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Protocols for Pronouncement of Death

Each state and each country has slightly different rules for the pronouncement of death. In some states, only a doctor may make the final pronouncement. Other states allow nurses or even emergency medical service technicians/paramedics to make the decision that death has occurred. No matter who makes the final call, there are three criteria that can be used to judge death: cardiac death, brain death and injuries or conditions incompatible with life.

  1. Cardiac Death

    • Cardiac death is the type of death with which most people are. It occurs when the heart and lungs irrevocably stop working. A clinician assessing cardiac death should listen for the absence of the carotid pulse and heartbeat, listen and look for the absence of spontaneous breathing and check to see if the pupils of the patient's eyes respond to light. The clinician must also make the determination as to whether the cessation of circulation and respiration is irreversible. Depending on the circumstances, the clinician may opt to declare the patient dead, or may call a "code" and began cardiopulmonary resusciation to try to revive the patient.

    Brain Death

    • Brain death is the one type of death that must always be determined by a doctor. It occurs when the entire brain, including the brain stem, ceases to function. The outward signs of brain death include complete unresponsiveness or coma, no reflexive response to pain, no brain stem reflexes and apnea, or the cessation of breathing. In addition to these symptoms, doctors usually perform one or more imaging tests of the brain to confirm that there is no electrical activity. A person who is pronounced brain dead is legally deceased, but his or her heartbeat and breathing may be maintained for a short time on life support to allow for organ donation.

    Conditions Incompatible with Life

    • It is usually emergency responders who make the determination whether or not a patient's condition is incompatible with life. A few examples of such conditions include decapitation or beheading, the body being cut or torn in half at the abdomen or chest, incineration or third degree burns that cover more than 70 percent of the body, decomposition and rigor mortis. However, emergency responders are trained to be very careful in making the determination of death. If the paramedic has any doubt about whether or not an injury is survivable, he or she should transport the patient to a hospital and let a physician make the final determination.

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