Paramedics declare death – A lifesaving decision

Objective Mobile Intensive Care Units (MICUs) are a valuable resource and their effective use is essential. In May 2012 Magen David Adom (Israeli National EMS) paramedics were allowed to declare and document death. The aim of this study is to assess if allowing paramedics to declare death leads to better utilization of MICUs. Methods Records were retrospectively analyzed before and after the adoption of the new directive allowing paramedics to declare and document death. MICU dispatches to declare death were retrospectively analyzed to evaluate dispatch times and call quantity difference. Results A total of 31,096 cases were evaluated where a MICU was dispatched to declare death. Average time on scene of the MICU pre-protocol was 63.14 min (N=15,408, sd=28.77), compared to a post-protocol time of 67.31 min (N=15,688, p=0.024, sd=28.30). A total of 110.44 minutes was used to declare death pre-protocol. These 110.44 min are significantly longer than the post-protocol average of 68.56 minutes (p<0.01; 95% CI (35.94, 47.81)) conservatively saving 41.88 min per call. In addition, there were 2196 cases of ROSC (Return of Spontaneous Circulation). Conclusion Applying the 41.88 excess minutes to the yearly 2543 calls pre-protocol extra yearly 1828 valuable hours have been saved. A recent study in Jerusalem concluded the percentage of survival to discharge was 6.1%, of whom 3.4% were neurologically intact. Applying these findings to this study we find that approximately 25 more patients per year survive to discharge neurologically intact post-protocol, therefore such guidelines not only save time, but might also save lives.