Disposition: DOA and ER Death

Death

is the irreversible cessation of circulatory and respiratory functions or the irreversible cessation of all functions of the entire brain, including the brain stem

A person shall be medically and legally dead if either:

In the opinion of the attending physician, based on the acceptable standards of medical practice, there is an absence of natural respiratory and cardiac functions and, attempts at resuscitation would not be successful in restoring those functions.

In this case, death shall be deemed to have occurred at the time these functions ceased; or

A person shall be medically and legally dead if either:

Republic Act 7170-Sec 2

In the opinion of the consulting physician, concurred in by the attending physician, that on the basis of acceptable standards of medical practice, there is an irreversible cessation of all brain functions; and considering the absence of such functions, further attempts at resuscitation or continued supportive maintenance would not be successful in restoring such natural functions. In this case, death shall be deemed to have occurred at the time when these conditions first appeared. The death of the person shall be determined in accordance with the acceptable standards of medical practice and shall be diagnosed separately by the attending physician and another consulting physician, both of whom must be appropriately qualified and suitably experienced in the care of such patients. The death shall be recorded in the patient's medical record.

Dead on Arrival (DOA)

Patients brought to Emergency Room without cardio-pulmonary and brain functions. This will include patients who did not respond to initial resuscitation. Resuscitation is no longer done to patients with signs of Rigor Mortis, Livor Mortis, Algor Mortis and Decapitation and advance state of decomposition.

Patient came in to ER

IS THERE SIGNS OF: Rigor Mortis, Livor Mortis, Algor Mortis, Decapitation and in advance state of decomposition

NO YES

NO vital signs DNR Resuscitate

NOT revived
Decision to stop resuscitation depends on the MD. No standard time when to stop.

Pronounce Dead DOA

ER Death

refers to death of patient, occurring at the ER, who is not yet admitted. These include patients who arrived at the ER with no detectable vital signs (BP, HR, and RR) but revived by initial resuscitative measures, but eventually died, regardless of the time of stay.

Postmortem care shall be done by the ER nursing personnel.

Patient came in to ER

NO SIGNS OF Rigor Mortis, Livor Mortis, Algor Mortis, Decapitation and in advance state of decomposition

Vital signs? NO YES

Resuscitate

Observation

Not revived

Revived

Pronounce Dead ER Death

* Patient is not yet admitted.

Death of ADMITTED Patient

This is a death of an admitted patient who is not yet accepted or reached the assigned ward. For such cases, the mortality shall be counted to the census of the admitting Ward. Scenarios

Admitted patient who dies at the ER Admitted patient who dies while on transport

Admitted patient who dies at the ER

death certificate shall be accomplished by the ER Officer.

Reason: physician at ward has not yet seen and examined the patient

Postmortem care shall be done by the ER nursing personnel

Admitted patient who dies/ codes while on transport

the patient shall be brought and resuscitated in the nearest unit which has an E-cart.
The physician who pronounced the death of the patient shall accomplish the death certificate

Responsibility of ER officer

The postmortem care shall be done by the nursing personnel in that unit.

Patient shall not be brought back to the ER or to the admitting ward

Reporting ER Death

Death certificate shall be accomplished by the ER Officer, if there is a definite diagnosis.

Otherwise, it shall be issued by the city/municipal health officer, or NBI or police crime laboratory in a medico-legal case after the conduct of an autopsy.

Section 4, Chapter XXI-IRR, P.D. 856 of the Sanitation Code of the Philippines

The death shall be reported to the local health officer within 48 hours after death the death certificate shall be forwarded to the local civil registrar concerned within 30 days after death for registration.

Role of ER Staff in case of ER Death

ER Officer and ER Nurses must complete the patient medical chart.

ER Officer must issue a death certificate if the diagnosis is certain; otherwise, mandatory autopsy is necessary before a death certificate is issued.

ER Nurse facilitates billing, post mortem care, and transfer of the cadaver to the morgue.

Role of the ER Physician in case of ER Death/DOA

Refer all ER deaths for autopsy to the physician (referred to as the Prosector) pathologist, hospital/NBI/PNP medico-legal officer, or Provincial/City/Municipal Health Officer, who will do the autopsy
Must write on the chart/medical record of the decedent the indication for the autopsy. Send a formal referral to the prosector regarding the reason for the autopsy.

Role of the ER Physician in case of Death

Must clearly inform the relatives of the decedent on the need for the autopsy.
If the relatives do not give informed consent or have outright refusal on the conduct of the autopsy, the ER Officer or attending physician must indicate in the chart the reasons and consequences The nearest of kin must sign a waiver for refusing the conduct of the autopsy. A waiver form may be adapted and revised by the institution.

Role of the ER Physician in case of Death

Shall not give any detail on the procedure of the autopsy.

Only the prosector will explain the procedure of the autopsy.

Provide a clinical abstract, which must include the circumstances surrounding the demise, and laboratory and ancillary test results including radiographs. For mass casualty incident, proper documentation of identification of the cadaver is deemed necessary.

Death due to Dangerous/ Communicable/ Infectious Diseases shall be properly disposed of with the following advises:

The remains shall be buried within 12 hours after death. Only the adult members of the family of the deceased shall be permitted to attend the funeral. The remains shall be placed in a durable, air tight and sealed casket. The remains shall not be taken to any place of public assembly. No permit shall be granted for the transfer of such remains.