AAP Verification of Death V5 April 2023.pdf

Verification of the Fact of Death and the Management of Bodies © Department of Clinical Education & 1 Standards  Verification of Death and the Management of Bodies Subjects covered during this training may evoke memories of incidents that you have witnessed or bee...

Verification of the Fact of Death and the Management of Bodies © Department of Clinical Education & 1 Standards  Verification of Death and the Management of Bodies Subjects covered during this training may evoke memories of incidents that you have witnessed or been involved in. If you have any concerns please discuss with your Course Director/staff at the education centre. Support is available to all staff, more information is available on The Pulse LINC emergency on Call – 0207 922 7539 Staff Counselling Referral Line (Optima) – 0800 0214 155 MIND Blue Light Infoline – 0300 123 3393 TRiM Assessment – local management referral (CTM in operations) Wellbeing Hub (0800-1800) – 0203 162 7554 © Department of Clinical Education & 2 Standards  ROLE and the Management of Bodies This subject is covered to allow the AAP to provide support to the senior clinician ©Department of Clinical Education & Standards Verification of Death and the Management of Bodies Objective By the end of the session, understand the processes an ambulance clinician will go through to recognise an individual as life extinct, following set policies and procedures. ©Department of Clinical Education & Standards Verification of Death and the Management of Bodies Issues Inappropriate resuscitation attempts in EoLC cases Verification of Death completed in ambulances Bodies moved without authorisation from HM Coroner ©Department of Clinical Education & Standards Verification of Death and the Management of Bodies When some one dies Three processes Clinical confirmation of death – clinically confirming that death has occurred Certification of death – cause of death Registration - The legal process to register the death © Department of Clinical Education & 6 Standards Verification of Death and the Management of Bodies Verification of Death: Situations Where Resuscitation May Be Inappropriate Condition unequivocally associated with death DNA-CPR, a valid Advanced Decision or a ReSPECT form Expected death as the result of a terminal illness Submersion for longer than 90 minutes ©Department of Clinical Education & Standards Verification of Death and the Management of Bodies Verification of Death: Situations Where Resuscitation May Be Inappropriate There is no realistic chance that CPR would be successful if ALL of the following exist together: > 15 minutes has elapsed since the onset of cardiac arrest (Not when person was last seen alive) No evidence of CPR in the 15 minutes before arrival of the ambulance Exclusion factors are absent (drowning, hypothermia, poisoning/overdose, pregnancy, child/neonate) Asystole for > 30 seconds on the ECG monitor screen. CPR should only be paused for a 30 second asystole check if all other criteria are met ©Department of Clinical Education & Standards Verification of Death and the Management of Bodies Verification of Death CANNOT be completed in the following situations: Pregnancy Hypothermia (where primary cause of death) Suspected drug overdose/Poisoning These patient should all be transported to the nearest A&E with on-going resuscitation – unless the circumstances would make transport futile ©Department of Clinical Education & Standards Verification of Death and the Management of Bodies Signs Unequivocally Associated With Death Massive cranial & cerebral destruction Hemicorporectomy or similar massive injury incompatible with life (such as half the body or more has been amputated) Decapitation Decomposition/putrefaction Incineration Hypostasis Rigor mortis Fetal maceration ©Department of Clinical Education & Standards Verification of Death and the Management of Bodies Resuscitation Decision Making - Adults In addition to the conditions unequivocally associated with death there are other criteria which can be used to confirm that resuscitation should not be attempted/ continued: A) The presence of a DNACPR (do not attempt cardiopulmonary resuscitation) decision or ReSPECT form that advises resuscitation is not to be attempted B) A valid Advance Decision to Refuse Treatment (ADRT) which refuses cardiopulmonary resuscitation or a Lasting power of Attorney (LPA) for Health & Welfare that includes decisions related to life sustaining treatments and where CPR is refused by the attorney. C) If a person is known to be in the final stages of an advanced, irreversible condition, in which attempted CPR would be both inappropriate and unsuccessful, CPR should not be started/stopped if already commenced. Even in the absence of a recorded DNACPR decision, ambulance paramedics may be able to recognise this situation and make an appropriate decision, based on clear evidence that they must document. ©Department of Clinical Education & JRCALC, 2022 Standards Verification of Death and the Management of Bodies Expected Death Due To Terminal Illness Sufficient evidence is required to support the decision not to attempt resuscitation & this must be documented on the EPCR Evidence?.... ©Department of Clinical Education & Standards Verification of Death and the Management of Bodies Clear Evidence of EoLC Syringe driver Palliative care drugs Patient notes Hospice involvement Drugs used in EoLC Morphine/Diamorphine Midazolam Hyoscine/Glycopyronium Ondansetron/Cyclizine Haloperidol Levomepromazine ©Department of Clinical Education & Standards Verification of Death and the Management of Bodies Learners to use Ipads to access: JRCALC Traumatic Cardiac Arrest Algorithm (2020) ©Department of Clinical Education & Standards Verification of Death and the Management of Bodies 5 Elements to Verification of Death No pulse No respirations No heart sounds Pupils fixed & dilated Asystolic rhythm ECG trace for longer than 30 seconds (printed & submitted with ePCR) Over 5 Minutes ©Department of Clinical Education & Standards Verification of Death and the Management of Bodies Remember to correlate the information you have Ensure what you are seeing fits with the history and clinical picture Think what information do you have from the call If they were talking five minutes ago they will not have PM staining or rigor mortis Do not be distracted by the mechanism of injury Verification of death is related to the specific condition Seek advice if needed ©Department of Clinical Education & Standards Verification of Death and the Management of Bodies Verification of the Fact of Death Expected versus Unexpected death ©Department of Clinical Education & Standards Verification of Death and the Management of Bodies The Management of a Death EXPECTED DEATH UNEXPECTED DEATH Was anticipated & as a result of deterioration Suspicious/not related to a due to an advanced, progressive period of illness/unnatural disease. CHECK UCP/ ASK HCP - IF UNSURE IF EXPECTED! Contact MPS (act as agents to the  Can move the deceased & remove any devices (NB: syringe pumps) Coroner)  Advise family to contact funeral directors of choice Provide bereavement information  Advise family to contact GP on next working day – to family MCCD X Do not move deceased  Leave LA3 with the deceased & provide bereavement information X Do not remove devices  Only call MPS if no responsible adult- be clear that death is expected For PAEDIATRICS: X No Out of Hours GP/111 EXPECTED DEATH- contact specialist team & adhere to care plan X No Coroner UNEXPECTED DEATH – call MPS & convey to ED ©Department of Clinical Education & 18 Standards Verification of Death and the Management of Bodies Important! DO NOT move deceased persons from scene even if in a public place – seek advice from CHUB if the police ask! ©Department of Clinical Education & Standards Verification of Death and the Management of Bodies Death of a Child in the Community (under 18’s) Medical Directorate Bulletin 214 (29th May 2018) provides a checklist of actions to follow in these instances. It is available via the Pulse and the JRCAL Plus app EOC can also provide assistance on scene with clarification of LAS procedures. ©Department of Clinical Education & Standards Verification of Death and the Management of Bodies Death of a Child in the Community In all cases where a child has been verified deceased by the ambulance service the Emergency Bed Service (EBS) must be informed who will complete the child death notification. Safeguarding concerns for both the patient and other siblings should be raised through EBS. Document all findings, decisions and actions clearly on the Patient Report Form. ©Department of Clinical Education & Standards Verification of Death and the Management of Bodies ©Department of Clinical Education & Standards Verification of Death and the Management of Bodies Updated 2023 LA3 A new LA3 is being distributed to reflect changes in resuscitation as per JRCALC Bundle 9 The old LA3’s will still be in circulation, areas of updated practice (such as 30 minutes ALS) should be written in the additional information box and documented on ePCR if you are using an old form. Please note that temperature is not diagnostic of death and patients must meet criteria in section A-G of the form. ©Department of Clinical Education & Standards Verification of Death and the Management of Bodies ©Department of Clinical Education & Standards Verification of Death and the Management of Bodies ©Department of Clinical Education & Standards Verification of Death and the Management of Bodies Safeguarding Referral In all cases of unexpected death in patients