1. Pronouncing Death - Not Just a Medical Event A. REED THOMPSON, MD Associate Professor Donald W. Reynolds Department of Geriatrics University of Arkansas for Medical Sciences

2. Legal Definition of Death l Complete cessation of breathing and heartbeat l Whole brain death

3. Pronouncing Death l One of the important rituals in our culture l A task traditionally relegated to the least experienced housestaff physician l Not felt to be important by physicians l Can be very important for a family

4. Components of Pronouncing Death l Medical l Humanitarian l Clerical l Legal

5. Medical Component Receiving the Call l There is usually no reason to rush to the bedside l The longer a patient is dead the easier it is to be certain of the death

6. Medical Component Prepare Yourself l Familiarize yourself with the medical facts in the case l Check current medications (opioids, barbiturates) l Discuss the situation with the nursing staff before entering the room - Was the death anticipated? - Who is present? l Prepare yourself internally

7. Medical Component In the Room l Introduce yourself as you enter the room with a nurse l Examine the patient l Remember this is an important medical ritual

8. Medical Component At the Bedside l Identify the patient by hospital I.D. tag l Check pupillary light reflex l Check carotid pulse l Listen for heart sounds (1-3 minutes) l Check fundi for “rail-roading” l Say something, such as, “Mr./Mrs.___is dead”.

9. Humanitarian Component l Console the family with an empathetic statement - “I’m sorry for your loss” - “I know this is very hard for you” l Observe silence in the presence of the bereaved l Touching the bereaved may be appropriate l Ask if there are any questions

10. Clerical Component l Document the time of death in the chart l Chart physical findings (absence of pulse, heartbeat, etc.) l Document that the attending physician was notified (or not) l Notify ARORA l Document if an autopsy was discussed (or not)

11. l Document if the coroner was notified l Dictate a death summary for the medical record l Notify morgue and mortuary personnel of contagious conditions l Complete the death certificate in a timely manner

12. Legal component l Arkansas Code Ann. 12-12-315 requires any person with knowledge of a death that appears to be caused by violence, drugs, poisons, MVA, or criminal abortion to notify the coroner. l Arkansas Code 12-12-315 requires all hospital deaths within 24 hours of admission be reported to the coroner

13. l Arkansas law (Act 499 of 1999) requires that all deaths in nursing home residents transferred to a hospital, who die within 5 days of the hospital admission, be referred to the coroner for investigation l Arkansas law (Act 499 of 1999) requires all nursing home deaths be reported to the coroner