Death Notifications

[Siffaliss]

Advising family of a deceased relative is part of what we do. Do you remember the first time you had to speak to a family about this? Would you change any part of your communication if you could?

[tcripp]

Advising family of a deceased relative is part of what we do. Do you remember the first time you had to speak to a family about this? Would you change any part of your communication if you could?

I'd like to add to your line of questioning. In some areas, a member of the victim services group would provide that information. If given the chance, would you leave it up to the advocate to give the death notification?

[EMS49393]

I have given notification several times when I work an arrest and obtain medical control for termination. I put myself on the same level of the patient, i.e., if the patient were seated, I would kneel near them before I began to talk. I calmly describe that when we arrived their family member did not have a heartbeat and was not breathing. I then explain that what we did, such as medication, breathing tube, CPR, defibrillation, etc. I do not go into gory details, but I make sure that the person I'm talking to understand how hard we worked to save their family member. I then tell them that I spoke with a physician at XX ER and he agreed that everything that could be done had been done and that we should cease efforts. I offer to answer any questions that I can, or obtain any outside support that they may need such as additional family or clergy.

Of course, the above only works for me if the family is not hysterical to the point that I feel we are in danger. As of yet, that has not happened to me. Most family is so busy grieving that they want comfort more than they want to fight.

It's a delicate situation, and something they do not teach you how to do. I really feel that a large part of my job involves social work, not just fancy medications and toys. I'm there for a patient, and I'm there for family when I have taken care of the patient.

I am a big fan of requiring sociology and psychology for paramedics for this reason.

[DwayneEMTP]

I don't think I'd change anything. It was a grandmother and her daughter and granddaughters were there. I explained what had happened, why I had chosen to discontinue resuc attempts, explained what they could expect from this point forward and made sure that they were physically ok. We don't need physicians OK here to choose not to initiate, nor to terminate resuscitative measures, though many choose to get them anyways to CYA.

Would I use use a Victim counselor to do this if one was available? Sure. I've helped several family members die, as well as two close friends, so I'm not terribly uncomfortable in that position, but if there is someone that was educated in the needs of these patients and they'd proved in the past to be competent, then I'd use every tool at my disposal to care for those in my charge. I'm not going to allow some yahoo to step up to the plate if they show that they have no skills, but I have no ego involved in being the center of attention. If someone else is better equipped to provide comfort then they will have my full support.

Dwayne

[Siffaliss]

I'd like to add to your line of questioning. In some areas, a member of the victim services group would provide that information. If given the chance, would you leave it up to the advocate to give the death notification?

Not if they're less than 20 feet away in the other room and it takes a full day for VSU ... I mean working a code etc etc ... EMS doesn't usually go to doors making notification if that's what you thought I meant.

[spenac]

My first sentence is very blunt and to the point so there is no confusion. ( I.E. They are dead. ) I have had to go to peoples houses and tell them of the death of a loved one. To many try and sugar coat it and then you have the family ask so will they recover. By being blunt they have no doubts that the loved one is dead then I can start comforting and helping them as needed. I have had many that have had death notifications thank me for coming and helping them. I have had some that sadly have been notified of other loved ones deaths by other people say they wish that the other time ('s) the person telling them had been more clear and direct like I was as it made it easier. So while it may seem cold hearted to be blunt it apparently is better in my experience.

[Richard B the EMT]

The only death notifications I have done, have always been just to people in the same home as the deceased, after either determination of death, or termination of rescusitive efforts.

[tcripp]

Not if they're less than 20 feet away in the other room and it takes a full day for VSU ... I mean working a code etc etc ... EMS doesn't usually go to doors making notification if that's what you thought I meant.

Didn't mean anything by the question. I live in a small town that has a VSU that responds within 30 minutes of dispatch. Now I know for certain that the EMS crew in this area does their own death notification on scene as needed. I was just curious if others would rather have the VSU intervene on their behalf.

I have been with those who have died, including several of my own family members. I haven't, though, been the one to notify a loved one of the death. You posted a good question and I'm trying to get perspective on the subject.

Dwayne - I like your input.

[jonas salk]

My first one went surprisingly well. The pts husband knew that his wife was dead and basically just wanted to hear someone else confirm his thoughts.

My last notification was pretty brutal. It was a call for 'man hasn't been seen in a few days'. We arrive at the pts apartment and his family was waiting out front and were quite frantic. They tried getting into the apartment but were unable. My partner and I were able to get in through the balcony and found the pt dead in his living room. He'd been dead for a while. I left the apartment through the door to get some paperwork from the truck. On my way down the stairs I ran into a cop and let them know that the patient was obviously dead. Unfortunately I hadn't noticed that a couple of the patients family members had made their way inside the building and were within earshot when i passed the word.

Learned a valuable lesson that day.

[HERBIE1]

I agree about not mincing words. Each situation is different- depends on the culture, ethnicity, family dynamics, age of PT, terminal illness or a sudden death. No standard text to follow- you need to use language and phrases that seems genuine coming from you, and appropriate for the situation. It's never "easy", many times families are well aware of what has happened, but occasionally someone may be in denial. You may hear questions like- Are you sure? I think I just saw him breathe- even though they may have profound rigor and dependent lividity. In cases such as those I tend to get clinical-"We have asystole or flatline on the monitor, the time limits of someone responding to treatment or surviving without oxygen, I'm sorry, it's long past the point where we can help them, etc. Sometimes people need a more clinical approach, sometimes they need it explained to them more informally. Experience will tell you which tactics to try, and sometimes you may need to switch gears in midstream. A person may seem to need a detailed clinical explanation, and suddenly they become overwhelmed. At that point, you need to bring it back to a more humanistic approach.

ALWAYS suggest they call a family member, neighbor, priest- someone- especially when they are alone.

Give them a purpose- get together their identification cards, a list of medications, their doctors names and numbers, and a funeral home preference if the death was expected. It keeps them going, and there will be plenty of time for grieving later.

Be there when they begin to make those calls, if possible.