In August of this year, a man who allegedly lunged at Baltimore City, MD, police officers with a knife was shot and killed. Paramedics responded to the scene, examined the patient and declared him dead. However, he began moving on the ground some 30 minutes after he had been pronounced dead by paramedics. Those same paramedics were called back to the scene and determined he was still alive.
Is it a mistake by the medics? Is it a fluke? Divine intervention? Who knows!
As legend has it (and some dispute this), the phrases "dead ringer," "saved by the bell" and "graveyard shift" all came about during the 1500s in England when space to bury people ran out. The bones of the dead would be dug up and put in a "bone house" so that graves could be reused. That's when it was noticed that about one in 25 coffins had scratch marks on the inside or bodies were in different positions from when they were buried. It was realized people were being buried alive. To prevent this from happening, whenever anyone was buried, a rope would be attached to a person's hands and run to a bell outside the grave. Someone would then have to listen for the bell. If nothing happened after a couple of days, the rope was pulled back up.
Our technology for determining death is better today, but it still happens.
Once I was browsing through an airport bookstore and a title of a book caught my attention — 90 Minutes in Heaven: A True Story of Death & Life. The story deals with a man named Don Piper, who died when his car was crushed by a semi-truck on his way home from a conference. Medical personnel who responded to the scene declared him dead and threw a blue tarp over his body while police investigated the scene and waited for tow trucks to arrive. The book describes Piper's experiences in heaven and his time spent during the numerous surgeries and recovery, but you cannot discount that he was declared dead and some 90 minutes later came back to life.
I was recently involved as an expert witness in a lawsuit outside Chicago, IL, where a horrific car crash killed three people after a wrong-way driver hit them head-on in the early-morning hours. One individual who was thought to be dead was later found to be alive in the backseat of the car by Illinois Department of Transportation (IDOT) personnel on the scene. This individual was checked twice with a heart monitor, which showed asystole (no cardiac electrical activity), and physically examined several times by different individuals — all who said he was dead. Ten minutes later, the IDOT worker noticed his chest rising and falling.
How does something like this happen?
A Google search reveals this happens more often than you think. I found stories from Arizona, California, New York, North Carolina and Virginia as well as Canada, the United Kingdom, Ireland, India, South Africa and elsewhere.
In a Brooklyn, NY, case, two EMTs responded to the scene after a landlady reported that her tenant was unconscious in the basement apartment. Examining the woman, the EMTs declared her dead after detecting the beginning of rigor mortis and the pooling of blood where her limbs rested on the floor. The medical examiner, a physician who responded to the scene, was in the apartment more than a half-hour when he heard what sounded like a single faint breath from the woman. The problem in this particular case is that the two medical personnel on the scene were EMTs and disregarded the paramedics responding to the scene. If the paramedics had arrived, they would have been able to hook the woman up to the monitor/defibrillator to determine whether she had any heart activity. But even a medical doctor thought she was dead for the half-hour he was there.
In North Carolina, a man hit by a car was declared dead by paramedics. Reportedly, a paramedic checked the man's vital signs only once before declaring him dead. A paramedic even saw his eyes twitch, but chalked it up to involuntary muscle movements. The man was placed in a body bag and transported to the morgue. Two hours later, while the man was in the morgue, the medical examiner who was examining the body noticed him breathing.
Basically, there are those we can explain and those we cannot explain. If the news reports from Brooklyn and North Carolina are true, it is easy to see how someone who is alive can be declared dead. However, the unexplained ones are the Don Pipers and the case out of Illinois where everything is done correctly, people are declared dead, and then later they come back to life.
Fire departments should have protocols from their medical directors on how to declare someone dead, including obvious death such as decapitation or decomposition. For those who are not obviously dead, the protocols at a minimum should include a physical examination and an EKG to determine heart activity. Make sure you follow your protocols and that your documentation is accurate and thorough. Above all, make sure you document no heart activity with a rhythm strip. Hopefully, you can stay out of the news and out of the courtroom by doing everything correctly.
GARY LUDWIG, MS, EMT-P, a Firehouse® contributing editor, is a deputy fire chief with the Memphis, TN, Fire Department. He has 32 years of fire-rescue service experience. Ludwig is chairman of the EMS Section for the International Association of Fire Chiefs (IAFC), has a master's degree in business and management, and is a licensed paramedic. He is a frequent speaker at EMS and fire conferences nationally and internationally, and can be reached through his website at www.garyludwig.com.