Check whether the death was expected and whether there was a DNACPR or ReSPECT decision.
Unexpected, unexplained or care-related deaths may need reporting: the procurator fiscal in Scotland, the coroner and medical examiner in England and Wales.
Act now
- 1
Time of death is when these criteria are met.
- 2
Check for a pacemaker or implanted defibrillator (deactivate an ICD per local policy) and note it.
Assess
- Confirm the patient's identity from the wristband.
- Observe for at least 5 minutes: no central pulse on palpation and no heart sounds on auscultation (in hospital this can be supported by asystole on ECG).
- After 5 minutes of continued arrest: no pupillary response to light, no corneal reflex, no motor response to supraorbital pressure.
- Any return of cardiac or respiratory activity restarts the 5-minute observation.
Investigations
- No tests are needed to confirm death. A rhythm strip showing asystole can support the findings in hospital.
Manage
- Document: date and time, the findings above, who was present, any implanted devices, whether next of kin are aware, your name, GMC number and bleep.
- Inform the responsible team and next of kin per local policy; the death certificate is completed by a doctor who knew the patient.
Escalate when
- Death after a fall or injury, in custody, sudden or unexplained, or possibly related to care: senior, and report per local rules.
Written to current guidance · sources checked 14 Nov 2026. We watch NICE for updates weekly.
Sources (1)
Reviewed by Aboodee Alhasso, MPharm MRCPharm IP on 14 Nov 2026
For healthcare professionals, as an aid to clinical judgement — not a substitute for it. Follow your local policy and ask a senior when in doubt.