The right words

[Trailrider]

I know that school teaches us the basic with communicating with patients and their families when it comes to death of a loved one or unfortunate events that have caused death, but during these trying and tough times how do you deal with certain situations like the death of a child or someone you are doing CPR on and is no longer revivable. How do you communicate with the families as they sit there in despair? I'm trying to chalk up the best answer but I have nothing. I don't feel that any amount of schooling, or experience on car could give you the right words to say.

I leave this discussion open to any one in the field, or med military personel to respond.






Stay safe out there ,

 

[Mariemt]

I know that school teaches us the basic with communicating with patients and their families when it comes to death of a loved one or unfortunate events that have caused death, but during these trying and tough times how do you deal with certain situations like the death of a child or someone you are doing CPR on and is no longer revivable. How do you communicate with the families as they sit there in despair? I'm trying to chalk up the best answer but I have nothing. I don't feel that any amount of schooling, or experience on car could give you the right words to say.

I leave this discussion open to any one in the field, or med military personel to respond.






Stay safe out there ,

" We did everything we could. I am so sorry for your loss. Is there anyone we can call? "
You don't want to get into religious beliefs as theirs may differ. You keep it simple.

 

[Trailrider]

" We did everything we could. I am so sorry for your loss. Is there anyone we can call? "
You don't want to get into religious beliefs as theirs may differ. You keep it simple.

I just feel like that's not enough, you know?

 

[Mariemt]

I just feel like that's not enough, you know?

well they don't want to hear stories about how you lost someone too, no you don't know how they feel. They won't believe they are "in a better place" you can't make them feel better.

Off your condolences while placing an hand on their arm and kneeling in front of them. If they have a pastor , call him or her.
What more can you do?

 

[RocketMedic]

I prefer tactful bluntness. "Your loved one is dead. There is nothing more that can be done. I am terminating this resuscitation. We will call the police and they will handle this situation from here. I am sorry."

 

[Wheel]

I just feel like that's not enough, you know?

The fact is that nothing you say will be enough, and that's ok. Death is a part of life, and while it hurts, that is perfectly normal. It sucks having to break that news, but someone has to do it in order to start the natural grieving process.

 

[Handsome Robb]

Whatever you do don't give them false hope.

If you're doing CPR explain to them what's going on, "Ma'am your husband's heart is not beating and he is not breathing on his own so we're doing those things for him. We're gonna do everything we can for him but you need to understand this is an uphill battle."

 

[TechMedic]

You have to be straight and truthful with them. Dont walk around the facts. You need to tell them their family member is dead. Its cold, but I watched a daughter bust through the ER doors after they pronounced (No one told her to go in) and screamed at her mom as if she was trying to wake her from a nap....

The first step in the grieving process is denial. The quicker they accept it, the better.

 

[abckidsmom]

I prefer tactful bluntness. "Your loved one is dead. There is nothing more that can be done. I am terminating this resuscitation. We will call the police and they will handle this situation from here. I am sorry."

I totally agree with simple, direct language, but through the fog of shock and grief, these words can be remembered as harsh and cruel.

I would communicate the same sentiment with these words:

"Your loved one's heart has stopped beating, and despite our best efforts, he has died. We have tried all we can, but it didn't work. We will call the police, who are responsible for arranging the next steps. I am sorry for your loss."

When possible, I like to pull the tube, put a pillow behind the patient's head, and cover him with a blanket or something and let the family members who would like to come in and sit with him do so. When he is freshly dead, they can hold his hand one more time and it will just feel cold. Later, it will feel dead dead, and will not be the same.

During the waiting time, I just closely observe them and look for small, reassuring things to say. Usually they want to retell the story of what happened, either to each other or to me. This opens up the door for reassurances of "no you couldn't have done more" or for them to ask questions about the arrest, or anything. Just being a quiet, friendly presence is so helpful.

If they look ill, or can't calm down, I help them in whatever way I can. We once transported the wife for chest pain 30 minutes after we called the code on her husband.

Great topic. This is something we all can do better on.

 

[Ecgg]

This has extremely strong element of situational dependence.

Distraught family with a young child in cardiac arrest transport to the hospital as they have better resources for family from councilors to social workers.

Arrest in the house with lots of concerned parties? Just the HHA? DNR issues?

Arrest in public place with family?

Arrest in nursing facility with staff demanding you remove them from premises?

I don't think you can develop a uniform approach to all these things. Avoid arguments at all costs, consult with medical control, use common sense.

 

[Sandog]

I prefer tactful bluntness. "Your loved one is dead. There is nothing more that can be done. I am terminating this resuscitation. We will call the police and they will handle this situation from here. I am sorry."

Your all heart...

 

[NomadicMedic]

I think it's really important to use the word "died".

When I terminate a resuscitation, I don't mince around. I never say "he's passed on" or "we've lost him". Like several others have said, you need to be blunt, not provide any false hope and when things have reached the end make sure you speak clearly and calmly.

I've had family members cry on my shoulder and I've had people try to hit me. Grief is a very personal thing and sometimes all you can do is just be there.

And it should go without saying that you need to be polite and compassionate… They may not remember what happened during the resuscitation, but they sure will remember how the paramedics left the house and how they were treated when they were told the news. Pick up your code trash, cover the person with a blanket or sheet. Be respectful and be professional.

 

[teedubbyaw]

I agree about being blunt about the obvious. That brings a sense of closure, if you will. All about using that bluntness with empathy and compassion.

 

[Trashtruck]

You need to use the words 'dead' or 'died'. There's no room for interpretation.
None of this prancing around with 'they've moved on' or they 'passed' or 'they're in a better place now' or 'we did all we could, but I'm sorry'

 

[bonesaw]

I think it's really important to use the word "died".

When I terminate a resuscitation, I don't mince around. I never say "he's passed on" or "we've lost him". Like several others have said, you need to be blunt, not provide any false hope and when things have reached the end make sure you speak clearly and calmly.

I've had family members cry on my shoulder and I've had people try to hit me. Grief is a very personal thing and sometimes all you can do is just be there.

And it should go without saying that you need to be polite and compassionate… They may not remember what happened during the resuscitation, but they sure will remember how the paramedics left the house and how they were treated when they were told the news. Pick up your code trash, cover the person with a blanket or sheet. Be respectful and be professional.

This is huge. Had a family member arrest a while back and when we went to the house a few hours later there were sharps, lots of used gloves, wrappers from airways/aed pads/ etc around. No excuse not to pick up after yourself if the pt is pronounced on scene.

 

[MSDeltaFlt]

I know that school teaches us the basic with communicating with patients and their families when it comes to death of a loved one or unfortunate events that have caused death, but during these trying and tough times how do you deal with certain situations like the death of a child or someone you are doing CPR on and is no longer revivable. How do you communicate with the families as they sit there in despair? I'm trying to chalk up the best answer but I have nothing. I don't feel that any amount of schooling, or experience on car could give you the right words to say.

I leave this discussion open to any one in the field, or med military personel to respond.






Stay safe out there ,

There is no best answer. Remember they're in an emotional state and it can be very easy for them to misinterpret your words. So be clear and concise and let them hurt. Be nonjudgemental. But be tactfully direct.

"I'm sorry. We've done everything we could, but he/she is dead".

If you're working the code and getting nothing, warn the family a few minutes ahead of time that if you don't get a pulse back soon then you will have to pronounce your patient dead. And use the word "dead". And if the patient is to be pronounced dead on scene, revert back to the paragraph above.

 

[TechMedic]

I think it's really important to use the word "died".

When I terminate a resuscitation, I don't mince around. I never say "he's passed on" or "we've lost him". Like several others have said, you need to be blunt, not provide any false hope and when things have reached the end make sure you speak clearly and calmly.

I've had family members cry on my shoulder and I've had people try to hit me. Grief is a very personal thing and sometimes all you can do is just be there.

And it should go without saying that you need to be polite and compassionate… They may not remember what happened during the resuscitation, but they sure will remember how the paramedics left the house and how they were treated when they were told the news. Pick up your code trash, cover the person with a blanket or sheet. Be respectful and be professional.

When the daughter snuck into the er room on my call, her mom was practically naked. They didn't even have time to cover her with a sheet

 

[Aidey]

This is huge. Had a family member arrest a while back and when we went to the house a few hours later there were sharps, lots of used gloves, wrappers from airways/aed pads/ etc around. No excuse not to pick up after yourself if the pt is pronounced on scene.

This is one of those depends on your local rules thing. Here the coroner is ok with us picking up loose trash, but nothing attached to the pt (IV, ET tube etc) and nothing that belongs to the pt. If PD is involved they do NOT want us covering the person with a sheet, even in a public area. If it is a major crime scene we clean up only the absolutely necessary items, like sharps. That way we don't inadvertently throw away something important or destroy evidence further.

Leaving sharps out seems like a big no no, but if the coroner/PD want everything left exactly as is, that is their choice.

 

[wanderingmedic]

As a general guideline I try to not allow arrests to get called in the field. I always prefer to continue CPR enroute and let the ED declare. I do this for two major reasons 1) I want the family to know that the ambulance crew tried their hardest and did everything they could for the patient 2) The ED is a more controlled environment for a family to get devastating news like that. The ED will also have social workers, chaplains, etc., who are trained to help families receive news like this - most EMT's and even medics have not received much if any psych training.

One of the things I have learned is that when one of my patients dies, their family becomes my patient. While medically there is probably not much I can do to help the family grieve I can be there for them. People (usually) dont give a rip about what I have to say after they have heard news like that, and just being there for the family is huge. Most of the time a shoulder to cry on/with, a person to hug, and a listening ear is the best care you can give. I realize that having a total stranger hugging you or crying with you might be uncomfortable and not for everyone, and that is fine. Just be as human, authentic, and personable as possible and let the family guide.

If the patient dies prehospital, I try to be as straightforward and respectful as possible, and say basically what everyone else in this thread responded. I ALWAYS make sure the family has the resources they need before I leave. This may mean calling their pastor/spiritual leader or contacting some of the family's friends so the family does not have to be alone (all done with the family's permission of course). Some of the larger churches in my area have pastors on call that can be paged in an emergency, and if the deceased's family does not have any specific pastor in mind I can get the pastor on call to be on scene within the half hour. Basically, I think its about providing holistic care to the family: spiritual, psychological, and physical.

*Disclaimer: Yes, I know that at times it is not possible or in your best interest to transport. I'm not trying to say these are hard and fast rules for me - or they should be for anyone else - they are just some of my thoughts and the way I have learned to do things. Each situation is unique and requires discernment as to what the best thing for the patient and their family would be.

 

[DesertMedic66]

This is one of those depends on your local rules thing. Here the coroner is ok with us picking up loose trash, but nothing attached to the pt (IV, ET tube etc) and nothing that belongs to the pt. If PD is involved they do NOT want us covering the person with a sheet, even in a public area. If it is a major crime scene we clean up only the absolutely necessary items, like sharps. That way we don't inadvertently throw away something important or destroy evidence further.

Leaving sharps out seems like a big no no, but if the coroner/PD want everything left exactly as is, that is their choice.

Same here as far as tubes and IVs go. Anything attached to the patient gets left in place and will be removed by the corner. Unless the patient is being released to the mortuary, then everything gets removed.