A Post About Death. There, I said the word.
Isn’t it funny how people are scared to say words connected with death? Here are some examples of what callers have said to me on finding a deceased body:
“I think the worst has happened”
“He’s not conscious… quite the opposite”
“He’s lying face down on the bed”
“She’s on the floor and isn’t moving”
“He’s very cold and blue in the face”
“She’s gone all black and smells bad”
“He seems to be very seriously injured”
“He’s been very depressed lately… I think he’s cut himself or something”
The latter case was the biggest understatement I had ever heard. It turned out that the patient had slashed his wrists, taken an overdose and then hung himself. The ambulance crew reported that the room had blood running down the walls and was like a scene from a horror movie. The “very seriously injured” man, meanwhile, was found approximately fifty metres from his head after a run in with a pillar whilst on his motorcycle.
Despite dealing with death on a daily basis, the Nee Naw Service are equally reticent about using words such as “death” and “dead”. There are actually specific pieces of ambulance jargon to get round ever having to use them. The first of these is the gloriously optimistic “suspended”, which refers to a patient who is unconscious and not breathing but who might return to life. All non-breathing patients are presumed to be in this state until the caller says otherwise, and us call takers waste no time in getting the CPR started, doing everything we can to coax the caller into it.
“Purple”, on the other hand, refers to a patient who is d-e-a-d. In most circumstances, when someone has not been breathing for three minutes, they are beyond resuscitation and thus “purple” (which, incidentally, is just a randomly chosen code word and not a description of the colour of their face). If a caller thinks the patient has been like that for some time, or if they’re cold and stiff, or even starting to decompose (yuk), then we put “purple” on the ticket rather than suspended — which lets the crew prepare themselves for comforting bereaved relatives rather than whipping out their bags and masks. In these circumstances, we still offer the resuscitation instructions, but it’s very much an offer and not necessarily one we’re hoping the callers take up. The reason for it is a small part “just in case” and a large part letting the caller feel they did all they could.
Purple Plus is what we call a patient who is definitely dead. We usually only make this kind of assertion when the crew have turned up and been greeted with a corpse. I’ve noticed that other call takers are very jumpy about declaring a patient to be dead, even with such a glorious array of euphemisms to choose from. Even if they dare to write “purple” or “suspended”, it’s usually prefixed with a “?”, as if writing that the patient has died on the ticket will increase the likelihood of this being the case. Sometimes, when feeling slightly delirious from lack of sleep, I feel like marking my tickets with “DEAD” instead of one of these namby-pamby euphemisms, and sending it off like that, in all its unadulterated starkness.
There has been a sharp increase in the number of deaths over the last few weeks because the temperature has dropped suddenly by about ten degrees. The summer months are our business, but most of the calls are a load of nonsense. In winter we get far more serious calls and far more deaths. It’s mainly the elderly whose poor tired bodies give out. In summer I often went a whole week without taking a call about a dead person — at the moment I’m averaging four per shift. My record is seven. I think I must have been sitting in the Unlucky Chair that shift.
on December 5th, 2005 at 3:39 pm
As i understand it, the euphemisms are in place because of the radio transmissions, i guess to give some dignity for one, and of course the radio ‘hams’ (why are they called hams??) people that randomly listen to emergency services, or other transmissons.
In training school we are told NOT to use such terms (to grieving rellies) as ‘passed away’ or ‘fallen asleep’ or ‘gone’ , because it could cause confusion and more distress, we have to use the D word, and believe me, the first time you do it, its hard, but in some weird way, it gets ‘easier’. Fortunately, i dont have a problem with Death, its the living, greiving relatives that i find most difficult to deal with.
on December 5th, 2005 at 3:49 pm
I guess that’s why they started, but they’re used all over the place, not just on the radio. Glad to hear you don’t use them on the road though.
on December 5th, 2005 at 4:49 pm
A bit off topic, but how did you get to be an ambulance despatcher type person? Could you write about that? For example did you choose to do it and find out more, or did it come up as a random choice at the job centre? What was the recruitment procedure like, and the training before you were allowed to Deal With The Public?
I’m not going to change career but I would love to hear about this.
on December 5th, 2005 at 4:52 pm
BTW - when I did “ambulance service” as my service study option for Duke of Edinburgh’s award back in 1992, they told us only paramedics can use the D word. Ordinary ambulance crew could only say things like “I’m very sorry, but there is nothing more we can do”. I wonder if that’s still true. Mind you, at that time we were being lectured by one of Somerset’s only two paramedics… I suspect there are a few more of them these days
on December 5th, 2005 at 5:35 pm
In the Fire Service we are not qualified to say Dead so we have to say apparently dead in radio transmissions. Even if you are under a train and they are in half, they are still apparently dead. We can only confirm death via the radio once done by a doctor. Then our message would say confirmed dead by hems doctor.
on December 5th, 2005 at 5:42 pm
I’ll do a post about it when I have time. Funnily enough, you’re the first person who has asked. Reynolds says that people ask him how to get into Driving The Ambulance all the time but I think this blog might have served to put people off doing my job!
on December 5th, 2005 at 8:36 pm
Forgive me for my ignorance on this subject, but is it better to call an ambulance or an undertaker when someone dies suddenly?
on December 5th, 2005 at 8:52 pm
Linda - to answer your question depends on the circumstances. If the person dies at home or in a private place, the best person to call is the person’s GP. The doctor will pronounce “life extinct” and if the patient is known to the doctor, the doctor will agree to sign a death certificate.
Paramedics (at least in my area) are authorised to pronounce “life extinct” but cannot issue death certificates.The two are not the same.
If the death is unexpected, the Coroner needs to be informed. Some areas have dedicated Coroner’s officers to do this. Those that don’t have to call the Police, who are also Coroner’s officers. This can be a bit traumatic when Auntie Nellie turns up her toes in bed and two bobbies turn up at the door.
Of course if the death is in any way suspicious, the Police are called anyway.
If a person dies in a public place, e.g. collapse in the street, call an ambulance. Even if there is nothing they can do for the person, they have a duty to remove dead bodies from public places. Again, the Police become involved as well.
Obviously, finding someone dead is not a regular occurence and thought processes might not be working properly, so whoever you phone, be it Ambulance, Co-op, Fire (yes, some people do!) or Police, they will advise you according to the circumstances.
on December 5th, 2005 at 10:23 pm
I had a job come through as “suspected cardiac arrest, CPR declined”. I wondered why on earth the caller had declined to do CPR, until I got there and realised that it was the insects.
on December 5th, 2005 at 11:27 pm
Mike rather you than me having to talk about the D word. I hope you don’t break that record you hold for the number of purples issued in a shift.
The Driving Instructor
on December 6th, 2005 at 9:25 am
I understand that British Transport Police are now allowed to consider someone dead if its obvious from the injuries.
ie, been run over by a train and limbs missing etc…
I realise that it needs medical training, but there are certain injuries where I think it falls into the ‘bleedin obvious’ box.
on December 6th, 2005 at 11:56 am
Sadly death is the only thing we are all guaranteed in life!
Maybe if more people would speak openly about it it would become a less “frightening” word.
Although I can understand why you guys have to be careful ….. you can’t go saying he/she/it is dead only to have the deceased terrify the caller by sudenly coming to life again!!
Keep up the good work with the blog!!
on December 6th, 2005 at 12:17 pm
Aren’t hams are called hams because their proper name is (h)amateur radio operators?
This blog is more exciting than ER and Casualty put together.
on December 6th, 2005 at 3:44 pm
Linda — the general guidelines are as follows:
Call an ambulance if:
you are any less than 100% sure that the person is dead.
you think there is any chance the person could be resuscitated and that trying to resuscitate them would be appropriate (sometimes people would rather die with dignity than have tubes inserted and their chest pumped).
Call the police if:
you find a dead body in a public place, whatever the cause of death.
someone dies in suspicious circumstances, as a result of a suicide or accident.
someone dies suddenly and unexpectedly having previously been in good health.
you find someone dead in their own home but don’t know anything about their medical history or GP.
Call the patient’s GP if:
the death is expected, either due to old age or terminal illness, and you are certain that they are dead.
In any case, the patient needs to be pronounced dead by a doctor (the police have their own doctors) before an undertaker can be involved. Also, the ambulance service will respond to any call about a dead patient as a) they work on the principle that if you called for an ambulance, you think that the patient can be saved b) we’re not going to argue with someone whose relative has died — if they want an ambulance, they get one c) even if there’s nothing that can be done for the patient, the relatives still need our care.
on December 8th, 2005 at 2:40 am
Incidentally, the police use ‘purple’ as a code word for royalty I understand. Well worth not confusing the two i imagine, especially in some of our less salubrious locales.
on December 11th, 2005 at 6:35 pm
Yeah, I heard that one too. I guess if the Queen dies it’ll be a case of purplepurple?
on January 2nd, 2006 at 4:44 am
Police officers can pronounce someone dead when there are obvious injuries which are incompatible with life.. (e.g. the head is missing.. )
on January 9th, 2006 at 7:04 pm
I’m a dispatcher in Columbus, Ohio (USA) and we would send the medics to a “non-breather” or “possible DOA,” depending on the call. We don’t generally trust the public to decide if someone is dead over the phone (unless there is the aforementioned insects, etc…) The EMT’s can pronounce on the scene and we call it a “Code 1″ — for example, “Ma’am, I need a Code 1 time.” We reply with the exact time, which becomes the official time of death.
We also send the police to accompany the EMT’s. If a Code 1 time is given, the police stay to comfort the relatives and arrange for the coroner.