You Make the Call – Still Hanging Around?

PD often asks us to preserve their crime scenes before we can get in and do our work, but this situation seems unique indeed.


While the particulars have been decently obscured, there was no hesitation on my part when faced with this situation.  We have a “reported” hanging and judging from the past medical experience of my callers it could actually be a car accident out on the lake.  We’re loading up the boat and making our way out there.

Until we can assess and determine a clinical plan other agencies will have to work with us, not delay us, in completing our task.  If we wait for PD dockside a viable patient could deteriorate making our interventions more complex and leading to a poor outcome.


So, on the boat we go.

10 minutes later, after listening to PD screaming for us to wait, we come around the bend in the lake to a cove where we see a small sailing boat with a person clearly hanging from the mast, motionless except for when the boat slowly rocks as our wake disrupts it.

His feet are about 6 feet off the deck and it’s been awhile since you were a Sea Scout but the rope tied around his neck does not appear to be there accidentally.  A jacket is hanging on the same mast and his shoes are neatly arranged below him on the deck.


Your primary assessment as the boat approaches includes the notation that the patient’s neck is deformed and elongated in such a manner that suggests internal decapitation.  The fingers are flexed into the palm and the arms appear rigid as the body slowly rocks on the boat.  The entire body moves as one.  Do to his dark skin color, no pooling of blood is noted, cyanosis and bruising are also difficult to distinguish.  Judging from the marks measuring the mast the length from his mandible to his clavicle is almost 12 inches with the possibly 3/8″ rope hidden withing the skin behind the mandible, taught.


The dock manager feels now is a good time to tell you that the person who found him was in a kayak and first noted him an hour ago.

PD seem to have been able to find another boat and have radioed for you to not enter the crime scene if the person is deceased.


Well, is he?

You make the call, based on your local protocols and policies.

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6 thoughts on “You Make the Call – Still Hanging Around?”

  1. Anything is possible. Who with medical training has come to the conclusion he is dead. Can you use your field glasses to check for chest rise. My first husband SURVIVED internal decapitation. I would still approach being careful not to disturb anything. I don’t need to touch my pt to assess vitals, but I could be told I abandoned my pt now that I have started care. PD did transfer care to you. Well, didn’t they?

  2. My protocols require me to initiate ALS care unless there are “signs of explicit biological death.” Those (per protocol) include: “Profound dependent lividity, rigor mortis without profound hypothermia, patient who has suffered decapitation, skin deterioration or decomposition, mummification or dehydration, or putrefaction.” If profound dependent lividity is the only sign present, we must also obtain and transmit an EKG before our “triple zero” is confirmed, at which point this case will become a police matter and we will return in service after being released by the PD or ME’s office.

    Per my protocols, I still have to ASSESS this patient, which could be as simple as boarding the vessel and checking for one of the signs listed above. If lividity isn’t easily discernible from a distance due to the patient’s dark skin color, it may be evident upon closer inspection, and even if it isn’t, simply touching and attempting to flex the toes would reveal the presence (or lack) of rigor mortis. If the patient is in rigor mortis, he is no longer a patient, but a corpse. If he’s not in rigor mortis, he’s a patient (at least according to my protocols), which means I then have to cut him down and run the code (again, according to my protocols).    

  3. Thanks to a “fatality” not being dead at an accident scene a few years ago, in order to request a DOPA order from medical control the monitor must be attached, with no activity in a leads.

  4. In our system, we don’t have to iniate resuscitation if any of the following are present:
    -injuries incompatible with life (we’re not required to hook the monitor up for this one).
    -rigor mortis
    -dependent lividity.
    -other obvious signs of death.

    I understand the legality issues to a point.  After that, common sense needs to take over.

    Report of hanging for an hour; body moves as a unit in the wind; 12″ neck extension; no visible activity.

    I feel confident that the pt. is deceased based on the info. given/seen.  I also feel confident, that upon relaying findings to medical control, they will not request that I get on the boat and hook my monitor up to him.

    While, as above, some do survive internal decapitation, it probably wasn’t after they jumped off of a sailboat mast with a rope on their neck.

  5. Do you have a rule prohibiting the police from riding in your boat? There is not a good reason to not take police if they are close enough to board the boat. If they choose not to accompany you, then they are communicating loudly and clearly, that they do not know how to control a scene. 

    I have never had a mast hanging, so I do not know how much of an assessment it might take to satisfy me that the patient is dead. If I feel that the patient is not just merely dead, but truly and sincerely dead, but I still need an ECG per protocol, I don’t mind waiting until after the police do their initial stuff and clear me to apply electrodes before applying the ECG. It’s all in the documentation.


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