Question: With respect to the Medical TOR, can we leave a deceased patient with family members after the TOR has been granted? It does not state in our medical directive who we can leave the body with (I always presumed it would Police, a family doctor, Coroner, Supervisor, Nurse at Nursing Home / patients home, etc.). In the Deceased Patient Standards it does state under responsible person / unexpected death chart... family members would be acceptable. I would imagine it would depend on the situation at the scene and family members state of mind. If you and your partner are at the scene of a medical TOR and another call comes in down the street for a code 4 - VSA for example, can both crew members leave the scene and have family take over care of the body? I know you could do a first response with one crew member, but again, two would be optimal. If you were a Supervisor on scene taking over care for your crew, could you leave the pt in the care of family and do a first response? You are on scene with a patient who has met the Obvious Death Criteria, can you leave the patient with family members or do we wait for Police, Supervisor etc. to attend the scene? Just wanting clarification on who would be the 'responsible person'. If a Paramedic felt that family would meet the criteria for 'responsible person', could we have family take over custody of the deceased person for Medical TOR or Obvious Death Criteria providing scene was safe, family coping well, no suspicious events at scene, etc.?
Thanks for the questions (there really are quite a number included in this one!).
Once you have a patient who meets the definition of a "Deceased Patient" which includes those who fall under the Medical TOR directive, it is important that you follow the Deceased Patient Standard (and you can find a copy of it here) www.lhsc.on.ca/About_Us/Base_Hospital_Program/Education/EHS_Training_Bulletins.htm
A major difference exists between cases involving "obvious or unexpected death", and cases of "expected death". In cases of obvious or unexpected death, found on page A-2, the standard (item #2) says the paramedic will contact dispatch who will then contact the coroner. If the coroner (or delegate) is attending the scene, the paramedic will stay on-scene until the coroner (or delegate) arrives. In item # 3, if there is going to be a delay for the coroner (or delegate), dispatch will seek further direction from the coroner as to whether or not the paramedics can leave the scene. There is no mention of a leaving the deceased patient with a "responsible person" in this part of the standard.
In cases of expected death (page A-3), the paramedics still contact dispatch. In item # 4, if the primary care physician or palliative care team member is coming to the scene, the paramedic remains until their arrival. However, item # 5 states that the paramedics can leave the scene provided a "Responsible Person" is present and the paramedics believe this person will remain on-scene until the arrival of the primary care physician or palliative care team member. The standard defines a responsible person as "an adult who, in the reasonable belief of the paramedic, is capable to remain with the Deceased Patient and assume responsibility for the Deceased Patient". Your supervisor could certainly be a responsible person, as could family members if you determine they are coping well. Police officers on-scene can also accept responsibility for the deceased patient in these cases.
Items # 6 and 7 provide further direction should the primary care physician or palliative care team member not be able to attend the scene, or no responsible person is available to wait on-scene. Paramedics should contact dispatch who will get direction from the coroner and/or police, including whether or not they can leave the scene.
Your local service likely also has operational policies that direct your actions when dealing with a deceased patient including whether or not you can conduct a first response with one paramedic