Question: The PCP Medical TOR says that I can "move the patient to the ambulance prior to initiating the TOR if family is not coping well or the arrest occurred in a public place". What is an example of a public place? and if I move them to the ambulance and then get the TOR, is this now the place of death and I have to wait for the coroner to arrive?
A public place is meant to define a location where, at the discretion of the paramedic, it is felt that pronouncing the patient and then leaving the body in full view of the public while awaiting the coroner to attend or release the body would be inappropriate. Classic examples of such would include (but not limited to) on the ice at a packed hockey arena, on the floor beside the table at a packed restaurant. This is at the discretion of the paramedic.
To be clear, in these public situations or any cardiac arrest situation, timely defibrillation is a key element of survival. As such, it is the preference of the SWORBHP Medical Directors that cardiac arrest protocols are followed where the patient is found as often as possible and when (of course) scene safety concerns are considered.
If the decision is made for whatever reason to move the patient to the ambulance prior to a TOR being approved by the BHP, then the paramedic is to follow the Deceased Patient Standard. This standard states that if the TOR is granted in the back of a moving ambulance then the ambulance can continue on to the receiving hospital. If the TOR is granted in the back of a non-moving ambulance, then this becomes the scene of death and the ambulance cannot move until it is released by the coroner.
Deceased Patient Care Standard link: http://www.ambulancetransition.com/pdf_documents/training_bulletin_111_deceased_patient_standard.pdf