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View Full Version : Car accident dead at the scene & Paramedics - timeline question



Wilde_at_heart
10-16-2013, 12:09 AM
Hi,
I've got a WIP where a van crashes at an intersection - t-boning the side of a car. It's supernatural, so the two in the van were actually killed immediately before the crash but it's only discovered later that the injuries sustained in the collision were all post mortem. (And no, they don't come back to life or anything, but they are killed by supernatural means - their life 'force' is literally sucked right out of them.)

In many newspaper articles, there are things like 'declared dead at the scene by paramedics.' I get that a lot of the 'official' business such as issuing death certificates and so on are dealt with later by the appropriate authorities and in a triage scenario, your priority is the severely injured one you know is still alive.

What I'm wondering is, what is the approximate amount of time that it takes to determine death, starting with, say, the paramedic climbing into the back of the van where the body is lying?

Thanks.

jclarkdawe
10-16-2013, 01:51 AM
Anywhere from a split second to a few minutes. Depends. Decapitation is a split second. Not too serious external injuries and it might take longer. Also depends on whether friends and family are around. Also depends upon how many patients versus how many EMTs.

Quite honestly, it's fairly easy to identify dead and probably going to die at a car crash just by a quick glance. The rest is confirming what you already know.

First thing you check is airway, breathing, and circulation. ABCs. Assuming no breathing and circulation from feeling for the carotid pulse and looking and feeling for chest movement, next step is checking with a stethoscope. No sounds with the stethoscope? Probably take out the monitor/defibrillator and seeing whether it shows a flat line.

You then call medical control, give a quick situation report to the nurse who answers, and ask for a doctor. You tell the doctor the more detailed description of what you found, and depending on the doctor, ask if you can call it/what does the doctor want you to do. No more then five minutes from time on scene.

After you call the victims, the police will start investigating and body removal can't be done until after their investigation is complete.

Best of luck,

Jim Clark-Dawe

asroc
10-16-2013, 01:52 AM
It doesn't quite work that way. Paramedics can't declare anyone dead, but we can, under certain circumstances, determine there is no point in starting resuscitation. In order for that to happen the patient must display injuries not compatible with life (decapitation, massive head trauma with visible brain matter, total exsanguination etc), or other obvious signs of death, like rigor, pronounced lividity or decomposition. In those cases the patient is presumed DOA. If this is not the case the medics have to start resuscitation.

However, if they are sure the patient's not going to live they have the option of calling their medical control over the radio, explain the situation and have the doctor declare the patient over the air. The specifics of that depend on their protocol. In some places you have to do a couple of rounds of CPR before you can call it in, and sometimes medical control insists on bringing the patient in.

So it depends. (Aren't I helpful?) If your characters got their heads torn off, it's a matter of seconds, but EMS might also work on them all the way to the hospital.

MaryMumsy
10-16-2013, 05:01 AM
It is going to depend on where your story is set and the local rules. Almost 20 years ago my FIL dropped from a massive heart attack. The EMTs were not allowed to 'pronounce'. They had to haul him to the hospital in an ambulance (which MIL received a bill for) so a doctor could pronounce. My understanding is that it is different now, but have no recent experience.

MM

jclarkdawe
10-16-2013, 06:08 AM
A witnessed arrest (heart attack observed by others) should always be worked, unless the patient has a do not resuscitate order. I might not have a whole lot of hope in that situation, but we do get people back from that situation. Not often, but if you're the one we save, it's worth it to you.

Best of luck,

Jim Clark-Dawe