What is an obvious death?
There are instances where a firefighter or police officer may be first on scene to a call, where a length of time has passed since the onset of the cardiac arrest and the arrival of first responders. A firefighter or police officer may withhold resuscitation if efforts would be deemed futile.
As per the Guideline for Determination of Obvious Death in the SWCPM Medical Directives and Policies, “obviously dead” means that death has occurred if gross signs of death are evident, such as:
- Decapitation, transection, visible decomposition, or putrefaction; or
- Absence of vital signs and:
a. A grossly charred body;
b. An open head or torso wound with gross outpouring of cranial or visceral contents;
c. Gross rigor mortis (i.e., limbs and/or body stiff, posturing limbs or body); or
d. Dependent lividity (i.e., fixed, non-blanching purple or black discoloration of skin in the dependent area of the body).
What is rigor mortis?
When a patient dies, a chemical change occurs that prevents muscles from relaxing, causing them to stiffen. Rigor mortis can occur 2-4 hours after death and initially affects smaller muscle groups, such as the face and jaw, before spreading to the limbs.
What is lividity?
Lividity is the pooling of blood that causes discoloration of the skin. When death occurs, blood stops circulating and, due to gravity, pools in the lowest dependent portions of the body, such as the arms, legs, and back.
Both lividity and rigor mortis can be affected by various circumstances, such as environmental factors and the patient’s health condition prior to death. If the firefighter or police officer is unsure whether the patient has lividity or gross rigor mortis, they should initiate resuscitation efforts and err on the side of caution.
What if, on assessment, stiffness is noted in the patient’s jaw, but no other “obvious death” criteria are present?
Gross rigor mortis is defined as limb or body stiffness and does not include isolated jaw stiffness. Jaw stiffness alone is not an indication of rigor mortis. If isolated jaw stiffness is noted during assessment, firefighters and police officers should initiate resuscitation as per the appropriate medical directive.
What happens if paramedics arrive on scene after fire or police have initiated resuscitation and upon their own assessment determine the patient meets obvious death criteria?
Paramedics are the highest medical authority when they arrive on scene and are often (but not always) more experienced in assessing patients for signs of obvious death. In situations where paramedics determine obvious death, they can instruct firefighters or police officers to cease resuscitation and do not need to call a Base Hospital Physician (BHP) to receive a termination of resuscitation (TOR). Please ensure that it is documented that when paramedics assumed patient care, they directed firefighters/police officers to stop resuscitation.
