Phoenix Education Group's Presentation on Death and EMS

1. Death and
Emergency
Medical
Services
Investigating how to handle
difficult situations in
Emergency Medical Services
© 2021 Phoenix Education Group

2. Course Intended Audience and Description
• This course is intended to be viewed by EMS providers and
students, but principles can be used by other healthcare
professionals
• Course Description
• As Emergency Medical Service Providers, this course serves to bridge the gap
that new providers may face when delivering the news of death to a family,
how to properly manage a scene with a deceased patient and how to
perform self-management after the death of a patient

3. Course Objectives
• Upon successful completion of this course, the provider will be
able to
• Explain the role of an EMS provider on scene with a deceased patient
• Understand the proper way to manage a scene when death has occurred
• Identify the proper steps to deal with a death on scene from the providers
perspective

4. Course Requirements
• To receive full credit, students must complete all lectures and
modules with 100% attendance
• Pass the final exam with a score of 90%

5. EMS and Death Events

6. Why do we talk about this?
• Death is inevitable, meaning that it isn’t a matter of if but when
you will find yourself on a scene with a death of a patient
• Although emergency professionals frequently coexist with death
and its process, it is still not an easy event to cope with and can
be considered as one of the most shocking experiences related to
their field of work. (1)

7. A look at the data
• “A qualitative study about experiences and emotions of emergency
medical technicians and out-of-hospital emergency nurses after
performing cardiopulmonary resuscitation resulting in death”
(Fernández-Aedo, I., Pérez-Urdiales, I., Unanue-Arza, S., García-
Azpiazu, Z., & Ballesteros-Peña, S. (2017)
• Purpose of the study was to investigate how providers reacted to
unsuccessful cardiac arrest death, since these are one of the most common
events resulting in patient death
• While there were only 13 participants, there were some helpful ideas to come
from this study

8. More about the data
• Some of the key findings
• Most of the providers had participated in more than 50+ cardiac arrest
events
• While opinions varied on the effects, the general negative emotions that
came out of a failed resuscitation effort were sadness, uncertainty or
doubt, and stress
• Generally, participants said they would be calmed and reassured when they
knew that they performed the technical aspect of their job with high
quality
• Support from peers was also instrumental in combating doubt and sadness

9. Some takeaways from the data
• If we understand how a death event will affect us, we can prepare
for the outcome before the event happens
• Having close coworkers that you can talk about the event
afterwards is vital
• Many providers try to leave their work at work unless they have a
family member who is in the healthcare field
• Providers mental health is a group responsibility

10. Our Role
Is it more than just performing task?

11. Prepare, Prepare, Prepare
• Preparation from a death event starts before we even leave the
station by ensuring that we do the simple task like
• Check off our truck to ensure that we have the proper equipment
• Mentally being prepared to respond to traumatic emergencies
• Invest in our own education to ensure proficiency
• This goes beyond simply doing the job, but understanding our protocols,
procedures, etc
• Set up a system of support – we should know who we can talk to when an
event occurs
• This could be your partner, a leader, a seasoned provider, a member of the
critical incident stress management (CISM) team, etc

12. Prepare, Prepare, Prepare
• We should also work to have outlets and a procedure to help
ourselves when we have a death event occur
• This could include having other hobbies, events, or other ways to
decompress after a difficult call

13. Things to remember during our response
• When responding to a high acuity call that has a high potential for
death, we should ensure that we are calm during our response
• Slow is smooth and smooth is fast – Essentially when we respond, we want
to be methodical in our execution of our craft
• Instead of getting all hyped up during your response, take a minute to mentally
prepare, review your protocols, etc
• We cannot save everyone
• One of the hardest things to do is to understand that we are not going to
win each time, but we can give them the best chance

14. Emergency Actual
• When we arrive, we want to remember the principle of being slow
to be smooth, and that in turn makes us fast
• Our role will be dictated by the call, resources and level of providers on
scene
• As an EMT, your role may be to gather equipment or maybe to triage patients
• As a Paramedic, you may oversee the scene, or performing advanced
interventions
• Either way, we are all in this together so we should all have our defined roles
prior to our arrival on scene

15. Emergency Actual
• Family Involvement
• While this may seem odd to some providers, the involvement of families
during death events is extremely helpful in the process (De Robertis, E.,
Romano, G. M., Hinkelbein, J., Piazza, O., & Sorriento, G. (2017))
• In many cases, family would like the offer to be involved in the lifesaving
measures as an observer, even if they do not accept
• As they watch you work, it reassures the family that you are doing everything for
their loved one
• Many hospitals, especially pediatric hospitals, have implemented family
involvement at bedside which does help in the death process
• When surveyed, patients usually wanted family around during an arrest or other
serious life threatening event, but they did want the option to make that decision
through end of life planning

16. So where do we come in?
• During the event, we should seek to act with compassion and
professionalism
• Allow the family to watch the event and even assign a crew
member to explain what is happening
• Understand that emotions run high, both for us and the family of
the patient
• As long as it is safe, allow the family to be present during critical
events. If it becomes unsafe, enlist the help of others on scene or
move the patient to a safe location

17. Some things to remember
• Family involvement is an option, not a requirement
• We should be honest with families about the prognosis and
attempt not to give false hope
• Not all families are good candidates to have at patient side
• Training is fundamental to having a successful emergency
• Even when the family is not present, we should have a high sense
of humanity – we work for the best outcomes regardless of who is
watching

18. What happens now?
After we discontinue efforts, what next?

19. Next Steps
• All calls eventually end, even if sometimes they feel they go on
forever
• When you determine that continuing care is futile, you should follow your
agencies guidelines to end efforts
• This may include you notifying the corner, transporting the body, etc
• Unless there is an agency protocol, you should never remove
anything from the patient/scene until allowed to by whomever has
control of the scene
• Now that the event is ending, we have to engage the family and
ourselves

20. Family Notification
• Even if the family has been present, it falls to the leader on scene
to provide notification
• This could be a paramedic, field supervisor, etc
• When talking to the family members, remember that they not only
remember what was said, but how you said it (Ombres, R.,
Montemorano, L., & Becker, D. (2017)).
• If possible, you should roll play during training to ensure that you know what
to say in the event of the death of a loved one
• If we poorly notify the family, this can actually prolong and intensify
grief

21. Elements of proper notification
• While there are no specific bullet points for how to properly notify
about death, here are some general ideas on creating your
“script”
• Directly address the family. If there are more than one family member, it
may be best to address the “family leader” – spouse, older adult, etc
• Be direct but not crass – Use direct language such as “Your loved one is
dead.” instead of language such as “I’m sorry, they have passed on.”
• Part of this is cultural sensitivity since everyone has different end of life views
• Avoid saying things like “I’m sorry” since the family may be looking for
someone to blame. Instead, say statements that support the efforts given
by the providers

22. Elements of proper notification
• In many instances, less is best. An example could be “Sir/Ma’am,
your loved one is dead. We did everything we could but there is
nothing more that we can do. How can we help you or is there
anyone that we can contact for you?”
• You should practice what you will say in this instance before you are on the
call, so this is something that can be incorporated into training
• Every situation is different, so you must learn to adapt your
wording to match the situation
• Sometimes, sitting with the family is appropriate, but you will
need to “read the room” to understand how to address this

23. Scene Management
• Some pearls of scene management when you do have a deceased
patient include
• Not removing anything from the body until allowed to by the controlling
agency – either the coroner or law enforcement
• Be sure to document factual findings and notify law enforcement if the
death is suspicious
• Ensure that the family does not move the body or attempt to tamper with
the body until the coroner or law enforcement allows it
• Cover the body with a sheet, ensure that you notify your proper authorities,
and then ensuring that you back out of the scene without disturbing the
body or scene

24. Dealing with Death
What happens after we leave the scene

25. Death can be difficult
• While we become accustomed to death in our industry, we must
be aware that some calls may hit differently than others
• Most (72%) of providers have said that death can be difficult to
deal with (Austin, C. L., Pathak, M., & Thompson, S. (2018)
• One of the reasons that it is so difficult is the lack of time that an
incident takes from arrival to transfer of care
• The solution is not a single, linear response

26. Options for dealing with death
• Coping exist in a few different areas to include:
• Problem-Focused
• Emotion-Focused
• Meaning Focused
• While the stages of grieving are usually taught in class, we have a
lack of understanding how to cope with death (Conning, R, 2018)

27. Problem-Focused Coping
• This mechanism is used by people to focus on strategies to do
something constructive and take action to remove the stressor
(Conning, R. J. (2018)
• Some examples of this would be
• Problem-Solving
• Time-Management
• Obtaining Instrumental Social Support
• Even though the idea of social support is extremely important, the
other tactics in this coping method do not work well with death
incidents

28. Emotion Focused Coping
• This form of coping attempts to reduce the negative emotional
response associated with stress
• Some examples that can be helpful are
• Distraction
• Emotional disclosure
• Prayer and/or meditation
• Journaling
• Emotional focused coping can also have some negative activities,
but providers can use some of these examples in a productive
manner

29. Meaning Focused Coping
• In this form of coping, the person focuses on having positive
emotions and encouragement as a way of overcoming a stressor
• Some examples could be
• Look at positives that happened even if they are mundane
• Speak about the benefits of the experience
• Refocusing priorities after the stressful event
• In this method, the key is a positive response in the face of
negative circumstances

30. Coping
• While everyone experiences death differently, these methods are
some of the general ones that people use during stressful
situations
• One practical thing that you can do early is to create a stress
management plan. This plan will allow for you to identify what to
do in case of stressors, especially when we have an extremely high
chance of engaging a stressful situation

31. Tools for providers
• As discussed earlier in the course, having a support system is
important to ensure mental stability when dealing with death
• Some helpful resources could be a CISM Team, Leadership Intervention
teams, etc
• Other helpful resources can be found online through areas like:
• The Code Green Campaign (https://codegreencampaign.org/)
• You also can set up yourself with success by having hobbies or
activities to allow you to destress outside of work
• This does not include having part time jobs, etc but something you do for
fun like hiking, biking, playing video games, or other activities

32. Wrap Up

33. Conclusion
• In our course, we have looked at just a small section of how to
deal with death. While we could spend a significant amount of
time on the topic, we hope that you have learned how to better
deal with death
• If you are interested in more information, please contact our
office at info@phoenixacademic.org to schedule a consultation
• We hope that you have enjoyed this presentation and look forward
to seeing you expand your knowledge as a provider!