Questionnaire/history: Questionnaire/history from? Condolences offered? Death expected? Main diagnosis? DNAR in place? Under palliative care team? Anticipatory medications prescribed? Last GP consultation? Coroner referral warranted? Death already confirmed (eg by LAS)? Competent health care worker available (eg registered nurse), who felt comfortable to help to confirm death by video consultation? Syringe driver in situ? Urine catheter in situ? ICD or PM in situ? Cremation planned? Access problems? Examination: Identity of body confirmed? Correct name of deceased verified? No signs of respiratory effort? No response to verbal stimuli? No response to painful stimuli? No pupillary response to light? No carotid pulse? No heart sounds? Management: Condolences offered? Confirmation of death form completed? Bereavement support info given? Syringe driver removed if in situ? Urine catheter removed if in situ? Advised to call undertaker? Advised to get death certificate from doctor who cared for the patient during the last 14 days of their life? Notes: If an ICD has not been fully deactivated before death then the device should ideally fully deactivated after death by the local cardiac physiologist to avoid the risk of electric shock to mortuary workers for example and to avoid the small risk of upsetting families with devices alarming from inside the deceased/coffins. Pacemakers and ICDs shall be explanted prior to cremation of the body due to the risk of lithium battery explosion. Do not remove PEG tubes. Reference(s): British Heart Foundation (BHF): Deactivation of ICDs at the end of the life: Principles and Practice British Heart Rhythm Society (BHRS): BHRS Statement on Deactivation and Removal of ICDs and Pacemakers Post Mortem during COVID Pandemic Geeky Medics (2021): Death Confirmation – OSCE Guide Office for National Statistics: Guidance for doctors completing Medical Certificates of Cause of Death in England and Wales