††††† 201 KAR 20:420. Determination of death by a registered nurse employed by an ambulance service.


††††† RELATES TO: KRS 72.020, 216B.410, 311.623, 314.181, 446.400

††††† STATUTORY AUTHORITY: KRS 314.131(1), 314.181(1)

††††† NECESSITY, FUNCTION, AND CONFORMITY: KRS 314.181(1) requires the Kentucky Board of Nursing to promulgate administrative regulations to establish a protocol for use by a registered nurse in making a determination of death. This administrative regulation establishes a protocol for determination of death by a registered nurse employed by an ambulance service.


††††† Section 1. If it appears that a person whom a registered nurse in the employ of an ambulance service has been called to attend is dead the protocol established in Sections 2 through 7 of this administrative regulation shall be followed prior to determining that the person is dead.


††††† Section 2. The registered nurse shall determine and document that the following signs of death are present:

††††† (1) Unresponsiveness;

††††† (2) Apnea;

††††† (3) The absence of a palpable pulse at the carotid site;

††††† (4) Bilaterally fixed and dilated pupils; and

††††† (5) Except in a case of trauma, asystole determined in two (2) leads on an electrocardiograph in accordance with American Heart Association standards.


††††† Section 3. The registered nurse shall determine, in addition, that one (1) of the following factors or conditions exist:

††††† (1) Lividity of any degree;

††††† (2) Rigor mortis of any degree;

††††† (3) The presence of venous pooling in the body;

††††† (4) Damage or destruction of the body which is incompatible with life; or

††††† (5) A standard form or identification evidencing a patientís desire not to be resuscitated in accordance with KRS 311.623.


††††† Section 4. If the registered nurse has determined and documented that the conditions of Sections 2 and 3 of this administrative regulation exist, the registered nurse may, subject to the provisions of Section 5 of this administrative regulation, declare the patient dead.


††††† Section 5. (1) Except if 201 KAR 20:430 or subsection (2) of this section requires that medical control contact be made, the registered nurse may contact medical control or a licensed physician, authorized in writing by the medical director, for advice and assistance in making a determination required by this administrative regulation.

††††† (2) Pursuant to KRS 314.181(6), the medical director of the service may direct, in the serviceís protocol, that prior to making a determination that the patient is dead that the medical director, or a physician authorized by him, be contacted and that the physician agrees with the determination.


††††† Section 6. The registered nurse shall document all items required by this administrative regulation on the ambulance run report form required by KRS 216B.410.


††††††††††††††† Section 7. If a registered nurse determines a patient to be dead, the registered nurse shall remain on the scene until the arrival of the coroner or a law enforcement officer. (25 Ky.R. 2232; Am. 26 Ky.R. 372; eff. 8-16-99.)