The foundation of emergency medical services (EMS) is built upon defined patient treatment protocols. Protocols are a step-by-step approach supported by evidence-based medicine that gives us confidence in handling even the most traumatic and challenging medical emergencies.
Some protocols are used very frequently – and others more rarely. We have protocols at the ready for any situation, whether by memory or quick written reference. However, there are some situations that occur often that we may not have a protocol or standard approach to handle effectively. References may be lacking, leaving us ill prepared. One of these events is death.
Related
- Gundersen Tri-State Ambulance in Wisconsin Offers Bereavement Support Tools for EMS
- Performing, and Emotionally Surviving, Notifications of Death to a Patient’s Family
- Bad News: Choosing your words and saying them well
When you have a career based on saving lives and reducing suffering, dealing with death gets pushed to the background. It’s not something anyone really wants to focus on or devote valuable training time to. So, even though we encounter death frequently in our work, we don’t have a standard approach to deal with it more effectively. Communicating with the family and loved ones after a death, post resuscitation attempts or pronouncement, is often a chance encounter. These encounters are often awkward and uncomfortable.
Just like any other protocol, we need to have a standard approach for handling how we communicate with the family and loved ones after a death. Paramedics must be comfortable with these skills. To develop this plan it’s important to anticipate the most universal and often non-verbalized questions the family may have. Check with your local health system for resources and experts who can guide you in developing a plan for dealing effectively with communication during a pronouncement of death assignment. Additionally, just as we practice other clinical skills, agencies should provide opportunities for training and skills practice.
- Is he/she okay? Or, is he/she dead?
- Did they suffer?
- Was everything done to save them?
- What was done?
- Can I see them?
- What do I do now?
Here’s a planned approach to answer these questions:
- I’m so sorry, I have to give you some bad news.
- Your loved one (you can use the deceased name) is dead.
- While we were treating him/her, we saw no signs of pain or suffering.
- You need to know that everything that could have been done, was done; we did everything we could, but there was no response.
- Next, you can say what was done, including everyone’s efforts, giving praise to the team (the police started CPR, the EMT’s responded quickly and applied the defibrillator, the paramedics started IV’s and gave cardiac emergency medications and placed an airway tube to provide breathing).
- If you’d like to see your loved one, you can, just give us a few moments to clean up our equipment. During this time it is important to do your best to make the body presentable, closing the eyes, wiping away any blood or fluids, positioning the head and body and perhaps placing a blanket or sheet over the lower body up to the chest.
- Here’s what you can do now. The police will be here to help you as they make their arrangements. We’ve called our emergency doctor to provide a pronouncement of death time. This will help the police to coordinate with the funeral home to come and transport his/her body. Think about any one you need to call and rely on family and friends to help you.
- Do you have any questions for me?
- I’m so sorry for your loss.
- Kindly thank everyone for their help and efforts.
Sometimes the family members blame themselves for not calling sooner. In this case, as you are explaining what was done, also include the loved one who called 911. Tell them that they did everything right by calling when they did.
As you are speaking with the family and giving praise to the team for their efforts, say it loud enough so that everyone hears. It’s a great opportunity to support and value the professionalism and skill of every responder.
There are times when it’s appropriate to tell the family of an elderly deceased patient “what a blessing it is that they died here with you, surrounded by those who loved them.” You may find that you have a crack in your voice or a tear well up in your eye, that’s normal and professional. Families want to know that you sincerely care about them and the job you do.
Having a protocol for every common patient presentation is essential and pronouncement calls should not be different. Being prepared and having a plan makes it much easier and effective to provide treatment. Pronouncement of death is an opportunity to bring healing to the patient and family. This opportunity is an honor to be felt and appreciated; to be present at the time of one’s passing on from this life. The words you say at this time and the caring you express will live on in the minds and hearts of all those present.
Reference
- Baile, W.F., Buckman, R., Lenzi, R., Glober, G., Beale, E.A. and Kudelka, A.P. (2000), SPIKES—A Six‐Step Protocol for Delivering Bad News: Application to the Patient with Cancer. The Oncologist, 5: 302-311. doi:10.1634/theoncologist.5-4-302 First published:01 August 2000 doi.org/10.1634/theoncologist.5-4-302