Pronouncing Death in the Field: A Source of First Responder Burnout

Are first responders prepared to provide death notifications to families?

As first responders, one of the most challenging tasks that we perform is delivering death notifications – both in the case of obvious death and pronouncing death in the field. These deaths are often sudden and unexpected, which makes these conversations even more challenging and traumatic for everyone involved.

Despite the termination of resuscitation in the field becoming more common, first responder training on the topic is lacking. Providing death notifications is a procedure that can be acquired with proper training and practice. Yet, many providers do not receive training on the topic in either their initial training or part of continuing education. Delivering death notifications while unprepared can potentially lead to work-related burnout amongst first responders, and is a clear target for education to reduce this occurrence.

Having to tell a hopeful family that there is nothing that can be done to save their loved one’s life is a difficult conversation to have, regardless of the circumstances. However, it is especially difficult when the death is unexpected or sudden. This can be a very emotional and difficult time for the people involved, and it is important that we are prepared to handle it in a professional and compassionate manner.

There are a few things that we should keep in mind when delivering a death notification. 

• • Try to be as respectful and compassionate as possible. 
  • Always introduce yourself and explain your role in the situation. Then explain that the person has died, and offer your condolences. 
  • It is essential to use the term “died” versus softer terms that may create confusion such as “passed away”. 
  • Try to be as clear and concise as possible. Avoid using medical jargon; explain what happened in plain language. 
  • Answer any questions that the family or friends may have.
  • Be patient. Be comfortable with long periods of silence. Stay present and wait for their questions.

It is important to remember that everyone grieves differently. Some people may be very emotional, while others may be more stoic. It is important to be patient and understanding and to allow the people involved to express their grief in their own way. By being prepared and compassionate, we can help to make this difficult time a little bit easier for the people involved.

The importance of training

Despite the importance of delivering death notifications, many first responders do not receive consistent training on how to do so. This is a critical gap in training, as it can lead to providers feeling unprepared and uncomfortable when they are faced with this situation. Research has shown that first responders who received training on death notifications are more likely to feel confident and competent in their ability to deliver these notifications and were less likely to experience burnout.  This specific training should cover the following topics:

• • The emotional impact of death on first responders and families
  • How to approach the family or friends of the deceased
  • How to explain the death in a clear and concise manner
  • How to answer questions
  • How to offer support

Coping with burnout

Pronouncing someone dead who you may have tried really hard to save and then having to deliver the unexpected and tragic news to the family members can be a very physically and emotionally draining experience. There may be a feeling of guilt and questioning if everything was done right during resuscitation. It is important to be aware of the signs of burnout and to seek help if you are feeling overwhelmed.

Some of the signs of burnout include:

• • Feeling emotionally exhausted
  • Feeling cynical or negative about your job
  • Having difficulty concentrating
  • Having trouble sleeping
  • Feeling physically exhausted
  • Feeling isolated or withdrawn from others

If you are experiencing any of these symptoms, it is important to seek help. Talk to your supervisor, your loved ones, a therapist, or another trusted professional. There is no shame in seeking help, and it is important to take care of your own mental health.

Resources

1. Literature: Paper outlining The GRIEV_ING algorithm in the Prehospital Emergency Care journal.
2. Podcast: Dr. Maia Dorsett joins Ginger Locke on the MedicMindset podcast! She shares what she knows about the process of death notification. Dr Dorsett frames a death notification as a procedure that can be taught, learned, and practiced.

Evidence of burnout: https://www.naemsp-blog.com/emsmed/2021/8/8/article-bites-33-is-death-notification-training-associated-with-decreased-burnout-among-ems-professionals

Thank you to our contributors

Michael Herbert & Katie Dainty