title: [Determination of death in mobile intensive care units operating without a physician].
abstract: Determination of the death of a person is one of the most complex issues in modern medicine. Therefore, in Israel (like many other countries), the authority to determine death belongs solely to medical doctors. Determination of death is a process built from 3 components: the declaration of death, certification of death and registration of death. Declaration of death is based on well established protocols, and is used as the normative basis for ending or avoiding resuscitation efforts in the pre-hospital setting. Certification and registration of death are essential for completion of the process, in order to enable care for the deceased--according to local custom. The division mentioned above does not exist in Israel. Therefore, declaration and certification of death are carried out solely by medical doctors. This situation necessarily demands the immediate presence of a medical doctor, whenever a process of death determination is being held. When death occurs in a hospital or a medical institute continuously occupied by medical doctors, there is no problem to fulfill this term. However, on the other hand, when death occurs outside the hospital or medical institute, the burden of death determination usually falls on the doctors occupying Magen David Adom ambulances. This leads to irrational use of a limited resource, aimed for emergency pre-hospital care. This review examines the problem and all the aspects involved, and offers possible solutions--based on acceptable guidelines.
authors.affiliation: Magen David Adom.
authors.forename: Eli
authors.initials: E
authors.lastname: Yafe
authors.forename: Zvi
authors.initials: Z
authors.lastname: Feingenberg
authors.forename: Rami
authors.initials: R
authors.lastname: Miller
authors.forename: Rafi
authors.initials: R
authors.lastname: Strugo
mesh_terms: D000552:Ambulances / Q000458:organization & administration; D003643:Death; D003644:Death Certificates; D004632:Emergency Medical Services / Q000458:organization & administration; D017408:Guidelines as Topic; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007557:Israel; D008952:Mobile Health Units / Q000458:organization & administration*; D010820:Physicians / Q000458:organization & administration; D024382:Professional Role