Medico-legal protocols

Dead on arrival (BROUGHT DEAD)

A patient may be found to be already dead on arrival at Emergency Department
1. On arrival at emergency department, if patient is found unresponsive the
CMO will be informed immediately.
2. Causality Medical officer will examine the body before removing from
transport. The following will have to be checked:

Dilated pupils, Non-reactive to light

Absence of heart beat

Absence of breathing

3. Take past history HTN / DM / IHD etc. from the attendant if available
4. Look for / Ask about any suspicious signs:

Poisoning Smell

Strangulation Ligature mark around neck / abnormal signs

Any external injuries

5. Expose the body completely and look for any external signs of injury.
6. Palpate the head and look for any haematoma, etc which may be missed.
7. If case of female patients, ask history of married life and if it is less than 7
years register it as MLC, it is mandatory.
8. Register all brought dead cases as medico-legal case if death has occurred
unexpectedly or from an unexplained cause.
9. After complete examination and confirmation by clinical evaluation death
& is confirmed, the individual should be declared as Brought in Dead (BID)
and the accompanying relatives/friends must be explained and informed
about the probable cause of death. They are given a Brought Dead
Certificate after the cause of death is confirmed.
10.No MRD shall be generated.
11. In such cases whether or not an attempt at resuscitation was made,
the following procedure must be initiated, and an entry made in Dead
on Arrival Register of :
a. Patients name
b. Age
c. Sex
d. Address
e. Fathers/husbands' name, address.
f.

If female patient, any overt signs of pregnancy? Bleed PV?

12.The local police should be informed immediately in case there is suspicion

or foul play. The police will do the further disposal of the dead body after
inquest. The Emergency Medical Officer will render necessary assistance.
13.Time of arrival of the dead body will be recorded
14.Information will be provided to the relatives that the death certificate will
be issued by the concerned authority and only after post mortem is done.
15.In case of unknown BID, body will be handed over to the police. Details to
be entered in the BID book and signed by the police
16.

In case of Brought in Dead Patient who was treated earlier in

hospital concerned consultant will be informed and the death certificate to

be issued as per his instructions.
In case foul play is suspected, the case is registered as MLC, Police informed,
etc., body to be handed over to police.
BROUGHT IN DEAD PROTOCOL

REGISTRATION
DO 12 lead ECG
RESUSCITATION FOR 30 MINUTES- (If event is less than 10 min)- discretion
of duty ER physician.
DECLARATION TO (next of kin/family/ accompanying person/police)
WRITE DETAILS IN BROUGHT DEAD BOOK, ATTACH ECG COPY
ISSUE BROUGHT DEAD CERTIFICATE IN DUPLICATE (CARBON COPY)
[Format for entry in brought dead book]
[Name,age,sex, s/o w/o d/o]_____________________________________
____________________________________________________________ was brought to the
emergency room of _________ Hospital at______am/pm on .

No spontaneous respiration/ pulse/ BP were recordable, 12 lead ECG

showed flat line in at least two leads.

ALS resuscitation was carried out for 30 min, with no response.

ALS resuscitation was not carried out as (reasons) -----------------------.

Patient was regretfully declared dead at___________am/ pm, on ...

Brought dead certificate issued to
Name & Signature of CMO on Duty
{Name of the Hospital}

Time & Date

Seal
Death in ER Death & Release of Dead Body
In case of a very serious patient, if despite resuscitation, the patient is not
revived and death occurs. The same has to be announced to the family.
The exact time of death has to be noted.

Death of a patient should be handled carefully with due respect to the

deceased. Body must be handled with care. After the necessary formalities
have been done, the body will be shifted outside the treatment area and
packed as per the protocol.

All necessary forms will be filled and handed over to the relative/ next of
kin and an acknowledgement will be taken for the body as well as the
certificates.

In case of any confusion, the Consultant Incharge EACD/Chairman must be

contacted immediately.

If there is a request to keep the body in mortuary, it must be brought to

the notice of the Medical administration. The Medical Administration will
decide about it.

The ER staff and the security will help in shifting and loading the body on
the hearse van.

Death Certificate
In the event of death of an inpatient / ER, CMO will verify the cause of
death with the concerned consultant/consultant on call.

Death certificate will be issued by the CMO.

No Death certificate will be issued by the CMO for BID cases.

The name, address and other details of the deceased will be confirmed
with the family before making the death certificate.

The cause of death should be well documented and a copy of the Death
certificate should be filed along with the medical documents of the
deceased patient.