How Do Doctors or Paramedics Know When a Person is Deceased? Debunking the Myth of Reviving in the Morgue

Introduction

There is a widespread myth suggesting that individuals can sometimes be declared dead but later regain consciousness in the morgue, leading to them waking up inside body bags or coolers. This article aims to dispel this widely-believed but scientifically unfounded rumor with a practical look at the protocols followed by medical professionals when declaring a person deceased.

Protocols for Declaring Death

Medical protocols for declaring death, especially in remote settings, are varied but universally stringent to ensure accurate assessment of biological death. As a Ships Medical Officer or Site Medical Officer, it is crucial to follow specific guidelines which include:

Identifying injuries incompatible with life, such as decapitation, crushing, burning, advanced decomposition, etc. Observing signs of advanced decomposition, including cadaveric lividity, rigor mortis, leakage of body fluids, and other indicators. Evaluating unresponsiveness to painful stimuli. Noting the cessation of spontaneous respiration and cardiac electrical activity. Observing fixed and non-responsive pupils. Conducting 30 minutes of Advanced Cardiac Life Support (ACLS) if necessary and if no spontaneous cardiac or respiratory activity is restored, declaring death. Presenting a properly executed "Advance Directive" or "Do Not Resuscitate" (DNR) order if applicable. Consulting with the most senior officer or the Medical Director before ceasing resuscitation efforts.

Despite these stringent protocols, there has never been a case where someone has revived after being declared dead in the author's 40 years of medical practice.

Remote Death Declarations

Many decedents do not die in hospitals but are identified and pronounced through remote communications. Emergency Room doctors will often assess the need for further resuscitation and, if deemed futile, order termination. In these cases, the rescue squad is usually involved, and they can perform simple tests, such as checking the eye's corneal reflex, to determine death.

Signs of Death

Signs that can indicate death include:

Obvious decomposition such as skeletonization and full rigor mortis. Injuries inconsistent with life, such as a brain found on the road next to the body. Sporadic use of EKG pads to determine heart activity.

Emergency personnel, even those without medical training, may declare death, and for crimes, the scene is often restricted to only those authorized to enter. When in doubt, the body is transported to a hospital for further evaluation.

Morgue Procedures

Morgue procedures are designed to be thorough and accurate. Once evidence is documented and photographed, the body is typically left in place for several hours to ensure all signs of life are confirmed. Even in crowded morgues, there would be no undetected breathing, as the preservation of bodies typically prevents this.

The myth of reviving in the morgue is rooted in a misunderstanding of death certification processes and the invasive nature of the morgue environment. Medical professionals follow strict protocols to accurately and reliably determine time of death, ensuring that deaths are properly certified and procedures are carried out with the highest level of care and precision.