Ambulance Technician Study

Management of the Deceased

Death, this is an everyday occurrence for ambulance crews and you will normally be the first on scene to deal with the situation. More often than not a death in the home is the most common sudden death dealt with by the ambulance service. This section will give a quick overview of the procedures that need to be adopted in different situations.

HM Coroner

Coroners are independent judicial officers in England and Wales who must follow laws which apply to coroners and inquests. Each coroner has a deputy and one of them must be available at all times to deal with matters relating to the inquest and post mortems Although they are appointed by, and paid for, by local councils, they are not local government officers, but hold office under the Crown. They are either lawyers or doctors. When a death was sudden, or unexpected, violent or unnatural, occurred during an operation, was due to an industrial disease, or when no doctor has treated the deceased during his or her last illness. Coroners enquire into those deaths reported to them. They will seek to establish the medical cause of death; if the cause remains in doubt after a post mortem, an inquest will be held.

Police

When attending a sudden death it may be necessary to ask for police attendance especially if the death is:

1. Possibly due to unnatural causes
2. Unusual in anyway
3. Caused by a suspected crime. i.e. Assault.

If any of the above have occurred:

1. Preserve scene as much as possible continuity of evidence)
2. Ask for police attendance stating you think the death is 'suspicious' 

Continuity of Evidence

"Continuity of evidence" or "chain of custody", that is, collecting information in such a manner that it can be later, if required, demonstrated in court how the evidence was obtained with proof that there was no risk of alteration to said evidence.

Procedures

Death in a public place

• Carry out CPR
• Removal to hospital
• Arrange for a doctor to meet you at A&E to confirm death. Then take patient to the hospital mortuary.

The ambulance service could be asked by the police to remove the body from the scene after confirmation of death unless other arrangements are in place. A police officer will generally accompany the body in the ambulance to the hospital or mortuary for continuity of evidence.

Death in the home

• Carry out CPR
• Remove the patient to hospital if there is a delay in the GP or Paramedic attending to confirm death.
• Try and collate all patient details, name, age, etc
• Pass details via radio to control so GP can be informed and asked to attend
• Wait for confirmation that GP is to attend if not request a paramedic if this is not possible then remove patient to hospital
• Once GP has certified death then it is respectful to place the body in bed
• Keep control informed on job progress

Recognition of life extinct 

Ambulance Technicians can only recognise, not confirm, death in the following circumstances: 

• Decapitation
• Massive cranial and cerebral destruction
• Hemicorporectomy (or similar massive injury)
• Decomposition/Putrefaction
• Incineration
• Hypostasis (post mortem staining)
• Rigor Mortis

Click for the JRCALC paper for Recognition of Life Extinct (ROLE)

Mortuary Procedure

On arrival at the mortuary it is generally agreed to follow this procedure:

• Handover to mortuary staff with details of
  • Circumstance of death
  • Who confirmed death
  • Location of body
  • Identity of body if known

• Mortuary staff will remove all clothing and any personal belongings. you may be asked to countersign for these.

• Mortuary staff will then countersign and give you a copy. This is to be attached to your paperwork.

Remember

A sudden, accidental, unexpected or traumatic death can be stressful to family and you. It is often a loss that does not make sense. The sudden death can leave you feeling shaken, unsure and vulnerable. If you are affected by a particular incident make use of the counselling service offered to you.