Recognition of Life Extinct (ROLE) [Video]

The process of Recognition of Life Extinct (ROLE) includes either conditions not compatible with commencing resuscitation or the decision to terminate a resuscitation effort.

Emergency Medical Technicians, Associate Ambulance Practitioners and Paramedics may recognise conditions not compatible with life and can cease commencing resuscitation, however,
only Paramedics may terminate a resuscitation attempt once a decision has been made that the conditions including pallor mortis, liver mortis, rigor mortis and decomposition.

Doctors are not required to verify death, as
Nurses and other HCPs (Paramedics) who have been trained to verify death can do so if in attendance. Ambulance personnel can only verify the “Fact of Death”. They cannot “Certify” the cause of death. Certification must be undertaken by a Doctor.

On arrival of the scene and the recognition of a pulseless and apnoeic patient (in the presence of apatent airway), resuscitation should be commenced whilst the facts of the collapse are ascertained unless the conditions unequivocally associated with death are present or a valid advance directive/DNACPR is confirmed to the ambulance staff. In all other cases resuscitation must be commenced and the facts pertaining to the cardiac arrest must be established.

According to the Academy of Medical Royal Colleges (AoMRC), death is the irreversible loss of essential characteristics which are necessary to the existence of a living human person.

Therefore, the definition of death should be regarded as the irreversible loss of the capacity for consciousness combined with the irreversible loss of the capacity to breathe. Death may be secondary to a wide range of underlying problems in the body.

This means that whilst the end point of death is always within the brain, it can be diagnosed using circulatory, neurological or somatic criteria to identify situations that will lead to the irreversible loss of the capacity for consciousness and the irreversible loss of the capacity to breathe.

Confirming death (also called verifying death) is a core skill for medical practitioners in the United Kingdom and this is most commonly undertaken using the circulatory criteria which include:

For a minimum of five minutes, confirm the absence of:

• Central pulse on palpation (carotid artery)
• Heart sounds on auscultation
• Respiratory sounds on auscultation
• Signs of life (e.g. movement and respiratory effort)
• Check pupil reflex

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