Dealing with death
Designating specific roles and other tips to make the hardest part of the job a bit easier
How do you tell someone that their loved one is dead? Is this something you were taught in EMT school or something you have learned on the job? Having to tell a patient's loved one they are deceased is one of the hardest things you will have to do as a first responder. Dealing with death is part of the job, but it is something that most of us were not taught how to deal with. [At the end of this article, download a checklist containing the information to document when a patient dies].
Preparing your crew before the call can make the difference between calamity and a well-oiled machine. Most of us have seen the American Heart Association videos where a team leader is named, and they give specific orders as to whom will do what task. This is not just for the controlled setting, like in the videos. It also works well in the field.
Know your roles
Designating a team leader is a good thing, no matter the call. I have also made it standard practice that one person on the team is assigned to interact with the family.
When someone calls 911, you usually are walking into their lives at the worst time. It is a moment that you may forget by the end of the day, but it is a moment the patient's family will likely remember for the rest of their lives. I remember the day my father passed away like it is still playing in slow motion in my mind.
Be informative and respectful. In a termination of resuscitation situation, explain to the family what is going on, why you are doing it and what will happen. Offer to help call hospice, if the patient had made arrangements, family or clergy.
If the scene becomes violent – transport! It happens. Families refuse to believe that their loved one has died. Nothing you say will change their behavior. A provider’s best practice is to have law enforcement respond to critical emergencies, (e.g., overdoses and cardiac arrests).
Clinical signs of death
Most EMS systems have a protocol in place to deal with a scene death. There are some cases, such as decomposition, incineration and decapitation, that require no intervention. Most death criteria include the four presumptive signs of death:
- Fixed/dilated pupils
The four should be accompanied by at least one conclusive sign of death (i.e., lividity, rigor mortis or massive trauma to the head or torso).
Never assume that someone is deceased. Always go through the steps of identifying the signs of death. Use your tools that you have available, listen for any lung and heart sounds, and confirm the rhythm with two different leads. If their signs don't match up or the patient is hypothermic, resuscitation efforts should be made.
Document, document and document some more
We have all been taught from the beginning of our careers that if you didn't document it, it didn't happen. Avoid jargon. Always use plain language when documenting the scene. Two PCR reports that particularly require focus on clarity and detail are patient refusals and death scenes.
One thing you can guarantee yourself if you stay EMS long enough, is that your report will be someday be used in a court case. What clothes was the patient/victim wearing? Who was their family physician? What did their medical history include? How were they found? These are just a few of the questions you could be called to answer in a court of law. Can you remember these facts five or six years after you wrote the report?
When documenting the scene, you want to paint a picture for the ones who will be reading it. Include everything your crew did (and did not do). Include copies of EKG strips to show asystole or PEA. If you did not start treatment or transport, make sure you have thoroughly explained why.
Treat every patient death as a crime scene
Every death scene should be treated as a crime scene until foul play is ruled out. Never leave the deceased alone until law enforcement and the medical examiner/coroner are on scene to take responsibility for the body. Wear personal protective equipment and be aware of what you touch or move so you can document it later.
Most law enforcement and medical examiner and coroners will want to know detailed information about the patient’s demographics. Develop a list to make it easier to have all pertinent information ready when needed. [Download an example at the end of this article.]
Know when you have seen enough
Dealing with death is never easy. Not only does it affect the family, but it also affects the responder. Post traumatic stress disorder (PTSD) or post traumatic stress injury (PTSI) can be acute or chronic. The All Clear Foundation and Code Green Campaign have excellent resources for supporting first responders at risk for PTSD, depression and suicide. There are many resources to help you deal with stress. Reduce the stigma. If you need help, please ask for help.