Death Protocol

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Unexpected Death

  1. Physician (or CHA) will call the Bethel Police Department for Bethel patients or Village Police Officer (VPO) for village patients
  2. The provider pronouncing the patient dead will need to speak with Alaska State Troopers (AST) at 907-543-2294 AND Medical Examiner (ME) at 888-332-3273. Get the ME case number for your records. The ME will gather information regarding the medical issues and circumstances of the death to make a determination of the need for an autopsy or not. The ME makes the final decision, but the physician can occasionally be persuasive one way or another in some cases. It is a good idea to give the ME and Troopers a good contact number for you in case questions arise later.
  3. VPO/Troopers/Hospital will maintain custody of the body until they and the ME make a decision whether to release the body to the family or bring the body to Anchorage for an autopsy.

4. The pronouncing provider will not be responsible for signing the death certificate of any patient that is an ME case.

Expected Death

An expected death should have an Expected Home Death Form completed and on file at the Bethel Police Department and the Troopers office. If the form was not completed before death or cannot be located, then the form can be completed and faxed after the death. This is important to do so that VPO and Troopers can release the body to the family without further investigation unless there are other suspicious circumstances

YKHC Expected Death Protocol in Clinical Resource Book

Medical Orders for Scope of Treatment (MOST) form can help with patient care discussions with family members for anyone with a life limiting illness.

All Deaths

  • Provider or CHA must document vitals and time of death in RAVEN
  • Provider must write a free text /message or encounter death note in RAVEN (using the FIN number for that event encounter). This encounter should document
    • Time of death
    • ME case number
    • Life Alaska reference number
    • Circumstances of the death and
    • Documentation that all required communication has occurred.
  • A Death Packet needs to be completed (located at NW and ER Nursing station). You can fill out appropriate forms for the village death using these packets or you can print forms from Death Packet Forms. This packet includes a notification of death, information for notifying Life Alaska with the Donor Protocol, a Transit Burial Permit (usually done by Alaska State Troopers in the village), Certificate of Death, Post Mortem Exam Release if needed and a packet of information for families about burial etc.
  • A preliminary draft copy Certificate of Death needs to be completed with the name of the patient, DOB, village location and next of kin with a good contact number. The certifying physician needs to complete reason for death, their name and title and license number. Rebecca Tunuchuk-Anvil (medical records technician) or YKHC Health Information Management will have the Official Certificate of Death request form completed and typed. You will be asked to sign the formal certificate. It is important to sign as soon as possible so that the family gets the death certificate processed for benefits etc.
  • A copy of the death note/message/encounter and the completed Certificate of death should be forwarded to Rebecca Tunuchuk (medical records technician) or YKHC Health Information Management with a cc to Chief of Staff. Please make a note about whether you will be signing the death certificate. For ME cases this will not be the pronouncing provider.
  • Complete Code Blue, Rapid Response, and Critical Care Debriefing Form.
    • For hospital events, the physician team leader and charge nurse are responsible for completing this form.
    • For village codes, the physician is responsible for completing this form.
    • Include feedback from every participant in the event.

Deceased will be kept in morgue in the hospital until disposition of body occurs.

Hospital Deaths

Nurses in the ER and NW use the Death Packet forms and protocols. They make all the calls (except ME) and complete the forms. The physician will need to fill out portions of the preliminary Certificate of Death as described in number 4 above and Notification of Death form.

Village/SRC Deaths

Pronouncing a patient dead in the village can be a challenge. It is simple if there is evidence of trauma that is not compatible with life or rigor mortis has set in. With unwitnessed events, the CHA must check a pulse for a long time and in more than one place. If a patient is found apneic and pulseless, without a witness, CPR should be initiated. CPR can be stopped if there has been adequate CPR and resuscitation without response. If a patient is found hypothermic, CPR needs to be initiated and the patient’s core temperature brought up to >90 degrees before a patient can be pronounced dead. A patient is not considered dead until they are “warm and dead.”

Emergency RMT Scenarios and Responses

Death Packet Forms

Disposition of Body

Notification of Death

Transit Burial Permit Procedures and Request Form

Expected Home Death Form

Death certificate worksheet