how to verify death

see also:

• death and the potentially dead
• the deceased patient in the ED
• verification of brain death in the ventilated patient
• reportable and reviewable deaths - deaths which MUST be reported to the Coroner
• how to complete a death certificate for cause of death

• a person is dead when there is irreversible cessation of circulation of blood in the body of the person, OR, irreversible cessation of function of the brain of the person.
• WA requires two medical practitioners certify that irreversible cessation of brain function has occured before organs or tissues can be removed for transplanation purposes ¹⁾
• New Zealand does not have a statutory definition of death

• verification of death is the process of assessing the person for absence of signs of life and documenting the time this assessment was done and what clinical features supported this assessment
• this is usually done by a doctor, but an on duty Div 1 or Div 3 nurse or ambulance paramedic may do so to ensure timely verification of death to alleviate any unnecessary delays in the movement of a deceased body from the place of death to a suitable location such as a mortuary, holding room or funeral service where a registered medical practitioner is unavailable immediately to sign the MCCD or to document in some other way that a person has died.
• nurses and paramedics should only ‘verify death’ when acting within an employment context.
• nurses and paramedics can opt out of this process as it is voluntary for them
• see Victorian government guidance note for the verification of death Feb 2010 (pdf)

• professional clinical judgement is required to make this determination and unique circumstances may warrant additional checks over and above the minimum guideline provided below.
• No palpable carotid pulse and
• No heart sounds heard for 2 minutes and
• No breath sounds heard for 2 minutes and
• Fixed (non responsive to light) and dilated pupils and
• No response to centralised stimulus (e.g. trapezius muscle squeeze, supraorbital pressure, mandibular pressure or the common sternal rub) and
• No motor (withdrawal) response or facial grimace in response to painful stimulus (e.g. pinching inner aspect of the elbow)
• optional:
  • ECG strip shows no rhythm

• assessing person's name and professional title
• date and time assessment took place
• clinical determinants used
  • eg. “no pulses, no heart sounds, no breath sounds, pupils fixed and dilated, no response to pain, certified as deceased at ….”
• should be documented in the medical record
• a copy of this should go with the patient if it is a reportable or reviewable death