My correspondent writes:
When attending a case in which a patient has died, state paramedics in Queensland can cease or withhold resuscitation based on a protocol contained within the clinical practice manual we use. Following this, the paramedic who ceased or withheld resuscitation can complete a Recognition of Life Extinct (R.O.L.E.) form and hand this to the attending police officers in order to provide evidence that an assessment has been undertaken to confirm that the person is deceased so that their body can then be removed from the scene and certification of death by a doctor can be carried out separately. This system works well for state-employed paramedics.
If the same circumstances were to occur on a mine site or gas construction site many hours from a state ambulance response, what would be the position of a commercial paramedic who was in attendance? They can cease or withhold resuscitation based on similar criteria as their state-employed counterparts, but would they, in their commercial capacity, have the ability under legislation to complete a “Recognition of Life Extinct” without input from the state ambulance service? Is this something that would need to be documented in their own clinical practice manual or is there specific legislation that refers to recognition of life extinct and the role of an “Ambulance Officer”.
The relevant protocol is ‘Clinical Practice Guidelines – Other Emergencies’. Relevantly that Guideline says (at p 3):
Part B – Management of a deceased person
Recording life extinct
Following determination that life is extinct, the paramedic is to complete a Life extinct form and the eARF.
Details regarding the criteria relied upon to determine life extinct are to be recorded on the eARF.
The paramedic is then required to record the following in the eARF:
I declare life extinct at [record exact time of declaration].
Notification of death to police
The Queensland Police Service (QPS) is to be notified of all deaths and provided with information that will assist the police to determine if the death is a reportable death as defined in the Coroners Act 2003 (Qld) (see following for the definition of reportable death).
eARF is the ‘Electronic Ambulance Report Form’ (see https://ambulance.qld.gov.au/records.html).
The ‘Life Extinct Form’ appears to be a Queensland Police form (QP0001). The Queensland Police Operational Policy on Coronial Matters says (at p 12) that even though they have a form, ‘There will continue to be instances where other versions of a Life Extinct Form will be used. For example, the Queensland Ambulance Service will use an Electronic Ambulance Report form to record the life extinct procedure.’
Queensland Corrective Services have a life extinct form, and whilst that is clearly a Corrective Services’ form I assume it is for all intents and purposes it records the same information as either QP001 or the eARF. In essence the paramedic is signing either a printed form, or the eARF to the effect that they examined the patient, determined that criteria to determine life extinct had been met, that is:
- No palpable carotid pulse;
- No heart sounds heard for 30 seconds;
- No breath sounds heard for 30 seconds;
- Fixed dilated pupils; and
- No response to centralised stimuli (‘Clinical Practice Guidelines – Other Emergencies’, p 2).
The eARF implies that is the basis of the diagnosis and confirms the time of that diagnosis.
Now to the law. The relevant law is, as the Practice Guideline says, the Coroners Act 2003 (Qld), as well as the Births, Deaths and Marriages Registration Act 2003 (Qld).
An application to register a death in Queensland must contain, amongst other details, information about the cause of, and the date of, death (Births, Deaths and Marriages Registration Regulations 2003 (Qld) reg 12 and Schedule 1). The paramedic’s eARF cannot record the cause of death but gives some evidence as to the date of death, or at least that the date of death was not after the date recorded on the eARF. The cause of death may be certified by a doctor if the doctor
(A) attended the deceased person when the person was alive; or
(B) examined the deceased person’s body; or
(C) has considered information about the deceased person’s medical history and the circumstances of the deceased person’s death; and
the doctor is able to form an opinion as to the probable cause of death. (Births, Deaths and Marriages Registration Act 2003 (Qld) s 30).
Consideration of ‘ information about the deceased person’s medical history and the circumstances of the deceased person’s death’ would include consideration of the fact that the person was identified as dead at the time and date recorded on the eARF.
Some deaths must be reported to the Coroner, a reportable death is one where:
(a) it is not known who the person is; or
(b) the death was a violent or otherwise unnatural death; or
(c) the death happened in suspicious circumstances; or
(d) the death was a health care related death; or
(e) a cause of death certificate has not been issued, and is not likely to be issued, for the person; or
(f) the death was a death in care; or
(g) the death was a death in custody; or
(h) the death happened in the course of or as a result of police operations. (Coroners Act 2003 (Qld) s 8).
A coroner must investigate a reportable death and record, if possible, ‘when the person died’ (Coroners Act 2003 (Qld) s 45(2)(c)).
None of these Acts, or their regulations make reference to ‘life extinct form’.
It is the duty of Queensland police to assist the coroner in the investigation of deaths (Police Powers and Responsibilities Act 2000 (Qld) s 794). Police must also complete a Form 1 Police Report of Death. This form is prescribed under the Coroners Act 2003 (Qld) and that is where the paramedics ‘Life Extinct form’ comes in. The Life Extinct form is not legally prescribed, it is simply evidence that assists the police to report to the coroner (if the death is reportable) and any doctor who is completing a cause of death certificate to know at least a date time that the patient was dead. The form is, as I say, evidence but it is not provided for in legislation and so is not something that is unique to Queensland Ambulance. As noted Corrective Services have a similar form as do others (see Capricornia Department of Health and Ageing, Aged Care Resource Pack, 2005).
So if a private or ‘commercial’ paramedic were to face a case where the person they are called to assist is clearly dead, ‘would they, in their commercial capacity, have the ability under legislation to complete a “Recognition of Life Extinct” without input from the state ambulance service? Is this something that would need to be documented in their own clinical practice manual or is there specific legislation that refers to recognition of life extinct and the role of an “Ambulance Officer”’?
Whether they could complete a life extinct form would depend on their relationship with the local police. If the private ambulance company developed a form they could speak to the local police about whether or not that would be useful. In the absence of the form the police would simply need to take a statement recording when the officer’s attended and determined life was extinct. That may be no more than notebook entry. Even if they did not liaise with the police, a private ambulance company could develop a form but whether the police decided to accept it at face value would be a matter for the investigating police in each case. Any ambulance provider would, I suggest, have to have clinical guidelines on determining when life is extinct and resuscitation can be withheld or withdrawn and any such guideline should also provide for appropriate record keeping so yes the use of any designed form should ‘ documented in their own clinical practice manual’.
There is no legislation that ‘refers to recognition of life extinct and the role of an “Ambulance Officer”’ either a QAS officer or anyone else. As I say all the form is, is evidence; it has no legal effect, it just helps the police, the coroner, and a doctor who may be completing a certificate as to the cause of death, to know that the person was at least dead at the time on the paramedics form.