$1 - $10,000 - 26.3% $10,001 - $100,000 - 21.1$$10,001 - $100,000 - 21.1$ $100,001 - $1,000,000 - 10.5%$100,001 - $1,000,000 - 10.5% $1,000,000 - $2,000,000 2.6%$1,000,000 - $2,000,000 2.6%

Patient Care CasesPatient Care Cases

Allegations of NegligenceAllegations of NegligenceArrival DelayArrival DelayInadequate AssessmentInadequate AssessmentInadequate TreatmentInadequate TreatmentPatient Transport DelayPatient Transport DelayNo Transport ProvidedNo Transport Provided

Patient Care CasesPatient Care Cases

SettlementsSettlements $0 - 42.1%$0 - 42.1% $1 - $10,000 - 0%$1 - $10,000 - 0% $10,001 - $100,000 - 15.8$$10,001 - $100,000 - 15.8$ $100,001 - $1,000,000 - 31.6%$100,001 - $1,000,000 - 31.6% $1,000,000 - $2,000,000 - 10.5%$1,000,000 - $2,000,000 - 10.5%

Protection Against Litigation Protection Against Litigation

Good Patient CareGood Patient Care Rapport With Patient and FamilyRapport With Patient and Family Comprehensive and Factual Written Comprehensive and Factual Written

ReportsReports Compliance with Standing Orders and Compliance with Standing Orders and

Safety RequirementsSafety Requirements Safe Emergency Vehicle OperationsSafe Emergency Vehicle Operations

Standard of CareStandard of Care

““How a reasonable, prudent, How a reasonable, prudent, properly trained EMT at the same properly trained EMT at the same level of training would perform level of training would perform under the same, ‘or similar’ under the same, ‘or similar’ circumstances.”circumstances.”

General StandardsGeneral Standards

Provide Medically Correct Treatment Provide Medically Correct Treatment Consistent with Scope of PracticeConsistent with Scope of Practice

Ensure Vehicle is Appropriately Stocked & Ensure Vehicle is Appropriately Stocked & SuppliedSupplied

Ensure Equipment is in Good Working Ensure Equipment is in Good Working OrderOrder

Operate Vehicle and Park in a Safe MannerOperate Vehicle and Park in a Safe Manner

ConsentConsent

Informed ConsentInformed Consent Expressed ConsentExpressed Consent Implied ConsentImplied Consent Special CircumstancesSpecial Circumstances

MinorsMinorsPatients with Impaired MentationPatients with Impaired Mentation

Battery (Tort)Battery (Tort)

Physical contact with a person without his Physical contact with a person without his consent and without legal justification.consent and without legal justification.

The plaintiff may recover monetary The plaintiff may recover monetary damages for battery without proving the damages for battery without proving the elements of negligence.elements of negligence.

Consent to Treat MinorsConsent to Treat Minors

The age of majority is 18 or when the The age of majority is 18 or when the individual becomes married.individual becomes married.

Minors can give consent for medical Minors can give consent for medical treatment when:treatment when: the minor is living apart from parent or guardian and the minor is living apart from parent or guardian and

manages own finances; ormanages own finances; or the parent or guardian cannot be contacted or is the parent or guardian cannot be contacted or is

unwilling to either grant or withhold careunwilling to either grant or withhold care

AS 09.65.100

Consent to Treat Minors (Continued)Consent to Treat Minors (Continued)

A minor parent can give consent for child’s A minor parent can give consent for child’s carecare

Consent is valid if EMS personnel relied in Consent is valid if EMS personnel relied in good faith on assertion of minor that he or good faith on assertion of minor that he or she could give consent under this statuteshe could give consent under this statute

AS 09.65.100

Refusal of CareRefusal of Care

Mentally competent adult patients have the right to Mentally competent adult patients have the right to refuse medical treatmentrefuse medical treatment

Mentally competent parents have the right to Mentally competent parents have the right to refuse treatment for their childrenrefuse treatment for their children

Patient should sign refusal formPatient should sign refusal form Ensure that all actions and the patient's condition Ensure that all actions and the patient's condition

are well documented, particularly LOC and are well documented, particularly LOC and assessment findings. The patient should be assessment findings. The patient should be encouraged to seek medical care.encouraged to seek medical care.

Negligence - DefinitionsNegligence - Definitions

‘‘Tort’ is a legal wrong for which damages can be awarded Tort’ is a legal wrong for which damages can be awarded in court.in court.

Tort law is primarily “common law,” defined and evolving Tort law is primarily “common law,” defined and evolving as courts decide cases.as courts decide cases.

‘‘Statute of Limitations’ defines the period in which the Statute of Limitations’ defines the period in which the lawsuit must be initiated. In Alaska, the complaint must be lawsuit must be initiated. In Alaska, the complaint must be filed within two years of discovery of the alleged filed within two years of discovery of the alleged negligence in a tort action. The statute of limitations for negligence in a tort action. The statute of limitations for contracts is 6 years..contracts is 6 years..

Typical Causes of NegligenceTypical Causes of Negligence

Not performing required skillsNot performing required skills Performing skills incorrectlyPerforming skills incorrectly Performing unauthorized skillsPerforming unauthorized skills

Requirements to Prove NegligenceRequirements to Prove Negligence The EMT had a ‘duty to act’The EMT had a ‘duty to act’ The EMT’s act or omission did not conform to the The EMT’s act or omission did not conform to the

‘standard of care’‘standard of care’ Injuries occurred to the plaintiffInjuries occurred to the plaintiff The acts or omissions were the proximate cause of The acts or omissions were the proximate cause of

the injuriesthe injuries The injuries are of a kind for which damages can The injuries are of a kind for which damages can

be awardedbe awarded

Vicarious LiabilityVicarious Liability

Also known as “respondeat superior”Also known as “respondeat superior” Occurs when employer held responsible for Occurs when employer held responsible for

negligence of employee or someone under negligence of employee or someone under employer’s controlemployer’s control

AbandonmentAbandonment

Defined as ‘Terminating medical care Defined as ‘Terminating medical care without legal justification or turning the without legal justification or turning the patient over to less qualified personnel patient over to less qualified personnel resulting in injury to the patient’resulting in injury to the patient’

Duty to ActDuty to Act

Generally, an EMT has a duty to act when he or Generally, an EMT has a duty to act when he or she is she is on duty on duty with an organization which is with an organization which is responsible for providing emergency care.responsible for providing emergency care.

““Duty” can be defined more broadly to mean an Duty” can be defined more broadly to mean an obligation to conform to a particular standard of obligation to conform to a particular standard of care.care.

Duties occur before, during, and after a run.Duties occur before, during, and after a run.

Anatomy of a Civil LawsuitAnatomy of a Civil Lawsuit

Suspicious IncidentSuspicious Incident InvestigationInvestigation Filing of Lawsuit Within Statute of Filing of Lawsuit Within Statute of

LimitationsLimitations Service of ComplaintService of Complaint Legal Representation Obtained and Answer Legal Representation Obtained and Answer

FiledFiled

Anatomy of a Civil Lawsuit (Continued)Anatomy of a Civil Lawsuit (Continued)

DiscoveryDiscoveryInterrogatories (written)Interrogatories (written)Depositions (sworn, in person, and recorded)Depositions (sworn, in person, and recorded)

TrialTrial AppealAppeal Settlement (Possible at any time)Settlement (Possible at any time)

Determination of DamagesDetermination of Damages

CompensatoryCompensatorySpecial DamagesSpecial DamagesGeneral DamagesGeneral Damages

Punitive Punitive

If You’re Involved in a SuitIf You’re Involved in a Suit

AlwaysAlways notify employer and medical notify employer and medical directordirector

AlwaysAlways make sure that complaint is make sure that complaint is answeredanswered

Principles of ConfidentialityPrinciples of Confidentiality

Establishment of Physician-Patient Establishment of Physician-Patient RelationshipRelationship

Legal Requirements to Maintain Legal Requirements to Maintain Confidentiality of InformationConfidentiality of Information

Increase in Legal Risks if Information is Increase in Legal Risks if Information is MisusedMisused

Alaska Statutes and RegulationsAlaska Statutes and Regulations

StatutesStatutesCreated by LegislatureCreated by LegislatureExample Example ASAS 18.08.080 18.08.080

RegulationsRegulationsCreated by Administrative AgencyCreated by Administrative AgencyExample 7 Example 7 AAC AAC 26.03026.030

Specific Alaska Statutes and RegulationsSpecific Alaska Statutes and Regulations These laws define many of the EMT’s These laws define many of the EMT’s

responsibilities and should be clearly responsibilities and should be clearly understood.understood.

Most of the statutes related specifically to Most of the statutes related specifically to EMS can be found in AS 18.08.010 - AS EMS can be found in AS 18.08.010 - AS 18.08.090.18.08.090.

Good Samaritan LawGood Samaritan Law

Encourages people to render care by Encourages people to render care by decreasing risks of liability.decreasing risks of liability.

Typically does not cover those with a duty Typically does not cover those with a duty to act.to act.

Does not cover gross negligence or reckless Does not cover gross negligence or reckless or intentional misconductor intentional misconduct

AS 09.65.090

Requirements to be CertifiedRequirements to be Certified

Individuals Individuals mustmust be certified in order to claim to be certified in order to claim to be state certified as an EMT-I.be state certified as an EMT-I.

Individuals Individuals must must be certified and under medical be certified and under medical direction in order to provide advanced life support.direction in order to provide advanced life support.

Agencies Agencies must must be certified and under medical be certified and under medical direction in order to provide advanced life support.direction in order to provide advanced life support.

AS 18.08.084

Authority of EMTsAuthority of EMTs

Statute requires that EMTs exercising this Statute requires that EMTs exercising this authority:authority: must respond to an emergency with an ambulance must respond to an emergency with an ambulance

service or first responder service; andservice or first responder service; and must have a current emergency medical technician must have a current emergency medical technician

identification card in his or her possession.identification card in his or her possession.

AS 18.08.075

Authority of EMTs (Continued)Authority of EMTs (Continued)

An EMT under this statute may:An EMT under this statute may: control and direct activities at the accident site or emergency until control and direct activities at the accident site or emergency until

the arrival of law enforcement personnel; the arrival of law enforcement personnel; order a person other than the owner to leave a building or place in order a person other than the owner to leave a building or place in

the vicinity of the accident or other emergency for the purpose of the vicinity of the accident or other emergency for the purpose of protecting the person from injury; protecting the person from injury;

temporarily block a public highway, street, or private right-of-way temporarily block a public highway, street, or private right-of-way while at the scene of an accident, illness, or emergency; while at the scene of an accident, illness, or emergency;


trespass upon property at or near the scene of an accident, illness, or trespass upon property at or near the scene of an accident, illness, or emergency at any time of day or night; emergency at any time of day or night;

enter a building, including a private dwelling, or premises where a enter a building, including a private dwelling, or premises where a report of an injury or illness has taken place or where there is a report of an injury or illness has taken place or where there is a reasonable cause to believe an individual has been injured or is ill to reasonable cause to believe an individual has been injured or is ill to render emergency medical care; and render emergency medical care; and

direct the removal or destruction of a motor vehicle or other thing that direct the removal or destruction of a motor vehicle or other thing that the emergency medical technician determines is necessary to prevent the emergency medical technician determines is necessary to prevent

further harm to injured or ill individuals.further harm to injured or ill individuals.


A person who knowingly refuses to comply A person who knowingly refuses to comply with an order of an emergency medical with an order of an emergency medical technician authorized under (a) of this technician authorized under (a) of this section is, upon conviction, guilty of a class section is, upon conviction, guilty of a class B misdemeanor. In this subsection, B misdemeanor. In this subsection, "knowingly" has the meaning given in AS "knowingly" has the meaning given in AS 11.81.900(a)11.81.900(a)

Immunity From Liability for EMTsImmunity From Liability for EMTs

Covers certified persons and agenciesCovers certified persons and agencies Covers physicians arranging transfer of Covers physicians arranging transfer of

patientspatients Covers emergency medical dispatchers and Covers emergency medical dispatchers and

instructorsinstructors Does not cover gross negligence or Does not cover gross negligence or

intentional misconductintentional misconduct

AS 18.08.086

Reporting RequirementsReporting Requirements

EMTs are required to report certain injuries or EMTs are required to report certain injuries or suspicionssuspicions

EMS agencies usually have standard operating EMS agencies usually have standard operating procedures and forms for reportingprocedures and forms for reporting

There may be a criminal penalty for refusing to There may be a criminal penalty for refusing to reportreport

Usually, there is immunity from liability for Usually, there is immunity from liability for reports made in good faithreports made in good faith

Duty to Report Certain InjuriesDuty to Report Certain Injuries

2nd or 3rd degree burns > 5% or more of 2nd or 3rd degree burns > 5% or more of bodybody

Burns to upper airway, laryngeal edema Burns to upper airway, laryngeal edema from super-heated airfrom super-heated air

Bullet wounds, powder burns or injuries Bullet wounds, powder burns or injuries apparently caused by firearmsapparently caused by firearms

AS 08.64.369

Duty to Report Certain Injuries (Continued)Duty to Report Certain Injuries (Continued)

Injuries apparently caused by a knife, axe, Injuries apparently caused by a knife, axe, or other sharp object, unless injuries were or other sharp object, unless injuries were clearly accidentalclearly accidental

Non-accidental injuries likely to cause the Non-accidental injuries likely to cause the death of patientdeath of patient

AS 08.64.369

Duty to Report Certain Injuries (Continued)Duty to Report Certain Injuries (Continued)

Oral reports must be made promptly to the Oral reports must be made promptly to the Department of Public Safety, or local law Department of Public Safety, or local law enforcement personnel.enforcement personnel.

Written reports must be made within 3 Written reports must be made within 3 working days of treating the patient.working days of treating the patient.

AS 08.64.369

Child Abuse and NeglectChild Abuse and Neglect

Reports must be made to AK Dept. of Health and Social Reports must be made to AK Dept. of Health and Social Services, Division of Family and Youth ServicesServices, Division of Family and Youth Services 465-1650 (Juneau)465-1650 (Juneau) (800)478-4444(800)478-4444

If child is in immediate danger, reports should be made to If child is in immediate danger, reports should be made to law enforcement personnellaw enforcement personnel

Reports to supervisor or medical director do not fulfill the Reports to supervisor or medical director do not fulfill the reporting requirementreporting requirement

AS 47.17.020

Protection of Vulnerable AdultsProtection of Vulnerable Adults

““A vulnerable adult means a person 18 years of age or A vulnerable adult means a person 18 years of age or older who, because of physical or mental impairment, is older who, because of physical or mental impairment, is unable to meet the person’s own needs or to seek help unable to meet the person’s own needs or to seek help without assistance.” (AS 47.24.900)without assistance.” (AS 47.24.900)

Emergency Medical Technicians and Paramedics are Emergency Medical Technicians and Paramedics are required by statute to report suspicions of abandonment, required by statute to report suspicions of abandonment, exploitation, abuse, neglect, or self neglect must report exploitation, abuse, neglect, or self neglect must report within 24 hours after first having cause for the belief.within 24 hours after first having cause for the belief.

AS 47.24.010

Protection of Vulnerable AdultsProtection of Vulnerable Adults

Reports should be made to the Division of Senior Service Reports should be made to the Division of Senior Service of the Department of Administration.of the Department of Administration. 269-3669 (Anchorage)269-3669 (Anchorage) 1-800-478-99961-800-478-9996

Law enforcement personnel should be contacted if the Law enforcement personnel should be contacted if the adult in in danger.adult in in danger.

A person who knowingly fails or refuses to make report A person who knowingly fails or refuses to make report may be charged with a crime.may be charged with a crime.

Immunity from liability extended for reports made in good Immunity from liability extended for reports made in good faith.faith.

Organ DonorsOrgan Donors

Requires that law enforcement and medical Requires that law enforcement and medical personnel make a “reasonable search for a personnel make a “reasonable search for a document of gift or other information document of gift or other information identifying the bearer as a [an organ] donor identifying the bearer as a [an organ] donor or as an individual who has refused to make or as an individual who has refused to make an anatomical gift”an anatomical gift”

AS 13.50.016

Emergency Vehicle OperationsEmergency Vehicle Operations

This is a major source of liability for EMS This is a major source of liability for EMS AgenciesAgencies

EMS personnel should know and comply EMS personnel should know and comply with state and local laws regarding with state and local laws regarding emergency vehicle operationsemergency vehicle operations


Lighting requirements for emergency Lighting requirements for emergency vehicles are specified in 13 AAC 04.090.vehicles are specified in 13 AAC 04.090.

Emergency vehicles may disregard laws Emergency vehicles may disregard laws regarding operation, parking, standing, and regarding operation, parking, standing, and stopping vehicles when displaying the stopping vehicles when displaying the required lights and using the siren in required lights and using the siren in response to an emergency.response to an emergency.


All operators of emergency vehicles must All operators of emergency vehicles must operate in a safe manner.operate in a safe manner.

Studies have shown that:Studies have shown that:In most cases, a lights and siren response saves In most cases, a lights and siren response saves

little time; andlittle time; and lights and sirens are used on more calls than is lights and sirens are used on more calls than is

warranted by the patient’s condition.warranted by the patient’s condition.

Blue Light LawsBlue Light Laws

Authorization issued by DPS Commissioner or Authorization issued by DPS Commissioner or designeedesignee Amended (Amended (6/976/97) regulations allow police chief, fire ) regulations allow police chief, fire

chief, or EMS chief to authorize if designated by DPS chief, or EMS chief to authorize if designated by DPS CommissionerCommissioner

The flashing blue light used by EMS personnel may not The flashing blue light used by EMS personnel may not be illuminated except when the driver of the vehicle is be illuminated except when the driver of the vehicle is properly certified to render emergency lifesaving or properly certified to render emergency lifesaving or medical services and his vehicle displays the "star of medical services and his vehicle displays the "star of life" symbol.life" symbol.

13 AAC 04.100

Blue Light Laws (Continued)Blue Light Laws (Continued)

A flashing blue light that must be visible from the front A flashing blue light that must be visible from the front and sides for a distance of 300 feet in normal sunlight. and sides for a distance of 300 feet in normal sunlight.

The flashing blue light authorized by this subsection may The flashing blue light authorized by this subsection may be illuminated only when the driver of the vehicle is a be illuminated only when the driver of the vehicle is a member of a fire or a police department member of a fire or a police department responding to an responding to an emergencyemergency, and the vehicle must display a sign or plate , and the vehicle must display a sign or plate that indicates the department membership and the name of that indicates the department membership and the name of the municipality or organization in which the driver is a the municipality or organization in which the driver is a membermember


Individual must provide verification that:Individual must provide verification that: the person's motor vehicle complies with the equipment standards the person's motor vehicle complies with the equipment standards

set out in 13 AAC 04;set out in 13 AAC 04; the person holds a valid Alaska driver's license that has not been the person holds a valid Alaska driver's license that has not been

suspended, revoked, cancelled, or limited within the three years suspended, revoked, cancelled, or limited within the three years before the form is returned; andbefore the form is returned; and

the person has read and understands the regulations for emergency the person has read and understands the regulations for emergency vehicle operation set out in 13 AAC 02.140 , 13 AAC 02.517 and vehicle operation set out in 13 AAC 02.140 , 13 AAC 02.517 and 13 AAC 04.10013 AAC 04.100


if requested by the commissioner or the if requested by the commissioner or the commissioner's designee, the person must provide commissioner's designee, the person must provide a certified copy of the person's driving record. a certified copy of the person's driving record.


Driver of vehicle with authorized blue light may:Driver of vehicle with authorized blue light may: park vehicle near scene in violation of traffic laws;park vehicle near scene in violation of traffic laws; exceed the speed limit if it does not endanger life or exceed the speed limit if it does not endanger life or

property;property; disregard regulations and ordinances regarding disregard regulations and ordinances regarding

direction, movement, or turning, if done at speeds lower direction, movement, or turning, if done at speeds lower than posted.than posted.

13 AAC 02.517


These privileges only exist while responding, not These privileges only exist while responding, not returning.returning.

A vehicle displaying a blue light must yield the A vehicle displaying a blue light must yield the right of way to an authorized emergency vehicle right of way to an authorized emergency vehicle responding to an emergency.responding to an emergency.

13 AAC 02.517


13 AAC 02.517

“The provisions of this chapter do not relieve the driver of an authorized emergency vehicle or a vehicle displaying a flashing blue light from the duty to drive with regard for the safety of all persons, nor do the provisions of this section allow the driver of a vehicle displaying a flashing blue light to proceed past a stop sign or red signal without first stopping”


Alaska EMS Section recommends that Alaska EMS Section recommends that EMTs using blue lights:EMTs using blue lights:Drive no faster than posted speed limit; andDrive no faster than posted speed limit; andObey all traffic laws.Obey all traffic laws.

SummarySummary

EMTs should provide good patient care EMTs should provide good patient care while maintaining patient rapportwhile maintaining patient rapport

EMTs should develop and practice good EMTs should develop and practice good documentation and reporting skillsdocumentation and reporting skills

EMTS should understand the reporting EMTS should understand the reporting requirements found in Alaska statutes and requirements found in Alaska statutes and regulationsregulations

Declaration of DeathDeclaration of Death

Allows EMTs, Mobile Intensive Care Paramedics Allows EMTs, Mobile Intensive Care Paramedics and Physician Assistants to Pronounce and Physician Assistants to Pronounce death in death in certain circumstancescertain circumstances..

Amends statutes AS 09.68.120 Amends statutes AS 09.68.120 DEFINITION OF DEFINITION OF DEATH DEATH and AS 18.08.098 and AS 18.08.098 AUTHORITY TO AUTHORITY TO PRONOUNCE DEATHPRONOUNCE DEATH..

EMT/MICP QualificationsEMT/MICP Qualifications

EMTs and Mobile Intensive Care EMTs and Mobile Intensive Care Paramedics must:Paramedics must:be members of an EMS agency certified by the be members of an EMS agency certified by the

state; andstate; andbe be unableunable to communicate immediately with a to communicate immediately with a

physician by radio or telephone.physician by radio or telephone.

Post Mortem LividityPost Mortem Lividity

A red or purple skin discoloration resulting from pooling A red or purple skin discoloration resulting from pooling of blood to dependent parts of the body after death. of blood to dependent parts of the body after death.

Usually discernible clearly 1 hour after death.Usually discernible clearly 1 hour after death. Increasing in color for 6 - 10 hours after death. Increasing in color for 6 - 10 hours after death. May be mimicked by hypothermia. May be mimicked by hypothermia. Heat hastens the speed with which it develops, cold slows.Heat hastens the speed with which it develops, cold slows.

Rigor MortisRigor Mortis

Stiffening of body and limbs.Stiffening of body and limbs. Discernible approximately 1 hour after death.Discernible approximately 1 hour after death. Stiffening increasing for 6 - 10 hours after death. Stiffening increasing for 6 - 10 hours after death. May be mimicked by profound hypothermia. May be mimicked by profound hypothermia. Heat hastens the speed with which it develops, Heat hastens the speed with which it develops,

cold slows.cold slows.

HypothermiaHypothermia

Cold core temperature which causes or Cold core temperature which causes or complicates cardiac arrest.complicates cardiac arrest.

Dead bodies cool at a rate of approximately 2 Dead bodies cool at a rate of approximately 2 degrees per hour at room temperature.degrees per hour at room temperature.

EMS personnel must be able to distinguish EMS personnel must be able to distinguish between hypothermia and normal cooling effects.between hypothermia and normal cooling effects.

Withholding ResuscitationWithholding Resuscitation

The EMT, MICP, or PA may withhold The EMT, MICP, or PA may withhold resuscitation efforts when the patient has injuries resuscitation efforts when the patient has injuries incompatible with life, including cardiac arrest incompatible with life, including cardiac arrest accompanied by:accompanied by:

incineration;incineration; decapitation;decapitation; open head injury with loss of brain matter; oropen head injury with loss of brain matter; or detruncation.detruncation.

Withholding Resuscitation (Cont.)Withholding Resuscitation (Cont.)

cardiac arrest accompanied by rigor mortis; cardiac arrest accompanied by rigor mortis; cardiac arrest accompanied by the presence of post mortem cardiac arrest accompanied by the presence of post mortem

lividity; orlividity; or advanced life support is not available, the patient is not advanced life support is not available, the patient is not

hypothermic, proper CPR has been performed for at least hypothermic, proper CPR has been performed for at least 30 minutes and the patient has not developed spontaneous 30 minutes and the patient has not developed spontaneous respiration or pulse.respiration or pulse.

Terminating Resuscitation:Terminating Resuscitation:

The patient may be pronounced dead when:The patient may be pronounced dead when: Advanced life support is not available, the patient is not Advanced life support is not available, the patient is not

hypothermic, proper CPR has been performed for at hypothermic, proper CPR has been performed for at least 30 minutes and the patient has not developed least 30 minutes and the patient has not developed spontaneous respiration or pulse;spontaneous respiration or pulse;

Advanced life support has been properly provided for at Advanced life support has been properly provided for at least 30 minutes without the patient developing least 30 minutes without the patient developing spontaneous respiration or pulse; orspontaneous respiration or pulse; or

Terminating Resuscitation (Cont.)Terminating Resuscitation (Cont.)

The patient is hypothermic and the patient has received at The patient is hypothermic and the patient has received at least 60 minutes of properly performed cardiopulmonary least 60 minutes of properly performed cardiopulmonary resuscitation in conjunction with rewarming techniques as resuscitation in conjunction with rewarming techniques as described in the current State of Alaska Hypothermia and described in the current State of Alaska Hypothermia and Cold Water Near Drowning Guidelines without the patient Cold Water Near Drowning Guidelines without the patient developing spontaneous respiration or pulse.developing spontaneous respiration or pulse.

Resuscitation and HypothermiaResuscitation and Hypothermia

Although the law allows CPR to be terminated or Although the law allows CPR to be terminated or not started when 30 minutes of properly performed not started when 30 minutes of properly performed ALS has been performed, even on the hypothermic ALS has been performed, even on the hypothermic patient, the Alaska EMS Section recommends that patient, the Alaska EMS Section recommends that resuscitation be continued for at least an hour.resuscitation be continued for at least an hour.

This will allow rewarming to be more effective This will allow rewarming to be more effective and your unit to have a better chance of contacting and your unit to have a better chance of contacting a physician for additional orders and advice.a physician for additional orders and advice.

Points to RememberPoints to Remember

Attempt to contact physician medical control Attempt to contact physician medical control before pronouncing patient dead.before pronouncing patient dead.

Document all findings and actions carefully.Document all findings and actions carefully. When in doubt,When in doubt, resuscitate resuscitate!! If possible, have someone attend to needs of If possible, have someone attend to needs of

family family duringduring resuscitation efforts. resuscitation efforts.

After Pronouncing a Patient DeadAfter Pronouncing a Patient Dead

Leave IVs and Tubes in Place.Leave IVs and Tubes in Place. Do not disturb jewelry, clothing, pockets, Do not disturb jewelry, clothing, pockets,

and other personal effects.and other personal effects. Cover patient.Cover patient. Minimize Number of Personnel at Scene.Minimize Number of Personnel at Scene.


If death was pronounced If death was pronounced en route:en route:Reattempt radio communications with Reattempt radio communications with

physician medical director or hospital.physician medical director or hospital.Transport deceased in accordance with standing Transport deceased in accordance with standing

orders or contact the law enforcement agency orders or contact the law enforcement agency with jurisdiction for additional guidance.with jurisdiction for additional guidance.


If death was pronounced If death was pronounced on-scene:on-scene: Notify coroner and law enforcement personnel.Notify coroner and law enforcement personnel. Treat the scene as if it were a crime scene.Treat the scene as if it were a crime scene. Protect scene until coroner and/or law enforcement Protect scene until coroner and/or law enforcement

personnel arrive.personnel arrive. Personnel exiting the scene should retrace steps.Personnel exiting the scene should retrace steps.

After Pronouncing a Patient Dead (Cont.)

After Pronouncing a Patient Dead (Cont.)

If in a If in a residence or building:residence or building: Remember what you've touched and entrance route.Remember what you've touched and entrance route. Avoid touching objects.Avoid touching objects. Avoid using the residence telephone.Avoid using the residence telephone. Be prepared to describe the condition of scene, e.g. Be prepared to describe the condition of scene, e.g.

placement of objects, etc., when you arrived at the placement of objects, etc., when you arrived at the scene.scene.

Notification of Patient DeathNotification of Patient Death

Historically done by hospital or law Historically done by hospital or law enforcement personnel.enforcement personnel.

This legislation will increase the frequency This legislation will increase the frequency with which EMS personnel notify survivors.with which EMS personnel notify survivors.

Notify survivors as early as is practicable, Notify survivors as early as is practicable, don’t let suspense build.don’t let suspense build.

Notification of Death (Cont.)Notification of Death (Cont.)

Introduce yourself and your role.Introduce yourself and your role. Use appropriate body language.Use appropriate body language. Find quiet place, if possible.Find quiet place, if possible. Take cues from survivors.Take cues from survivors. Use the patient’s name.Use the patient’s name.


Use simple, non-medical, clear terms:Use simple, non-medical, clear terms:““heart attack” instead of “AMI.”heart attack” instead of “AMI.”““dead” instead of “no longer with us.”dead” instead of “no longer with us.”

Answer any questions you can.Answer any questions you can. Allow silence.Allow silence. Ask them if they have any questions.Ask them if they have any questions.


Touching may be appropriate.Touching may be appropriate. Don’t be afraid to show your emotions.Don’t be afraid to show your emotions. Ask if there is someone you can call for Ask if there is someone you can call for

them, e.g. clergy, friend, family member, them, e.g. clergy, friend, family member, etc.etc.

Try to prepare survivors for what is next.Try to prepare survivors for what is next.


Notifying people that a loved one has died Notifying people that a loved one has died is one of the most stressful challenges an is one of the most stressful challenges an EMT or MICP may face. EMT or MICP may face.

Make sure you recognize signs of stress in Make sure you recognize signs of stress in yourself and colleagues.yourself and colleagues.


Reassure survivors that you did everything Reassure survivors that you did everything medically possible.medically possible.

If possible, reassure the survivors that there was If possible, reassure the survivors that there was nothing else they could do.nothing else they could do.

If it is true, tell them the patient did not suffer.If it is true, tell them the patient did not suffer. Arrange for support for survivors after you leave.Arrange for support for survivors after you leave.


If it will be possible for the survivors to view the If it will be possible for the survivors to view the body, and they wish to do so, prepare them for body, and they wish to do so, prepare them for how it will look.how it will look.

AS 13.50.016 requires medical and law AS 13.50.016 requires medical and law enforcement personnel to make a “reasonable” enforcement personnel to make a “reasonable” attempt to determine whether patient wished his or attempt to determine whether patient wished his or her organs and/or tissues donated. If the patient her organs and/or tissues donated. If the patient was a donor, notify nearest medical facility.was a donor, notify nearest medical facility.

DocumentationDocumentation

The pronouncement of death must be certified by a The pronouncement of death must be certified by a physician within 24 hours after the pronouncement made physician within 24 hours after the pronouncement made by the EMT or MICP.by the EMT or MICP.

Run sheets should be completed in accordance with local Run sheets should be completed in accordance with local protocols.protocols.

A copy of the run sheet should be given to the person A copy of the run sheet should be given to the person completing the death certificate if allowed by local completing the death certificate if allowed by local protocol.protocol.

Documentation (Cont.)Documentation (Cont.)

The EMT or MICP must provide to the person The EMT or MICP must provide to the person signing the death certificate, the following signing the death certificate, the following information:information: name of the deceased;name of the deceased; the presence of a contagious disease, if known;the presence of a contagious disease, if known; date and time of death.date and time of death.

SummarySummary

Pronouncing death is an important responsibility and Pronouncing death is an important responsibility and EMTs and MICPs must understand the law well.EMTs and MICPs must understand the law well.

Reattempt to contact medical control before pronouncing Reattempt to contact medical control before pronouncing death.death.

When in doubt, resuscitate.When in doubt, resuscitate. Be responsive to your psychological needs, as well as Be responsive to your psychological needs, as well as

those of, survivors, and other rescuers.those of, survivors, and other rescuers. Ensure activities and findings are documented Ensure activities and findings are documented

appropriately.appropriately.

disclaimer this is an informational slide for instructors and not intended to be shown. every...

Documents

treatment slide

alaska slide

informational slide

safe manner slide

patient care cases settlements

impaired mentation slide

ems patient

patient encounters