Death notification: Increased training and support needed

The rise in death notifications during the COVID-19 pandemic has highlighted the lack of training and impact on EMS provider burnout


This article was originally posted in the May 5, 2022 Paramedic Chief Leadership Briefing. Subscribe today for more research insights, leadership tips and operational strategies delivered to your inbox.

“I’m sorry, but your daughter is dead.” The thought of having to deliver this kind of news to someone even once is gut-wrenching. Now imagine having to deliver this news multiple times per day in relation to someone’s best friend, spouse, sibling, parent or child. For many EMS clinicians, this was a daily reality during the height of the COVID-19 pandemic.

In the 2022 ESO EMS Index, we evaluated the number of instances in which an EMS provider likely faced the difficult task of delivering a death notification pre-COVID vs. during COVID. We recognize there has been an increase in out-of-hospital deaths, during the COVID period, both directly due to COVID disease as well as indirectly due to other causes, including drug overdose. The measure highlights the increase in the number of patients in whom resuscitation was not attempted, or resuscitation efforts were terminated on-scene. This substantial increase in on-scene deaths during COVID means that EMS clinicians likely delivered 47% more death notifications compared to pre-COVID.

The increase is staggering, and the burden was not equally distributed, as areas hit hardest with COVID saw much greater increases in deaths.

The impact on EMS burnout

The medical community has observed a correlation between COVID rates and out of hospital cardiac arrests. In the graph, we see the difference in EMS encounters with a patient where no resuscitation was attempted, or resuscitation was attempted but the patient was pronounced dead on-scene and was not transported to a hospital in the pre-COVID time frame (June 1, 2018 – March 15, 2020) vs. during COVID (March 16, 2020 – December 31, 2021). This demonstrates a significant increase in the number of encounters where an EMS clinician would have likely had to deliver a death notification on-scene.

Notifying a family of the death of a loved one can be a challenging and stressful task for providers, especially EMS clinicians who may have to deliver a death notification on-scene for what is often a sudden and unexpected death. The provision of death notifications on-scene has been independently associated with burnout for EMS clinicians, particularly when the EMS clinician has not been equipped with formal training.

We don’t talk enough about death notification

Unfortunately, EMS clinicians typically receive little to no training on how to deliver death notifications, though they are likely to experience a situation in which a death notification will be needed. Even a small amount of training can help EMS clinicians feel more prepared to handle a death notification. One study showed that a 90-minute education session composed of a lecture, breakout sessions and role-playing helped EMS providers increase their confidence and competency in delivering death notifications. Meanwhile, avoiding this type of training can not only be harmful for EMS clinicians, but can also worsen the healing process for the survivors.

While delivering death notification is linked to EMS clinician burnout, the research also shows that death notification training, especially when integrated into ongoing EMS education, reduces the odds of EMS clinician burnout. By offering death notification training, agencies can play an integral role in helping EMS clinicians reduce burnout and have the knowledge and skills to confidently perform in their role.

Support for EMS clinicians

  • Invest in training and continuing education on delivering death notifications that is specific to EMS professionals. Delivering death notifications is linked to EMS clinician burnout, but appropriate ongoing training can help mitigate this effect.
  • Ensure all levels of EMS clinicians receive training on delivering death notifications.
  • Track the number of death notifications EMS clinicians have given. Ensure that EMS clinicians have access to resources and support to help them manage the emotional toll of delivering death notifications.
  • Foster a culture of support within your agency and actively work to remove the stigma that seeking help with mental health is a sign of weakness. Offer evidence-based counseling resources that are tailored to EMS and encourage providers to seek help when needed.

While we are possibly seeing the tail end of the COVID pandemic, the effects will linger for some time to come. First responders are still affected – especially based on the evidence above. Follow the data and provide the support needed to keep EMS clinicians healthy and safe.  

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