The right words

[mcdonl]

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......

Our protocols do not allow that anymore. (Maine)

I find that it is not only what you say, but what you do. If the person is so grief stricken they cannot stand... help them safely sit down. If they are agitated and expressing anger...give them space.

We are all humans and even though we have rules and protocols we need to be able to judge the human response to the situtation we are now a part of and determine for each and everyone of the situations what is appropriate.

We know what to say, and what the protocol says to do medically, it is on our shoulders as men and women to determine the rest.

Like most of you, I have dealt with the loved one of a suddent death who is out of their mind, and the teenage child of a dead parent chatting on the phone like none of us were there.

Every situation is different, every human is different.

 

[NomadicMedic]

Transporting the working arrest for the sole reasons that you want the family to think that everything is being done and because you don't want to deal with their grief is simply lousy patient care and lousy customer service. Not to mention dangerous for all involved.

Not that I haven't transported a working code, but it's usually after the doc decides that he can do something in the ED that I can't. Luckily the majority of those docs have retired. (Really doc? 40 units of vasopressin after I've already given six Epi because you won't let me call the code? I'm sure that 40 units of vasopressin will resurrect him.) I bring them in dead, they usually stay dead. Thee ain't no magic elixirs in the crash cart.

If you're uncomfortable dealing with the family after declaring a death in the field, that's on you. Get more education. Talk to a chaplain. Talk to a social worker. Equip yourself with the tools you need to do the job. Helping a patient's family and loved ones cope with grief is just as important as doing a bunch of Paramagician stuff.

Actually, it's more important.

Any monkey can learn to put a tube in the trachea and drill an IO. It takes a real professional, someone with exceptional people skills to be able to tell husband that his wife, whom he's been married to for 23 years, is dead and there's nothing you can do about it.

 

[Aidey]

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.

To summarize, you're wrong, for a very long list of reasons.

1. Studies of the family members of people who have died have shown that the families STRONGLY prefer for the person to be declared at home. Including children. Any resources the hospital may have are vastly out done by not having to drive somewhere, and being able to be at home in an environment they are comfortable with. The same studies showed that receiving the news from a paramedic or a nurse had equally high "approval" ratings.
2. It gives false hope.
3. It isn't safe. For you, anyone else in the ambulance, the family following behind and everyone else on the road.
4. It isn't effective. Studies have shown that CPR in a moving ambulance is barely above useless.
5. Transporting has zero correlation to increased ROSC/survival. If you can't make them un-dead on scene, what makes you think the ED can?
6. By transporting a dead body you are potentially disrupting a crime scene.
7. By transporting you are causing to family to incur a large hospital bill, on top of all the funeral expenses they will now have.
8. It is a waste of ED resources. It takes up a bed, a doc, the code team etc. That bed can be taken up by a dead body for hours if the morgue is full or the coroner isn't available to come and take the body.

How on earth is a strange ED a more controlled environment than ones own living room? And don't you think that actually telling the family "we did everything" would be more effective than transporting the body? How do you think it looks to the family if the hospital stops efforts before they can even get to the room? Or stops within a couple minutes of arrival? Does that give the impression of "doing everything"? The family isn't going to know ahead of time that there was nothing else the hospital could do.

Our protocols do not allow that anymore. (Maine)

Good. There is a reason that not transporting CRP is becoming the standard.

 

[Household6]

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.

I've been instructed to leave everything (except sharps of course).. I had assumed that leaving your trash helped preserve a possible crime scene, I wasn't aware that it was a local protocols thing.. I assumed it was a standard reg for everywhere.. Interesting.

 

[NomadicMedic]

You were instructed to leave your trash? When you work a code? Seriously? Empty boxes, ET tube wrappers and the other flotsam and jetsam from a code?

Wrong and disrespectful.

 

[Arovetli]

You were instructed to leave your trash? When you work a code? Seriously? Empty boxes, ET tube wrappers and the other flotsam and jetsam from a code?

Wrong and disrespectful.

Disagree, especially if it is a crime scene as was indicated. Not always the "all old people deaths are a crime scene" scene....but a true crime scene.


Non crime scene, sure. Dont trash grannys house.

 

[TechMedic]

I remember one call that as We left, one of the family members gave us some equipment they said We left there a long time ago.

 

[Aidey]

You were instructed to leave your trash? When you work a code? Seriously? Empty boxes, ET tube wrappers and the other flotsam and jetsam from a code?

Wrong and disrespectful.

I have been too, and I wasn't going to argue with the cop with the big *** gun about it. The call was a multiple patient shooting with multiple shooters that had bullets and casings and debris everywhere. They didn't want us disturbing anything more than we already had. We were lucky they let us take our gear bags.

 

[sir.shocksalot]

I have been too. It was a multiple shooting with bullets and casings and debris everywhere. They didn't want us disturbing anything more than we already had. We were lucky they let us take our gear bags.

I think that some people are visualizing two very different situations. The posters who were saying to not leave your stuff there were probably thinking of grandma/pa dead on the living room floor after being admitted to the eternal care unit. Your suicide/homicide/questionable death circumstances are sort of a different animal. Ultimately the smart thing to do is ask PD what they want.

 

[Aidey]

I think that some people are visualizing two very different situations. The posters who were saying to not leave your stuff there were probably thinking of grandma/pa dead on the living room floor after being admitted to the eternal care unit. Your suicide/homicide/questionable death circumstances are sort of a different animal. Ultimately the smart thing to do is ask PD what they want.

I know, but Rob told someone who said they had been told to leave their trash that it was rude and disrespectful. I was trying to illustrate that it isn't going to be rude and disrespectful in all situations.

 

[NomadicMedic]

Right. I was under the impression we were talking about the typical unsuccessful resuscitation. Isnt that what this thread was about? That's the time you'll need to tell families that nana has died. Those are the people that you'll commonly be supporting, the distraught family members at a common run of the mill code or pronouncement.

If you're at a shooting/crime scene, there are typically a zillion cops with the family.

And sure, if you're working a code at a crime scene, leave your stuff. If you're working a code at nana's house, pick up your mess.

 

[Aidey]

Even at a crime scene/suspected crime scene telling the family what is going on may fall on you. The family might be surrounded by PD, but that doesn't mean PD is going to give them much of an explanation.

 

[NomadicMedic]

I think we're saying the same thing... Just in different ways. The OP was asking for help in finding the words to tell family that a loved one has died. I think we all covered that completely.

If you're talking to the family, you're going to be kind and compassionate...But direct with your answers. I also related that it was important to pick up your trash and treat the hone and decedent with respect.

I don't know how the crime scene stuff got added into this conversation, but I maintain if it is NOT a crime scene, pick up your trash. Same as, if you're the only person who can address what's going on with the family, then do it. In every shooting/stabbing I've ever worked (and we did more than a few in Yakima) the cops knew enough about what was going on that they could speak to the family while still controlling the scene.

But hey, every system is different. And as always, YMMV.

 

[Aidey]

I was also thinking of the accidental deaths that automatically get an investigation, often that happen at home. Gun mishaps, farm accidents etc. The scene might not be crawling with cops right away, but EMS knows it is going to be treated like a homicide until proven otherwise.

 

[Brandon O]

Lots of great tips in this thread. I would emphasize directness, but also don't try to "surprise!" them with the news; if you're sitting there working a code for a while, they should understand that this is a dire situation and they should be ready for a bad outcome. And as said, when necessary, think of the family as your patient now. DON'T try to play battlefield shrink and "weigh in"; just be supportive and try to smooth things so they have to handle as little as possible.

There's good stuff out there on psychological first aid if you want more. The Red Cross does classes.

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

My understanding is that patients should generally not be extubated once declared (or presumed) dead. The body remains in an unchanged state for the coroner/ME -- I wouldn't sweat a blanket, but tubes, IVs, etc stay in. Medicolegal thing. Not sure if this differs state to state.

 

[Aidey]

To add to what Brandon said, my conversation with the family is usually a 2 part process. Once we get to the point we are going to call the doc, I'll tell the family something like "Nothing we've done has been able to make your husband's heart start working again. I'm going to call the doctor at St. Acme's and see what he has to say".

This also helps explain why someone is walking away and talking on their cell phone in the middle of a code, something that people could interpret the wrong way. Once I get permission from the doc to stop, I'll let everyone know and then talk to the family again.

 

[Trailrider]

thanks for all the post contributions, it has shed some light on the topic. thanks.

 

[Stoked]

I guess the question that comes to mind for me is something like "how does one notify when they know they can't"?

Explanation- in my former career I had to do many death notifications, and over the years I developed a slight issue with it- uncontrolled laughter. Along the lines of "I'm sorry to have to (snicker) tell you (giggle) this, but (guffaws commence)..." I knew a couple other cops that also went through this, but most of them seemed to block it out. Not so here, sergeant eventually banned me from doing them. Someone complained; I had a notification on an MVA where the teen driver came out a crispy critter (head-on vs. Semi at highway speed) and when the father opened the door, I was laughing so hard I was nearly in tears.

I know this will be part of the job if I end up in EMS full or even part time, so I've been pondering it.

Thanks.

 

[the_negro_puppy]

I guess the question that comes to mind for me is something like "how does one notify when they know they can't"?

Explanation- in my former career I had to do many death notifications, and over the years I developed a slight issue with it- uncontrolled laughter. Along the lines of "I'm sorry to have to (snicker) tell you (giggle) this, but (guffaws commence)..." I knew a couple other cops that also went through this, but most of them seemed to block it out. Not so here, sergeant eventually banned me from doing them. Someone complained; I had a notification on an MVA where the teen driver came out a crispy critter (head-on vs. Semi at highway speed) and when the father opened the door, I was laughing so hard I was nearly in tears.

I know this will be part of the job if I end up in EMS full or even part time, so I've been pondering it.

Thanks.

 

[TechMedic]

I guess the question that comes to mind for me is something like "how does one notify when they know they can't"?

Explanation- in my former career I had to do many death notifications, and over the years I developed a slight issue with it- uncontrolled laughter. Along the lines of "I'm sorry to have to (snicker) tell you (giggle) this, but (guffaws commence)..." I knew a couple other cops that also went through this, but most of them seemed to block it out. Not so here, sergeant eventually banned me from doing them. Someone complained; I had a notification on an MVA where the teen driver came out a crispy critter (head-on vs. Semi at highway speed) and when the father opened the door, I was laughing so hard I was nearly in tears.

I know this will be part of the job if I end up in EMS full or even part time, so I've been pondering it.

Thanks.

You think it's funny when people die...?