One of the hardest tasks for a paramedic or emergency medical technician is telling family members that their loved ones have died. Emergency medical services (EMS) staff often are competitive by nature and, although outcome is a poor way to judge the efforts of an emergency responder, it is often how responders perceive it.
Building Credibility & Managing Expectations Set up for this task begins when EMS staff arrive on scene, even before assessing the patient. At all times, EMS staff must build credibility with the patients and their families by demonstrating that they are professional, skilled, and serious about the tasks that they must perform. Television and movies – where a patient’s survival is based on the needs of the plot rather than on reality – affect the public’s perception of EMS, so it is important to manage expectations.
The steps for preparing a family for the death of a cardiac arrest patient are similar to telling a patient that he/she has a terminal illness. EMS staff can set realistic expectations by conveying the direness of the situation and telling the family the truth: “Your family member is gravely ill, the heart has stopped, and he/she is not breathing, but we will do everything we can.” Families may expect the patient to receive immediate transport to the hospital, but EMS staff can reassure them that the ambulance is bringing the “emergency room” to the patient, thus shortening the delivery of advanced care. The nature of first response often dictates the setting and timing of an encounter, so it is critical for staff to recognize what they can and cannot control.
In cases where the patient has a low likelihood of survival or when emotions are high, it is often advisable to move the family members to another area or room. Although it is never good to surprise someone with bad news, delaying the news does no good either. Following are some key points to remember:
- Whenever possible, have the family members sit and, as long as it can be done safely, sit or crouch to look them in the eyes. Eye contact with family members is important because they may interpret looking away as a sign of guilt or concealment.
- Get quickly to the point with a short transition.
- Give details, never hide facts, and repeat details given at the beginning, “The heart has stopped and he/she is not breathing.”
- Do not use euphemisms. Under stress, people have trouble understanding complicated concepts; EMS staff must ensure that the family clearly understands the information they convey.
- Most importantly, treat the patient and family with respect and honesty, and maintain the patient’s dignity. The simple and time-honored act of covering a body with a sheet may seem “old fashioned,” but it becomes more relevant in a world where everyone has a digital camera with an Internet connection in their pockets.
EMS teams build credibility not only by doing a professional job, but also by being honestly intent on giving patients the best chance of survival. When the EMS team controls the family’s expectations from the beginning and properly assures the family that the patient is receiving the best care possible under the circumstances, family members can begin to prepare – with a minimal element of surprise – for the moment when EMS staff must officially deliver the bad news.
Joseph Cahill is a medicolegal investigator for the Massachusetts Office of the Chief Medical Examiner. He previously served as exercise and training coordinator for the Massachusetts Department of Public Health and as emergency planner in the Westchester County (N.Y.) Office of Emergency Management. He also served for five years as citywide advanced life support (ALS) coordinator for the FDNY – Bureau of EMS. Prior to that, he was the department’s Division 6 ALS coordinator, covering the South Bronx and Harlem. He also served on the faculty of the Westchester County Community College’s Paramedic Program and has been a frequent guest lecturer for the U.S. Secret Service, the FDNY EMS Academy, and Montefiore Hospital.