Calling a Patient Deceased Too Early…

The SMH website reported a case in Victoria (Australia) on the 1st of April in which two MICA paramedics (senior paramedics) identified one patient as trapped and deceased before expediting to hospital with another patient who was seriously injured. The “deceased” patient was alledgedly later found by SES workers to still have signs of life and was transported to hospital.

Although, only a full enquiry into the event will determine what happened and what can be done to prevent a similar event, it is an important lesson to be learned for all paramedics to be certain before calling a patient deceased. This is particularly difficult and important in a motor vehicle crash, in which there are often multiple casualties. It is often difficult while treating multiple patients, or seriously injured patients in a motor vehicle crash to take that extra minute that is required to flash the torch inside a vehicle and outside and look for other patients. This is particularly difficult when you have one or more critically injured persons who need your full attention.

I remember many years ago treating a very sick mother who was unconscious and trapped in a car, when we eventually extricated her and left the scene, she became conscious and started to become concerned about her baby. None of us had seen her baby in the car. There were multiple casualties, and these were still being treated at scene. Fortunately, someone ended up finding her baby (still alive) and had been thrown through the windscreen. Another time, I remember a crew calling a helicopter off because the only patient of a high speed roll-over had no pulse and “presumed” dead. More than half an hour later, the same crew called the helicopter back stating that they had originally only felt an absent pulse in a trapped, but severed arm, and the patient was still alive.

These are very rare and extreme circumstances, but they do happen.

It is also important to note that in some circumstances, the paramedics are correct to treat a trapped person as “deceased” if they do not have the resources to save all lives. In a multiple victum situation, many emergency management protocols focus on the concept of “providing the most good for the most number of casualties” – this does not necessarily mean that you can save them all.

At the end of the day, paramedics work in a very difficult environment and do the best they can to save the people they can. This sounds like a terrible accident that could have happened to any paramedic, but will definitely be in the back of my mind the next time I treat someone as deceased at a scene.