Clearly Dead?

Jeff Clawson, M.D.

Jeff Clawson, M.D.

Ask Doc

Dear Dr. Clawson,

My name is Sebastien Maire. I’ve attended the medical director course in Tucson, Arizona, in 2004. I’m now working in the emergency department of the hospital Hotel-Dieu de Levis in Quebec. I also spend some time doing prehospital work with Doctor Jean Lapointe that I think you met a few years ago during your stay in Quebec.

During the last meeting of our 911 center (that is CAUCA: Chaudiere-Appalache’s 911 center), a question came out about Protocol 9 (that is cardiac arrest/ death). People were wondering if all the questions of the entry protocol (Is he conscious? Is he breathing?) needed to be asked when someone was calling for a person who’s dead and clearly identified as dead (example, a nurse from a medical facility is calling and saying the patient is rigid and cold in a warm ambient temperature). The question arose because it seems that the responses for the conscious and breathing questions are frequently the repetition of “He is dead, as I already told you. Why are you asking me that?”

We do understand the utility of these questions when a cardiac arrest is not certain. We will conform to your answer on the subject, that we think is different from an uncertain cardiac arrest. If you think that a modification of the Case Entry protocol is not possible, we would gladly accept any other input you would have on the subject.

Sincerely yours,

Sebastien Maire, MD, FRCPC (emergency medicine)

Medical Director Assistant in Chaudiere-Appalache

Quebec, Canada

Dear Dr. Maire,

It is good to hear from you. This is a good question that we have heard many times before. The answer has several aspects:

1. We do not know the actual level of training (and competence) of everyone we encounter as a caller, regardless of what they claim

2. We do not know if they were the actual person that evaluated the patient 3. Medical people make mistakes, occasionally

4. We need verification for the audiorecorded record that we clearly determined the absence of consciousness and breathing without any grayness.

Within the spirit of protocol enhancement and tactfulness, if a caller is known to be a medical professional, these questions could be posed as follows:

Okay, for the record, is he conscious? Answer: No

Again, for the record, is he breathing? Answer: No

Thank you for your patience. We just want to be completely sure, as our protocols and verifications here at 911 require.

When we start changing the protocol to solve social and emotional (not clinical) issues, we generally cause more problems—not less.

Finally, any professional nurse or doctor that would get mad at a 911 calltaker needs to be questioned because they are clearly not all together emotionally—a condition more prone to mistakes, I might add.

I hope this helps. Let me know if further discussion would be useful …

Jeff Clawson

P.S. Please give Dr. Lapointe my best regards!