Does anyone have any ideas to better deal with breaking bad news?

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Permalink Reply by J.Quick on April 13, 2009 at 8:05pm

As many of the prior post have said, there is no easy way to inform a family, friends, spouse, or partner that their loved one is dead. It is a task that we are not taught in EMS, like so many others. In my many years of “roving the streets” I have had to learn to deal with this my self. While I can’t say what you should do, I can offer what seems to work best for me and my crew.

1. If you find the situation too much for you then you need to excuse your self from it. The trauma associated with losing someone is not something most people are truly prepared for, even if it is expected, “breaking down” will only exacerbate the already fragile emotions of those involved in it. There is nothing wrong with “punting” this to someone who is emotionally uninvolved.

2. Do not, under any circumstances, use language that is vague or misleading. Telling a family simply “we did all we could,” implies that the family should have been more diligent, or that the pt is to blame for happened.

3. Be honest, nothing is worse than dragging the pt loved ones thought the reeds, if there is nothing that could be done, or nothing further that can be done, Try explaining to the family that “Their condition was such that nothing medically can be done. I have to inform you that they are dead” DO NOT SAY “at this time they are dead” as this implies that there is still hope.

4. Don’t use any religious references, i.e. they are with Jesus, or they have gone to be with the Lord. Case in point, a young Paramedic, me, informed a Muslim family of this fact. It did not go over well, at all. You don’t know the family’s back ground, so don’t assume.

5. With pediatrics, I have never left a child on scene, unless a crime has been committed. I know that there is a lot of debate about this, however, all pediatric emergency department, and even regional hospitals have grief councilors, I am not set up to do such, see #1.

6. Never tell the family you know what it is like to lose a loved one, you don’t. Even if your life is riddled with tragedy, you are not that person and will never know how they feel. Let them greave.

7. If you tell the family you are going to do something for them, i.e. call family, call the church, then do it.

I know that this is a hard subject to tackle, and it is never easy. Use tact and be compassionate, understand that this is the worst time of that person’s life. You were the final hope and you are now telling them that there is no hope, people will cope and the grieving process will start. Just remember that thirty minutes ago you were sitting with your partners telling off color jokes, and now you have to inform a family of the worst possible news, so when it’s all over don’t dwell on it, we picked this profession, be professional.

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Permalink Reply by Travis Kusman on April 14, 2009 at 2:29am

There is no doubt that "breaking bad news" is difficult at best. Many replies to Lauren's initial question recommend being honest, sympathetic, CALM and PROFESSIONAL when delivering this type of news. I absolutely agree. I also support the many respondents who have asserted that excellence in both clinical and customer "service" are essential core competencies which EMS professionals should strive to attain. I would like to add to the interesting and valuable dialogue within this discussion by offering a practical example of one approach to delivering "bad news" which I have utilized successfully on many occasions over the course of my career, most recently this afternoon WHILE caring for a victim of cardiac arrest.

As is typical in many cardiac arrest scenarios, the resuscitation of the patient this afternoon took place in the presence of bystanders (three adults to be exact), some of whom were more collected than others. The group of observers included the victim's wife, middle aged son and caregiver. During an organized resuscitation in which compressions were ongoing, an IV had been established, appropriate ACLS medications delivered and the patient intubated, it became apparent based upon persistent asystole that the efforts of myself and other first responders were likely to ultimately be futile.

Following contact with medical control by my partner (who was out of the view of the bystanders as well as far enough away from them that they couldn't hear his radio report) which resulted in orders being obtained from the on-line physician to cease resuscitative efforts, I invited the middle aged son (who was relatively calm) of the patient to stand next to me, indicating that I wanted to speak with him. With chest compressions and medication administration ongoing and myself ventilating the patient, I explained to his son in PLAIN LANGUAGE (not medical terminology) that we found his dad not breathing with his heart not beating upon our arrival. I explained to him that the firefighter providing chest compressions was doing so to mechanically circulate blood to vital organs, that I had inserted a tube into his dad's "wind pipe" through which I was delivering 100% oxygen to his lungs and breathing for him, and that the other paramedic on the scene had delivered medications via the IV line to try to "restart" his dad's heart multiple times. I then shared with him that his dad had not physiologically responded to our efforts, that my partner had discussed the circumstances with a doctor at the hospital, and that the consensus of the medical team was that continuing resuscitative efforts would not change the current situation. He listened intently and responded "okay" while looking at his mother. Refocusing his attention, I asked him to look at the cardiac monitor / defibrillator while I asked the team on scene with me to stop CPR.

Reinforcing that his dad's heart was not beating while pointing to the asystolic tracing on the monitor, I proceeded to cease ventilating the patient. At this point I explained that his dad's chest was no longer "rising and falling" as I had stopped breathing for him. He clearly understood the gravity of the situation and began crying (which was expected). It was at this point that myself (with a hand resting lightly on the shoulder of the son of the patient) and the prehospital team offered our condolences to the family. Interspersed with sobbing, the wife of the patient said "We understand and thank you for everything that you did to try to save him."

I share this story as it is often presumed that bystanders and family members "can't handle" witnessing the resuscitation of a critically ill or injured significant other. In fact, permitting observation of our actions (particularly in situations in which resuscitation efforts are likely to be futile) can facilitate the grieving process if managed appropriately.

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Permalink Reply by David Harris on April 14, 2009 at 8:57pm

As a retired Police officer I had to make numerious death notifications. They are most difficult but the hardest was telling a parent about the death of their child. I always said a prayer before I had to make contact. Took a deep breath and tried to get it out in a single sentence or two. Honesty was first and foremost. Be compassionate yet stay focused. Chose your words carefully and let them ask questions. It is never easy.

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Permalink Reply by Val Roach on April 16, 2009 at 4:37pm

Absolutely, I agree with about eye contact and quiet tones with clear language. Another point I teach: be careful reaching into that survivor's space or touching as a connection to understanding, that space may be closed to you. If there are cultural differences, it could be absolutely taboo, or, misconstrued while the family is in such stress. Also in cases of language differences, folks in crisis resort to their "home" language, so be sure to use words that are interpreted with finality, not to mislead with hope. Your body language, your face, vocal tones and words must all be congruent and reflect empathy with authenticity. It's never an easy assignment.

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Permalink Reply by Rita on June 5, 2009 at 4:41am

i always find that it gets through to the family faster when you are compassionately blunt with them and use simple/plain language, i will usually have them sit down and i will kneel down to be at their eye level and say " _________ is dead, *a few second pause* i'm sorry" and only then will i answer any of their questions or explain why i can't do anything more for the person. when telling the family that their loved one is dead i always try to say the loved ones' name so that it really gets across to them.
i also generally will give the spouse a minute or two with the dead spouse if it's a natural.non-violent death, give them time to say good-bye, but my partner or i will remain in the room with them the whole time.
i think it's important to remain professional as the family will be looking to you for answers, they need your support not for you to be a gushy mess, save the emotions for after the call. i also like to hang around for a little while waiting for the coroner to arrive, offer to call the rest of the family or the family pastor, put on a pot of coffee, little things that will help them jump start the mourning process.

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Permalink Reply by Val Roach on June 5, 2009 at 12:44pm

I agree that being forward and even blunt is the best approach. As they're falling into that huge black hole that opens up after receiving bad news, they look for any thread of hope that will make this all go away. Don't leave a light on where it ought not to be. I also agree that reaching into that personal space to touch is a risk for a knuckle sandwich or a giant shove. You body posture can invite a touch or hug, but staying respectful of personal space is first, then look to the remaining family member(s) for permissions.

Rita said:

i always find that it gets through to the family faster when you are compassionately blunt with them and use simple/plain language, i will usually have them sit down and i will kneel down to be at their eye level and say " _________ is dead, *a few second pause* i'm sorry" and only then will i answer any of their questions or explain why i can't do anything more for the person. when telling the family that their loved one is dead i always try to say the loved ones' name so that it really gets across to them.
i also generally will give the spouse a minute or two with the dead spouse if it's a natural.non-violent death, give them time to say good-bye, but my partner or i will remain in the room with them the whole time. i think it's important to remain professional as the family will be looking to you for answers, they need your support not for you to be a gushy mess, save the emotions for after the call. i also like to hang around for a little while waiting for the coroner to arrive, offer to call the rest of the family or the family pastor, put on a pot of coffee, little things that will help them jump start the mourning process.

receiving

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Permalink Reply by Jordan J. Hotzel on June 7, 2009 at 1:57am

I'd suggest speaking with a local doctor or grief counselor as they have specific training in doing just that. The best thing you can do is tell them the truth without being too technical, show "fellow feeling", and remember that everyone's reaction will be different.

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Permalink Reply by Frank Lenoir on August 12, 2009 at 1:32am

Excellent answer... I have never had to do so as an EMT, but a few times as a LEO, I've had to tell family members that their loved one was dead. Simple, straightforward and compassionate. It's best to have them "pulled to the side" if possible; emotional and extreme reactions happen. It's also a time when you have to forgo (sp?) a little professionalism at times, and be more compassionate. If they want to beat on your chest, within reason, so be it. If they need to collapse into someone's arms, take the few minutes to be there for them. I would recommend having a witness to ensure there are no allegations of wrongdoing with the physical contact, but that's never been an issue that I've seen come up (yet).

And at the end of the day / shift, take what you saw, and let it help you with your own relationships. Let it remind you how precious life is. Under all the politics and squabbling, that's why we're here, right?

Be safe.

Michael said:

My only suggestion, based on my experience is that using plain language is best. Avoid euphemisms for death or dying. I was with a young doctor as she told the family that the husband had died. She used words such as "we did all we could", "passed away", "hes' gone" etc. The family though were clutching at straws and were not hearing the meaning. The young doctor kept trying to have them acknowledge that he had died but clearly was not succeeding as she was unwilling to use clear language. I knelt down held the wifes hands and in as compassionate voice as i could muster informed her that her husband had died. It was then that she heard the meaning and understood.
How do you cope: do not be ashamed to cry and grieve with people. Appreciate those of your own and let them know it. I have found that a good long hug from my wife at the end of a situation like that reminds me that, while I care about the other persons loss - it is not mine.

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