To decide whether or not to call the coroner, ask yourself the following questions:

• Is the death due to non-natural cases (such as accident, homicide, or suicide)? Note: An injury (eg. hip fracture) preceding a medical death (eg. pneumonia) is a non-natural death and therefore a mandatory coroner's case, if the death may be attributable to the injury.
• Was the death sudden and unexpected (i.e. not reasonably foreseeable)
• Are the events leading to the death the subject of investigation by police, the hospital, Children's Aid, a professional College, or any other agency?
• Is trauma (including a fall in hospital), suicidality, overdose or poisoning related to this death?
• Have there been ay allegations of malpractice, treatment errors, negligence, or foul play?
• Is the deceased a prisoner in custody, or an involuntary psychiatric patient?
• is this a pregnancy-related maternal death?
• Is this a neonatal death or stillbirth where there are issues of care or injury?
• Is this a stillbirth in which the delivery occurred outside a hospital, or no MD was present at the delivery?
• Is the deceased is from a long term care facility such as a nursing home, is this a threshold case?
• Have family or caregivers expressed concerns about the death?

If the answer to any of these is "YES", then you should notify the coroner, who will decide whether or not to launch an investigation. These rules do apply (a) when organ harvesting for transplant is planned and (b) in children's deaths; but, in these cases, it is particularly important to call the coroner if you have any uncertainty at all. There is no "24-hour rule" in Ontario, nor are surgical deaths or home deaths automatic coroner's cases - use the above criteria for those instances.

The most frequent mistake made in notification of the coroner is the failure to link a preceding injury with the death. For instance, where an elderly person falls at home, sustains a hip fracture, undergoes surgery, and dies 5 days later of pneumonia, the underlying cause of death is the accidental fall (because this is the occurrence which initiated the chain of events culminating in death), and this is therefore an accidental death, not a natural one, and must be reported to the coroner. Another commonly seen issue arises where case has been exemplary, but the family continues to express concerns despite adequate efforts to reassure them. Always call the coroner immediately in this situation; the coroner is independent, and is trained and experienced in intervention to defuse predicaments such as this.

Once you have pronounced the patient dead, and have made the decision that this case should be discussed with the coroner, do not move or touch the body (including cleaning up body fluids, removing tubes or lines) without the coroner's permission. If the coroner decides not to accept the case, you should complete the death certificate, request a hospital autopsy if indicated (for which family consent would be required), and release the body as per hospital protocols.

Coroners have broad powers to investigate a death, and professionals are expected to provide full co-operation. The coroner may discuss the case with you and, in some cases, the coroner may have a police officer assist in the investigation, sometimes by taking a statement from professionals involved in the care.