communicating death in ems kerry evens rn, bsn, cfrn, cen chief flight nurse north colorado med evac
TRANSCRIPT
Communicating Death in EMS
Kerry Evens RN, BSN, CFRN, CEN
Chief Flight NurseNorth Colorado Med Evac
How Do you Say IT??
American Cultural Bias
• Death is the Enemy:
• “When someone is born we rejoice. When someone is married, we celebrate. But when someone dies, we pretend nothing happened” Margaret Mead
• Reality = Death is a part of life.
Objectives
• Identify sources of provider discomfort with communicating death
• Discuss a personal case• Discuss cultural differences in death• Review grief stages• Learn specific methods of effectively
communicating death
“When someone dies, we’re suddenly
confronted with our own mortality –
something we never talk
about, and that most of us are afraid to think
about.”
My Story
• I’m not a trained psychotherapist/counselor• ER/PICU/Transport RN for 20 years• Estimate that I’ve been involved in over 1000
deaths in my career• Professionally experienced with breaking the
news of death• Most impactful – my own experience with a
family death
My Story
Jan. 5, 2002
• Climber Killed near “The Fang” in Vail
I was at work…
• 10 years later – I can recall perfectly• Vivid snapshot memories of those moments– Small room– Social worker– Telephone – news from my friend– Ride to Summit County– Viewing his body – Pile of cut up clothes
What I Felt
• Variety of emotions:– Fear– Panic– Confusion–Worry– Numb/Detached and Alone– I felt like I was going to die– I felt like I wanted to die – I wanted answers, but I dreaded them
What I wanted
• Someone to just be straight with me• I wanted the cold facts• I wanted to be sought out an TOLD
information• I wanted reports/X-rays and first hand
accounts• Someone to treat me like I was a part of the
tragedy
What I Didn’t Want
• I didn’t want to be shielded• I didn’t want to be asked “how are you
doing?”• I didn’t want to hear “everything happens for
a reason” or “he’s in a better place”
Memorializing and Moving On
• I became very functional– Coping/Survival
• Scholarship fund• Tibetan fund• Donation to RMNP – bench/funds• Spreading ashes around the world - friends• Writing on leaves
EMS – You Can’t Die!
• Cultural Bias – in general - American• Death is Bad – Resuscitation is Good!• EMS is there is “Save Your Life”,
“Everyday Hero’s” Blah, blah, blah……
• Reality TV ER shows don’t help this perception
• Reality is that 1.76 persons die per second worldwide.
Training on Death/Grief and Communication????
• How much training to we get in EMS?• Fewer than one third of medical residents
report receiving training in the process of death pronouncement
• Because of lack of training we are uncomfortable
• As soon as that pt. is pronounced – everyone…….
Scatter Like Roaches……
“A Good Death does Honor to a Whole
Life”Petrarch
How Do WE Deal with Death?
• Educational desensitization• Humor• Language Alteration• Scientific Fragmentation• Escape into Work• Rationalization• EMS tend to be Altruistic personalities
You Know it’s a Bad Call
• Pre-emptive – when you arrive at the call:
• Introduce yourself quickly• Reassure – “We will do all we can.”• Builds a relationship and trust• Designate a “communicator” to keep
the family informed.• Think ahead in your care – the family
will “see this”
The Call Ends “Badly”
• Now what?• Prepare yourself:– Be “Present”– It’s natural to feel inadequate– Be genuine – tell the truth– Slow down and listen to the needs of the
family – stated and unstated– Be aware of your own
physical/emotional needs
Setting
• Setting: Private, quiet• Consider your own appearance• Who is the right one to break the
news?• Be focused on the people you are
talking to– Sit down –Make eye contact– Physical touch if appropriate
• A word on litigation
Those 2 Minutes
• 30 second – 2 min. to relay information• Critical that the key points are delivered
initially• Know the name of the deceased!• Avoid euphemisms• Use words “Dead”, “Died” and “Death”• Memory of first moment vs. first days
Those 2 Minutes
• Reassure – everything possible was done– Briefly/simply explain what you did
• Understand/address initial feelings of guilt
• Explain what caused the death• Answer questions• “If you want to heal folks, lay ears on
them”
Next Steps
• Explain what will happen next– Calls to be made–What happens with the body– Offer resources if your department
provides
Local Cultures
• Anglo• Latino• Somalia• Asian
Grief Stages
• Shock and Denial – Protest– I can’t believe this–We need to listen in this phase– Offer safe environment to express
feelings– Support
• Pain and Guilt– Overwhelmed– “What if” or “If only”
Grief Stages
• Anger and Bargaining– How could they leave me?
• Depression, Deflection and Loneliness
• Acceptance and Hope
Grief Stages
• Initial: Acute emotional spike typically lasts about 15 minutes
• Exonerate the family if appropriate• Avoid the words “I’m Sorry”• Be prepared for initial reactions
What About Telling Kids?
• In EMS cases – it should be the family’s decision
• Children thrive in a climate of realism• Let them see that is OK to show emotion• Be ready to answer questions• Use simple and direct descriptions:– “Stopped working”, or they “wore out”
What About Telling Kids?
• < 3 y/o: – They Understand sadness– Think of death as reversible
• 3-6 y/o:– Magical thinking– Death is a “taker” that “gets you”
• 6-9 y/o:– Better comprehension– Need clear/simple explanations
What About Telling Kids?
• 9-12 y/o:– Death may be a punishment– Feelings of guilt
• Teenagers:– Understand concept of death– Much like adults– Need support and outlet
“It is the nature of all things that take form to dissolve again.”Buddha
Questions?
References
• Book: “How do we tell the children?” Dan Schaefer Ph.D & Christine Lyons
• Book: “American Book of Living and Dying” Richard Groves and Henriette Klauser
• Emergency Medical Technicians - body, funeral, life, time, person, human, Types of EMS Providers, Training Standards, Roles, and Responsibilities of EMTs
References
• http://www.deathreference.com/Da-Em/Emergency-Medical-Technicians.html
• http://www.fhp.org/fhpdocs/CrossCulturalResourceGuide.pdf
• http://www.hcplive.com/publications/Resident-and-Staff/2007/2007-04/2007-04_01
• http://findarticles.com/p/articles/mi_m0MJU/is_2_9/ai_93610991/pg_8/?tag=mantle_skin;content