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| Care of the dying There is never a time when nothing can be
done to help a patient -- even one who is obviously dying. One may be
quite unable to prevent a person from dying, but at a minimum, there
remains the important duty of ensuring that the victim retains the
following:
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The best possible
preservation from suffering and pain.
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People around to care for
him/her.
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That his/her dignity as a
human being is preserved and respected.
Make every effort to ensure the patient remains tranquil in mind and body during the
period of dying. Comfort, companionship, compassion, and the relief of
both mental and physical suffering should be your aim.
Though the outlook is grim, treat the patient as though he/she will
survive. There is a chance that help may arrive and a person who was
doomed minutes before could be carted off to a hospital by rescue chopper
and survive. |
| Cause of death It is important to try to establish the
reasons for death. Causes of death can be ascribed to two main groups:
- Natural causes such as illnesses.
- Injuries stemming from accidental, deliberate, or chance
events.
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There are two “types” of death:
- Clinical Death from which a person CAN be resuscitated.
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NEVER give up on these
victims. They're often saved.
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Example: Heartbeat
and/or breathing has stopped.
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Mistaken death: A
person who is suffering from hypothermia or has taken large doses of
certain drugs -- usually sedatives or tranquilizers -- may appear
dead. A thorough assessment of the victim is essential! All of the
circumstances surrounding the victim’s current condition may help you
decide whether hypothermia, a drug overdose, a fall from height, etc.
are possibilities.
- Biological Death from which the victim can NOT be
resuscitated.
- Examples: Decapitation, major decomposition.
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| Signs immediately following major injury and/or Clinical Death
These three signs can all be -- and often are -- all present in both
clinical and biological death. Again, the difference is that a person can
be resuscitated from the below conditions even though all three symptoms
are present.
Note: Never
consider anyone to be dead until pronounced by a medical doctor. If no
doctor is available, you and others in your group must all
agree that at least the following three signs are all present AND
can not be treated successfully: |
| The heart has stopped No pulse will be felt and no heart
sounds will be heard. To check for this, put your ear on the left side of
the chest near the left nipple and listen carefully. (If you are not sure
what to listen for, listen to the left side of the chest of a live person
first.) To further test that blood circulation has stopped, tie a piece
of string tightly around a finger. In life, the finger will become
bluish, but in death it will remain white. As another test, slight
pressure on the fingernail or lip of a living person will cause the area
to become pale. When the pressure is released, the natural pink color
returns. In death, this will not occur. |
| Breathing has stopped Listen and feel with your ear directly over the
nose and mouth. You should feel no air coming out. As you listen, watch
the chest and abdomen -- you should see NO chest and abdominal movement.
As another test, a mirror held in front of the nose and mouth will be
clouded by the moisture in the outgoing breath of a living person (if
weather conditions are right). No
clouding of the mirror will occur in death. |
| Pupils are fixed and dilated Shortly after death, the
victim’s eyes become dull as moisture evaporates from their surface. The
pupils are usually large and always “fixed” meaning that shining a
bright light directly into the eye does not make the pupil change size. |
| Signs appearing well after Biological Death
Note: None of the
signs described below is infallible in itself. Some people have normally
stiff or immobile limbs, others have clouded corneas, etc. However, there
is usually little difficulty in coming to a decision when the following
points are taken together. |
| Rigor mortis This is a stiffness of the body that usually
comes on about 3-4 hours after death (timing will depend to some extent on
the ambient temperature). This temporary stiffness lasts for 2-3 days and is most
easily noticed in the victim's joints. |
| Post-mortem lividity or staining After death, the skin
becomes pale, ashen or gray as a consequence of no circulation. A further
result is that the blood in a dead body will tend to gravitate toward the
body’s lowermost regions, whatever they may be. In other words, if the
body was left lying on its back after death, there will be reddish or
purplish patches resembling bruises over the back and on the underside of
the limbs. The coloration resulting from this pooled blood is called
"post-mortem lividity” or “staining". |
| Clouded corneas The cornea is the clear window at the front
of the eye. It goes milky about 15 hours after death. |
| Decomposition Changes due to decomposition can be seen 2-3
days after death and will usually appear first on the abdomen where a
greenish color may be observed. This is usually a sure sign of death. |
| Documentation of events Documenting someone's death in a
remote field area will require that you employ
your best observational skills as a professional scientist. If the
victim had been ill or injured prior to death, the circumstances of the
incident that led to the illness/injury should have already been
investigated
and recorded (including
pictures).
Records of the nature and progress of the illness/injury, and of the
treatment given should also have been made. If possible, have all your
observational notes read and countersigned by at least one other person in your
party. These records should be carefully preserved being that there will
be official inquiries. Bear in mind that in unattended deaths (i.e. no
doctor present), such inquiries and an autopsy are necessary even though
there was, at the time, no apparent criminal or suspicious circumstances
surrounding the death.
If the circumstances of death are other than straightforward,
photograph the body where it was found and from several angles. When/if
the body is moved, take more pictures of the scene to show any blood on
the ground or other evidence. Try to record all observations you think
may be helpful in identification of, or of interest with regard to, the cause
of death. Note why you took each picture and what you intended to show. |
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Labeling, marking and preservation of a dead body Obviously,
there is usually no difficulty in identifying the body of a crew-member
known to you or others in your group. However, if you have to leave the
body (say, to hike out for help) be sure to record the GPS coordinates or map
location. If possible, mark the area with
some sort of high-visibility flagging. Tag the body with the person’s
official identification or a note including his/her full name, cause of
death, and a brief note about where you are heading in search of
help.
If you are forced to leave the body in an area where it could be
ravaged by animals or otherwise moved/altered, consider options for
securing or preserving the body. This may involve seemingly
outlandish tasks such as: removal from a flood-prone gully, deep burial, or wrapping the body
and suspending it from a high tree.
Before doing either of these or anything else, consider the time it
will take the authorities to reach the scene -- such preservative measures
may not be necessary. Whether you should move the body, stay
with it, or seek assistance, will partly depend on how remote your
location is. |
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