Statement of Purpose: Prehospital death pronouncement policies are common among ground ambulances. No previous report has addressed such policies among Air Medical (AM) programs.

Statement of Methods: Statement of Methods: Structured telephone interviews of 125 of 143 (87%) AM programs (14 fixed wing, 68 rotor wing, 43 both) were conducted by research staff from 6 to 8/95.

Summary of Results: Summary of Results: Only fifty percent of AM crews are permitted to pronounce death in the field. Of those AM programs which permit pronouncement, direct medical command physician contact is required in 35% of pronouncements while 25% of programs utilize protocols. Of those AM programs which permit pronouncement, 77% of flight nurses can pronounce while only 33% of paramedics. Most programs (95%) conduct QA reviews of all deaths.

Statement of Conclusions: Prehospital death pronouncement is permitted in only 50% of AM programs. Since prehospital death pronouncement may obviate the need for AM transport, AM programs may be transporting clinically dead but unpronounced patients wasting scarce medical resources. This differs greatly from ground EMS programs where death protocols are common. Particularly puzzling is the small percentage of flight paramedics who are allowed to pronounce when compared to flight nurses since ground EMS pronouncements are performed by paramedics. AM programs should review their prehospital pronouncement protocols since managed care initiatives will drive health care organizations to abandon the wasteful practice of transporting clinically dead, but unpronounced, patients.