A new procedure developed and brought into the prehospital environment by Gundersen Tri-State Ambulance helps prepare responding paramedics and EMTs provide immediate support to on-scene survivors of fatal medical events and traumatic injuries.
Recognizing the Need
Tri-State staff respond to hundreds of calls each year where a death has occurred, and a family member or close friend of the deceased is present. At these scenes, Tri-State paramedics and EMTs would simply offer survivors their condolences and attempt to answer their questions. The lack of formal education and training resulted in an uncomfortable feeling for staff.
Tri-State staff never would have thought at the time about the stressors and issues impacting survivors after the loss of a loved one. They also would not have understood how their actions — or lack of action — in the moments after such an event could have a positive or negative impact on the survivor’s grieving process.
Thankfully, Tri-State has been working to address this issue and improve how scenes are handled with the end goal of better preparation for staff while at the same time offering greater compassion to the survivors.
Connecting the Dots
In 2018, a paramedic for Tri-State who also works in the critical care unit for Gundersen Health System, approached Tri-State leadership and explained the robust bereavement support offered when a patient dies in the hospital setting. At Gundersen, nurses, techs and providers can complete relationship- and evidence-based bereavement training. This education is offered by Resolve Through Sharing (RTS), a not-for-profit program of Gundersen Medical Foundation, which develops training for healthcare professionals and support materials for the bereaved.
When in-hospital deaths occur at Gundersen, support materials are provided to grieving loved ones. In addition to local resources, folders are customized with a variety of RTS brochures, booklets, cards and mementos. RTS materials are designed to address the psycho-social needs of survivors.
Topics include healthy grieving, making meaning of the loss, telling others, grieving over the holidays, children and grief, caring for self, seeking professional help and more. In addition, staff, including non-medical support staff, sign a sympathy card. Sometimes a personal note is included.
With the Tri-State paramedic recognizing the potential and presenting a strong case to leadership of how such a program could work in the prehospital setting, Tri-State immediately connected with RTS to explore the opportunity of expanding the program.
RTS leadership was instantly on board. They had been investigating ways to improve bereavement support in Gundersen’s emergency department. Partnering with Tri-State to develop a bereavement standard of care in the prehospital setting was the next logical step.
The Tri-State paramedic was able to bring stakeholders together to formulate a plan to bring the program to the prehospital environment. Tri-State’s medical director was already familiar with the program in the hospital setting and participated in the development and sought funding opportunities.
Partnering with the Experts
As discussions between RTS and Tri-State progressed, Tri-State leaders soon realized how fortunate they were to have the international leaders in professional bereavement training and support part of the same health system. It was enlightening to learn RTS has trained over 50,000 professionals in hospital settings and military bases around the world.
During the development of the prehospital program, a fair amount of back-and-forth occurred between Tri-State and RTS with developing the training while also ensuring the appropriate information to the prehospital setting was included in the support folders. One of the primary requirements for Tri-State was that personnel would carry only one version of the support folders in their ambulances and support vehicles. It did not seem feasible for paramedics and EMTs to have to locate and sort through the appropriate folder with information specific to that incident.
Instead, Tri-State needed to have a broader collection of support material and handouts that would address the most common types of calls. One of the challenges during the development process was determining what materials would be most useful. RTS had an array of existing materials created for the hospital setting that met Tri-State’s needs. Each piece was carefully evaluated. Some were incorporated with no modifications. Others required adjustments for the prehospital setting. The materials needed to be specific enough to reach the bereaved on a personal level but general enough to apply to death resulting from any cause.
A folder was agreed upon and piloted. After three months, the folder was modified as a result of survey responses and anecdotal evidence. One piece was moved from the folder to an as-needed option and another brochure was created to be added in its place. After this change, staff felt more comfortable with the materials and usage increased.
Program Utilization and Results
Not unlike other programs and new initiative launches, it was imperative that Tri-State paramedics and EMTs not only understood the program but would be willing to use it at scenes. As a big part of the program is the online training component, Tri-State reached out to their region’s Wisconsin Healthcare Emergency Readiness Coalition (HERC) for funding for Tri-State staff and any EMS provider who responds in their large geographic service area. Working scenes with other area EMS responders who are also trained in the program is a benefit, especially if the responders are on scene before Tri-State.
The grant funds were approved, and more than 200 training codes were purchased. More than 100 members of Tri-State’s staff and an additional 34 area EMS responders were trained as of October 2019. Tri-State expects to have well over 200 EMS personnel trained by the end of March 2020. Because the training is endorsed by the Tri-State medical director, continuing education hours are also provided.
After completing online training and several in-person discussions with staff, the program did a soft-launch in May of 2019, but did not have strong support until September. As of October 2019, more than 40 support folders have been utilized on scenes and staff is supportive.