Dead on the scene?

Different juristictions have different procedures, so you should call a local small town CORONERS office and ask for their procedures.

Generally speaking, if EMT's arrive on the scene, and their is no life signs, they call the CORONER or the Justice of the Peace in some small towns. They will then come out and pronounce death before transporting.

But really, it does vary from area to area.

To follow up, a small town county general hospital might have an arrangement with a local funeral home, a county contract, to take the body there until family members can be contacted. Otherwise it might go to county generals morgue for holding, until the family makes arrangements and then it will be released to the appropriate funeral home.

Dead is defined in different ways. There is the layman's term dead, but then there is medical death. There are only a few instances when a paramedic would declare someone dead on the scene (and they aren't allowed to declare someone dead in other situations). Someone who has been decapitated, someone showing dependent lividity (wikipedia it), or someone with rigor mortis can be declared dead on the scene by a paramedic. Other than that, people usually get a high speed ride to the nearest hospital.

For instance, someone who crashed their car, has a head injury, and no breathing or pulse would not be declared dead on scene, even though you or I might call that person 'dead'. That's because there's a very small chance that medical intervention can bring them back to life. In those (majority of) cases, a doctor has to declare you dead.

In general, someone in that situation would go to the ER very quickly, then be pronounced dead there or worked on first and then pronounced dead. From the ER, an orderly would cover them up and take them to the hospital morgue. After that I don't know where the body would go. (Note: this is based on my EMT training in California so laws may be different elsewhere, but I'm guessing they are similar.)

For more info I would look up EMT's and paramedic's protocols. also research medical definitions of death.

My friend's husband is a funeral director and he would often have to show up at accident scenes with the coroner to supervise the removal of the body.

Nerdy -
One reason for taking someone with "non-survivable injuries" to the hospital is for spare parts.

If there are multiple injured persons, you do triage and help those that can be helped, leaving the others for later.

This is how it works here...

If the person has obvious serious trauma (maybe a huge crush injury, obvious serious head injury, decapitation, etc) and no life signs, the paramedics can declare the person dead after confering with medical control and the medical examiner is called. Once they finish their check, the funeral home is called and they take the body.

However, if there are no obvious injuries involved and the accident is recent, usually the paramedics will work the person and transport to the hospital. In a lot of cases, the cause of the accident is medical related and the patient has a chance at survival. By medical related I mean things like diabetic issues, heart attack, stroke, etc.

This question involves a lot of different permutations.

First question is this varies from jurisdiction to jurisdiction. EMTs are licensed under the medical direction of a doctor connected to the local emergency room. Then the state has it's requirements and guidelines. This determines when an EMT gets to call someone.

The starting point is the severity of the injuries. This has to be combined with the length of extrication. If we arrived on the scene and the person had no pulse, pupils fixed and dilated, and significant injuries, and we we're looking at an hour or more for extrication, we'd call it, after talking with the ED.

If there is any sign of life, we'd transport, even if we knew they were going to get called at the hospital. We had one patient that had so many leaks we used up all of our IV bags during the extrication and transport. CPR all the way and by the time we got to the hospital, his blood was a very pale pink.

One criteria for calling patients is the ten minute window for brain death. No CPR and no pulse for more than ten minutes and the brain is dead. Shorter periods will cause damage, the longer the more damage. You can't do CPR with a seated person very effectively. Also, as Tsu said, with multiple victims, you do triage and depending upon resources, you might call someone because by the time you're able to deal with them, they're going to be dead.

Once someone is declared dead, then the question becomes whether the police feel there is a crime scene involved. If the police determine it's a crime scene, then the fire department would have to wait until they got done with their investigation. And a lot of wrecks involving a dead body are crime scenes in which one or more of the drivers will be charged with a crime such as DWI, speeding, reckless operation which can result in a charge of negligent homicide.

If the accident is a crime scene, then the body has to go in for an autopsy. You can't tell whether the person had a heart attack or stroke shortly before the accident, and for another driver to be convicted of negligent homicide, the victim has to have died from the accident.

If the prosecutor, the medical examiner, and the police agree that no crime has been committed, the body can go directly to the funeral home.

Remember that depending upon the area, EMTs can be separate from anything else, part of the fire department, or part of the police department.

I would talk with the rescue squad for where you want to stage your accident. I was a EMT/firefighter on a volunteer squad for many years.

Best of luck,

Jim Clark-Dawe

it would also depend on how many victims are involved. If multiple vics, then the ones who are less likely to survive are triaged as less urgent and the ones that can be helped are concentrated on- those with no discernable signs of life are listed as DOA and they move on.

All good answers above. Another issue is organ donors. If the victim is identified as an organ donor, they will make it a priority to get the body to the ER ASAP. Our EMTs have conducted CPR on victims we were sure were brain dead on the way to the ER, in order to preserve the organs.

The short answer to your original question is, if there is ANY question that the victim might be saved, they do everything possible to get him to the ER, and they would not declare that person dead on the scene.

In our department, as Kity Pride said, It has to be obvious that the victim is dead, and even then the coroner was called to the scene to declare him dead. Half the time the coroner would instruct us to transport the victim to the ER and he would meet us there. He was sure to get a free cup of coffee that way.

These two books should pretty much answer any question anyone may have about murder-scene investigations and coroners' offices (which, of course, handle not only murder victims but also car-accident victims, etc.). Going to them on Amazon will also show you lots of other books on the same topics.

Crime Scene Investigation (by Dr. Cyril Wecht, one of the best forensic pathologists on the planet)
http://www.amazon.com/dp/0276429745/?tag=absolutewritedm-20

Deadhouse: Life in a Coroner's Office
http://www.amazon.com/dp/157806743X/?tag=absolutewritedm-20