Obvious death means the patient shows signs or injuries clearly incompatible with life, so resuscitation would not help and should not be started. Responders confirm death following local protocol, protect the scene and support the family.
Key symptoms
- Unresponsive, with no breathing and no pulse
- Found long after last being seen well
- Stiff jaw and limbs (rigor mortis)
- Purple pooling of blood in the lowest body parts (dependent lividity)
- Valid DNR order or POLST at the scene
What you find on exam
- Confirm no pulse, no breathing and no heart sounds
- Look for decapitation, decomposition, incineration or other injuries incompatible with life
- Fixed, dilated pupils
- Asystole on the monitor in more than one lead
- Note body position and scene details
Tests
- ECG strip showing asystole for the record
- Contact with medical control per protocol
- No laboratory tests in the field
- Record the time death was determined
Treatment basics
- Do not start CPR when obvious death criteria are met
- Leave the scene undisturbed if a crime is possible and notify law enforcement
- Notify the medical examiner or coroner per local rules
- Support the family with plain words, including the word dead, and time to grieve
- Document all findings carefully
Red flags
- Any doubt about death: start resuscitation
- Hypothermia or cold water drowning: the patient may still be revived
- Signs of violence or an unsafe scene
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; NREMT psychomotor skill sheets (EMT and Paramedic); National EMS Education Standards (2021). Written by Making Synapses. Making Synapses is not affiliated with these organizations.