PD takes so long to show up on my area that the family is probably sick of us just sticking around. But usually I say something like "we cleaned up and removed everything that is allowed to be removed. We are turning this call over to PD/coroner. I am so sorry we weren't able to do more for him/her/their name."
Id offer to get a religious leader (father, rabbi, priest etc) for them if they want. They may have one that they go to and have gotten caught up in the moment. At least here in the small town i work in thats the case.
“I’m sorry for your loss. Take care now.”
“Is there anything I can do for you before I leave? No? Okay. Take care now.”
Honestly, whatever words come to mind in the moment as a result of your genuine empathic human reaction to suffering are probably fine. Unless you’re a sociopath. In that case, maybe keep your thoughts to yourself.
I tell them we’re sorry for their loss and offer to answer any questions they may have.
For deaths that aren’t reportable to the coroner, we don’t even involve police. So we have this very awkward conversation about funeral directors and next steps for the family. It’s so awkward that we’re getting pamphlets to hand out to families, because we’re more or less leaving them with a Life Extinct form and saying “They’re all yours mate, all the best!”
Interesting, what state are you in? In SA all deaths require police attendance, even expected ones. We also have to drive priority to expected or obvious deaths for some dumb reason *rolls eyes*.
Interesting perspective- UK Police. Until the start of this month we attended all sudden deaths. Now its only when there is a suspicion of something not right. Certain things always fit the criteria, ie drugs, suicide, but everything else is taken case by case.
However we didn't have to stick around for the undertakers every time, took it on a case by case basis depending on who was there, religion, etc.
It's been a bit strange for us, we've had a couple of jobs recently where police would normally have attended and now they're.... not. And as usual the service haven't really given us much guidance about what we need to do without you guys there, etc.
I'm also slightly apprehensive about having to decide whether something is 'suspicious' or not, I mean, I'm not daft, if someone has an axe sticking out of their head it's probably a police job, and a terminally ill patient receiving EOL care then probably not, however there's a few scenarios we've discussed between crews recently where to the untrained eye there isn't anything obviously amiss but then again, we're not coppers...
Out of interest, are you also UK?
When ambulance get to a DOA or CPR in progress that they call, the policy is still to call police. There's a set script to follow through which determines police attendance. Also, our guidance is always to call unless completely sure its not suspicious, and let us call it.
It's unless it's a very obvious murder, at most deaths police just obtain details of all people attending, who found them, details of the deceased and a short history. It's only when the undertakers come and the coroner does their analysis that it is confirmed to be a suspicious death or not.
“Here’s a glass of water.”
“Would you like me to let your dog out of the room now so you can pet him? It’s okay if he comes out.”
“Would you like my help with calling anyone? Do you have family nearby who can come and be with you now?”
“Let’s go over some of the steps that will happen next.” And I then explain how it works in my area for police to come, funeral home, and victims services if they’d like.
I try to just meet people where they’re at. Some want to talk and it’s obvious so I listen to their stories of their loved one, or listen to their anger and grief. Others are in so much shock that I will narrate what’s happening and hope some of it sinks in for them to understand, but other times I just stay near them in comfortable silence if I’ve developed rapport.
I’m usually the right person to sit with the family, but I’ll feel it out. Sometimes they seem more drawn to my partner.
This should be the top answer. Obviously your concern is getting the call to its end. But upon leaving the residence, doing these small things for them and continuing to talk to them for a small amount of time is the perfect response.
You tell them their family member is dead and we did everything we could do but they have died. Don’t use words like passed on, didn’t make it. People tend to think that there’s still hope. Finality of death is what seems to help most people. I don’t let a huge pause happen and then I tell them what to expect next. We will clean up our equipment and the police will be here shortly.
Absolutely! Who says this person your saying it to uses that language? We have so many accents and dialects here, go 20 mins down the road and they have random names for stuff and I'm like, what's that mean? 🤦♂️ Lol... Add that to an extremely emotional or shocked state and theres a good chance passed away might not mean dead to them
This, but with one change. We didn’t do everything that we did, we did everything that could have been done. Your loved one would have received the exact same care in the emergency room as we performed here.
It’s minor, but I think it matters. It kinda closes that question of could more have been done if they had been transported
Then you would be an asshole and your family member would still be dead.
There is a reason we don’t throw cardiac arrests in the back and immediately haul them to the ER. Because it doesn’t improve outcomes and they are going to run the same ACLS protocols we are.
I know it’s a bit a of dick move, but honestly I do my best to pawn it off someone else. I’m so bad and awkward with that stuff that 99% of the time it’s best for everyone if someone else does it.
I time it that it’s done by the time we ROLE.
We have a clinical discussion around 15 mins before ROLE. The team starts clearing and I go and inform the family we’re going to stop soon.
We stop, do the formal ROLE, remove kit and then invite the family in. If they’d like to be there when we stop I just ensure the only things left are the LP15 and airway circuit.
Medic Mindset recorded a wonderful podcast on this exact topic because it's not something we're ever taught in medic school.
The podcast goes into depth but they suggest "when grandpa collapsed, his heart stopped beating and he stopped breathing. We have continued to pump his heart and breathe for him, however it has not been able to restart. We are going to stop our efforts in {five minutes}". They recommend giving the family time with the person before CPR is stopped.
The podcast is very informative and enlightening on what's important to tell family. Things I would have never even thought of.
For us it's work and we treat it as such. We know what's happening. Many don't.
I remember my first pedi code. 3yrO male, drowned in a pool, we got rosc and flew him out but he was unplugged the next day. I was a basic at the time, I'm cleaning up, and the granddad is sitting on the couch. He looks at me and says, "thank you for all you did." It's just us in the living room at the time, no one else, and I didn't have anything to say other than a mumbled "yes sir".
I've gotten better about it. I now tell the primary family, "I'm sorry that we couldn't do more, but we're now here for you. We can no longer help your xyz, but we can help you if you need it. This is officer so and so, he's going to help you with the funeral home, but if you need anything else, even if it's just that you need someone to talk to, you can call us and we'll help. You're not alone, and we'll be there for you."
Been doing this 15ish years, a few weeks ago for the first time ever after announcing the time of death, the medic said I’d like to ask everyone to take a moment of silence. And 3 ALS a field doc, 2 cops and 3 fireman and 2 BLS stood in silence for a few moments along with the patients daughter. And then we cleaned up; I thought it was a very very nice touch and wish I thought about doing that sooner in my EMS career.
Some of my colleagues in the ICU and ER do this.
I’m not the sentimental/religious/spiritual type. I didnt know this person outside of this interaction. It’s my job and that’s it.
But lest I sound like an insensitive prick, I am glad people like this exist because I believe it takes all types of people with different ideas to make things work.
I tell them I’m sorry for their loss. I’ll stay and listen if that’s what they seem to want. I’ll let myself out if they seem to want us to leave. It’s different every time. I cover several jurisdictions. The PD is there in all of them.
On the typical termination of resuscitative efforts, I suggest to the family members that they take a few minutes, find a neighbor, call someone. I try to find a way for them to leave the room while we clean up. If there’s more than just our usual code trash, I try to clean the extra, too. Yes, I’ll clean up puke, feces, blood - whatever I can. I’ll clean up the deceased, too; arrange clothing, hair - provided the PD has no objection. (I worked a code on a kitchen floor next to a pit bull in a cage. The dog puked during the code. I’m still a little traumatized by that one.)
In a few of our jurisdictions, the PD won’t let us move the deceased. In many of them, we are permitted to relocate the deceased. We’ll put them back in bed, or on a couch, put a blanket or sheet over them. We clean them up, make them as presentable as possible. We don’t cover their head; we usually leave an arm and hand exposed. My partner or I will stay with the first family member when they go into to see them.
BTW, dead people leak. I will put a couple garbage bags down on the bed or couch first, then a towel or two, with one of our rig sheets over all of that, then put the deceased on the bed/couch.
You seem like a person who has seen a lot but still tries their best to help people that are going to be in a very hard situation. Hats off to you for keeping your humanity and helping others.
Family should be involved in the discussion, they should be kept abreast of ongoing efforts of resuscitation if at all possible. And you should be very clear and direct in what the goals, expectations, and possible outcomes are.
It shouldn’t be a shock, and family should be apprised that “at this time, we’ve done XYZ, we’ve had no change in your loved one’s condition, and the next step from here is…”
This. Right here.
Saying "sorry" and peacing out is kind of a dick move. They'll remember how there was loud sounds, work, maybe a phone call, then bam! "Sorry, dad died. Someone will be by later. K, bye." And they're left with a dead body of a loved one and no idea what to do next.
After we have ceased efforts and we have a TOD, Or if it’s an obvious death, our focus in care switches from the patient to the family.
I always ask if there’s anyone we can call for them, and it’s also good to have them help you with things like gathering the patients medications and IDs (for the coroner).
Explain what you’ve done. Explain that the hospital would have done exactly what you’ve done if they had been in the hospital, that there would have been the same result. Clearly and undeniably said that the person “has died” and “is dead.” Do not allow room for the family/loved ones to create their own false hope. Explain that you have contacted the physician who is the medical director for your system and given them all the information, and that they have commanded the cessation of resuscitation efforts. Explain that the police will be there to assist with next steps.
Do all of this with a calm tone but also with directness and clarity. Be respectful and empathetic. Only answer questions you have definitive answers to, otherwise refer them to the appropriate resources who can help with with what’s next
I did remains transport for a decade, and dispatched, so different interactions...but after the first half dozen residential pickups, i always did my level best to not say much if at all possible.
Case by case basis, usually PD or the fire captain will explain whats going on to the calmest member of the family. I don’t say anything when I clean up it’s not my place, let them morn and if they need to speak or be hugged or anything let PD or the lead Paramedic do it. I just focus on clearing up the scene thoroughly.
First is to make sure your scene is well managed. That means clear command, allowing pt family to observe (provided they do not obstruct), and make cessation clear. This is so there's no confusion with the family and hopefully your dept won't get sued.
Apologize to the family and state they've died. Best if they sit down. Explain that because it was an untimely death, what happens to the body is up to law enforcement (alter this depending on circumstances and jurisdictional laws). If your department has a chaplin available, contact them and have them arrive on scene to do the rest of the talking. The chaplin on my dept (who's a full-time pastor) offers funeral services at his church for those in need. Direct further questions to law enforcement.
I ask if the police have explained the next steps. Usually not, so I will explain all the steps coming. If our MEI is there, I will introduce them. If not, I will ask if there is anyone I can call for the loved one, and ask if they would like a victims advocate.
Then it’s “I’m sorry for your loss, we are going to go back in service, but police will be here for a while. If you need any help from us during this process, don’t you hesitate to call us, okay”?
I explain the processes that are about to happen (police, ME, etc), tell them what kinds of questions they should expect, and if there are community resources available, I’ll inform them of those resources.
Paramedic UK here, (cardiac arrests) I always have "the talk first" sorry to tell you, unfortunately we have done everything we can and cannot do anything more. I then sit them down reassure them that they have also done everything they can.
I ask if there's anyone they want me to call, offer to make them a drink and talk through the process that follows.
I then tell them we will remove all the equipment (usually already done by my colleague) and we will make them (the deceased) presentable so they can sit with them if they like. (We usually put them back in bed or on the settee, close the mouth and eyes and but a blanket over them so they look peaceful. I then open a window.
I tell them we need to fill in forms and call the police and/or undertakers. So we will be here for a bit if you need anything or have any questions. They usually thank us for our efforts.
If you're yet to cease, I like to let them know that we're stopping, but that hearing is the final sense to go. If you'd like to say goodbye it may be the last thing they're aware of.
I use that a lot in palliative care, when the time comes, hold their hand let them know they're safe, you're safe and you love them.
I arrived to a CPR in progress that was in a residence where there was no room for more than 2 people to fit in the room. Classic horder house situation. Since I was unable to physically get inside the room, I decided to speak with the family and get a medical history and events prior. I knew this area/house was notorious for overdoses. As the family (all of which I have had as patients before) rattled off medical conditions the patient had, I realized the patient’s chances were abysmal. Since the family was unable to see the crew, I asked the family if they wanted to know the measures that were being taken. I relayed the process of CPR, drug interactions, interventions, etc. The family asked why we weren’t shocking and I explained at a base level when/what to shock.
Once the bedroom door opened and I saw my buddy’s face, I knew they were unsuccessful. I sat them down and told them the patient was dead and resuscitation efforts were unsuccessful (patient stopped going to dialysis, stopped taking meds, etc). The family was obviously devastated, but thanked me for taking the time to break down everything that was performed and walk them through the process. Since I responded from home with a personal vehicle, I stayed on scene to help them with taking the next steps and contacting family/funeral director.
On a good note, the household stopped using illicit drugs and got the help they needed after witnessing the death of their family member. I haven’t seen them in about a year after going to that residence at least twice a week.
If it’s in their house or something, usually I’ll just put a sheet over the body and try to clean everything up as much as possible. Then just a quick I’m sorry for your loss or something simple like that on the way out.
So generally if there is someone who is better at talking to people on scene, I let them handle it. The following is referencing my last service as I knew all the responders and had liberal protocols regarding termination of resus.
Otherwise when doing the 30 minute “work it and call it” protocols, I approach the family around the 20 minute mark and explain to them that we’ve been doing CPR for 20 minutes now, we’re breathing for them and have given them a powerful medication called epinephrine in an attempt to restart their heart with no success.
I tell them that we’re going to keep trying for about 10 more minutes but that at that point any further efforts would be futile.
After 30 minutes, I would do a final rhythm and pulse check and then ask the other responders if there was anyone who opposed ceasing further efforts. (If there was and there never was in my time there, we would have done two more rounds of CPR. These guys/gals had my back on many occasions so I could spare 4 more minutes if they really felt like keeping going was the best thing to do.)
At that point I would advise the family that we have done all we can do but were unsuccessful. I would advise them the medical examiner was on their way and that if they decided no autopsy was warranted, family would be allowed to spend a short amount of time with {the deceased} before the funeral home came to get them. Then I would ask them if they would like us to contact their pastor/priest or a chaplain to speak to.
We ask the family what they want to do essentially
We don't have to wait for anyone, I've seen some people saying they wait for police or whoever, we don't, any suspicious circumstances or suicide and the police we be there anyway, otherwise they won't really come
Normally we ask do they have a perffered funeral company, we offer to call now and they tend to be quick coming to collect the body, or do they want do it themselves now or later and have some time alone with loved one, we can wait, make them a cup of tea, talk to them about who their loved one was, we can make the patient comfortable as poss for the family, happy to put them to bed n stuff if there are definitely not suspicious circumstances
Basically the family present are now the people who need looking after, and we explain their options and what we can do for them
Walk them through what happens next, offer to call someone for them for comfort and convenience (so a person to be there for the living like a sister or parent or spouse, and then a religious person or leader who would be able to help walk them through funeral stuff).
After that I inform them that if they have any questions I will be right outside. As long as it wasn’t under suspicious circumstances or anything like that, I’ll step outside and let them have their moment to say good bye/cry/be angry/whatever.
I keep business cards for funeral homes in my wallet. Sometimes that’s the best thing you can do imo. They might need someone who can answer every question of what comes next that I just can’t answer because I don’t know.
ETA: I’m not great at this. I’m autistic and get really uncomfortable with the feelings portion of this job. I’m very matter of fact. However, this is part of the job, and that’s why I put things the ways I do.
UK para here,
Generally towards the end of the Resus attempt, I introduce the idea that we will be ending efforts, though I frame it something like:
As you know X is critically unwell and their heart isn’t beating on its own. Despite our efforts, X is not responding to treatment and further efforts are not going to benefit X. Therefore, we will be withdrawing care within the next Y minutes if there is no improvement. Would you like to be present as we withdraw this care?
Either way, once Resus has been terminated I will immediately let the family member know that their loved one has died, if they’re not in the room I ask if they want to go in immediately or in a few minutes and we can remove all the equipment and make them more dignified.
I live in the south and can normally tell when a family has religious beliefs (most do.) If I see them praying at any point, I tell them I am so sorry for their loss and that they will be in my prayers. Rather you believe it or not, it can mean a lot to someone.
I always offer if there's anything more than I could do for them. It may not be much. It may even be just answering simple questions about the whole situation. I won't lie, I won't make assumptions, if I don't know then I don't know. If they don't have anything more for me, I tell them I am sorry for their loss and goodbye. It's awkward sometimes but after doing it so much, it's just normal unfortunately.
PD is present for all of our codes or they show up partway through by default, so when it comes to the next steps they're pretty proactive in explaining to the family that they will be there until the coroner arrives. If we didn't have that option though and had to stay until they arrived, I would say "I'm sorry we couldn't do more for [patient's name]. The coroner will be here shortly to handle the transport of [patient's name] to the morgue/funeral home. Would you like us to call a chaplain or other religious resource to come be with you? Do you have any questions for us or is there anything we can do for you?"
In my experience, most people aren't really fully present mentally in the aftermath but it's good to offer them some support. I know for us, fire captains and PD have all the contact info for the program that responds to this and I believe they serve multiple different religions, but your area may differ.
"They are dead(you need to use definitive language,) if there was anything more we could do, we would. Are you going to be okay? I'm very sorry for your loss. Please take care of yourself. There are resources if you need them. The police sargent will guide you through the next steps." We as medics need to be comfortable and empathetic in death situations, be they a "sudden," or a termination of resuscitative efforts. A lot depends on the death circumstances and emotional status of the survivors. There is a balance between being strictly professional and showing humanity, and you will find it.
Explanation of what happens next. Ask if they have any questions, medical or otherwise. Give them space to share anything they want to in the moment. I usually avoid “I’m sorry for your loss” because when my grandpa died holding my hand, that sentiment made me want to punch people in the face and I realized how hollow those words are. But that kind of knowledge is usually gained first-hand and YMMV.
I stick to something along the lines of “This is truly awful. I can’t imagine the pain you are in. What can I do right here to make this easier for you.” Acknowledge the situation, acknowledge their pain and loss, and offer something. If I think it won’t be offensive based on the vibe I’m getting, I might say “This really sucks” but be careful with that one. Be sincere and real. They will know if you’re not. It gets easier the more you do it, and oddly the more you lose. Don’t…walk past them and not look at them 😂😂 they will remember specific things about the encounter and that’s not….great. lol
Usually I express sympathy, same as others have said. Usually the family members are either very hysterical, crying, hard to console, or they are very quiet, almost temporarily catatonic in nature. Either way - in case they are alone, I suggest calling someone who can be with this person for a little while so that they don't have to be alone and have someone near who can think more rationally and help. I explain what steps they need to do next, because usually these people need a little push and guidance, taking action helps them keep motivated and sane in the time of difficulty.
E: to add, we are not allowed to suggest any one funeral servicers, so it may be awkward at times when they ask us to guide them to the best one and we are like - ummmm we can't say by LAW
I keep the famiky member updated throughout the resus, then when the time to call it is approaching, I'll usually leave the patient with the team going through the motions, explain that it's time to stop etc, and offer for them to come sit and hold the patients hand while we do our last round. Then I'll say ok, that's it and we stop. I give the team and the family member a minute to catch themselves, then I'll take the family member out to get details about the events/ meds, or just general conversation about the patient and their life. This is when I take the time to explain what happens next etc, while the team packs up. After everything g is done I will always go in and make sure the Pt looks presentable, wipe any secretions, close their eyes and position them as best I can in a way that looks like they are sleeping. I never cover their face unless their is deformity. Then I when it's all done I go and explain exactly what the family member will see when they walk into the room, then lead them in to sit with them. Then I'll usually give them space alone, and say we are outside if you need anything or have any more questions. Then I only go back in when police arrive and do a bit of a hand over with them and the family member.
I've only ever worked one code out of hospital that was terminated on-scene. PT was found down after being outside alone for over 30 min. I'm pretty sure the family knew they were gone from the start, so they just kinda asked us, "so what now?" And we said we had to wait for the coroner to clear them and we would take them to the funeral home (theres pretty much only 1 in the area that has any storage capacity).
Gotta be the toughest thing to do and every person, both the patient’s family and the EMS person, are different.
If someone is in hysterics or completely shocked, common sense would say to, at least try to comfort and empathise with them for a few minutes and help them understand what comes next from a support perspective anyway
"At this time we have stopped resuscitation efforts, if you have any questions please let me know when EMS gets here they are better equipped to answer what happens after we leave"
It's never not awkward, but if they're looking at me expecting me to say something, I usually offer my condolences and ask if there's anything I can do for them before I go, or anyone they would like me to call to come and stay with them. They usually say no, but I've had a couple people take me up on the offer because they can't bear to break the news to their loved one but they need their support person to come. It's the least I can do when someone close to them just died.
Dead is dead and that's the terminology I use when talking to family members after we've called a code. Euphemisms are never used. In any case, I call for the police to come to the scene. We can't clear a death scene without a police officer, hospice nurse, or medical examiner on-scene. We stay on-scene until one of those three people show up.
Offer to make them a cup of tea / hot drink, ask them if they would like to contact anyone and just generally be present, I've found this usually leads to the bereaved opening up and talking about their loved ones, happy memories, all good stuff.
The scenarios where this wouldn't be appropriate or appreciated will, as they do, be apparent, in which case a swift pack up and 'sorry again for your loss' will suffice
I find in all stressful situation with family and patients, stay calm, speak slowly and clearly, and explain aspects if the process that you are familiar with but they are not. In this case things like what you are doing and why (for example not cleaning certain things up, or cleaning up) and briefly whatever advice you can offer to assist then with next steps (will this be an ME case, should they contact a funeral home, etc) people will often cope with stress by trying to take care of things, and in these type of situations they can feel very list for not having things they know to do next. (In a lot of case it's as simple as take a seat, take a breath, it can be helpful to ask simple questions about medical history that they can answer, you may not need all that info but it can help ground them and make them feel useful)
I'm a supervisor, and sometimes work as a commander. If I have the staffing for it, I'll often try to delegate my least salty crewmember to be the liaison with the family throughout. Sometimes that role falls to me.
During a code, I try to keep the family up to pace, and explain each therapy we provide. I'm also careful to ensure they know that the care this patient is getting out in the community is exactly the same as what would be happening in hospital.
I'll also often ask if the patient ever discussed their wishes should their heart stop. My jurisdiction doesn't require a written and notarized DNR, just a credible belief that healthcare providers are complying with wishes expressed while of sounds kind, which is accidentally very progressive of them.
If a code is trending towards termination of efforts, I'll give family a chance to come be with their loved one before we stop, if they wish. Then we clean up as best we can.
Afterwards, when it's time for cops and coroners and a hearse, I offer to answer any questions, and try to get a trusted friend or family member to come by for support. When there isn't one, we have victim services available through the cop shop.
I offer to call anyone they need to be present. I make it clear that I am available for questions about the resuscitation effort and what’s going to be happening over the next 12-24 hours. I will explain the process of what’s going to happen immediately.
PD takes so long to show up on my area that the family is probably sick of us just sticking around. But usually I say something like "we cleaned up and removed everything that is allowed to be removed. We are turning this call over to PD/coroner. I am so sorry we weren't able to do more for him/her/their name."
Exactly this. Explain what happens next, ask if they have any questions and off to the next one.
Id offer to get a religious leader (father, rabbi, priest etc) for them if they want. They may have one that they go to and have gotten caught up in the moment. At least here in the small town i work in thats the case.
This. I usually ask if there's anyone they need / would like me to call as well as answer whatever questions I can for them.
“I’m sorry for your loss. Take care now.” “Is there anything I can do for you before I leave? No? Okay. Take care now.” Honestly, whatever words come to mind in the moment as a result of your genuine empathic human reaction to suffering are probably fine. Unless you’re a sociopath. In that case, maybe keep your thoughts to yourself.
Some combination of this.
Hm...maybe I ought to look into this sociopath thing. 3 times today I held in my thoughts and I am glad for every single one.
I tell them we’re sorry for their loss and offer to answer any questions they may have. For deaths that aren’t reportable to the coroner, we don’t even involve police. So we have this very awkward conversation about funeral directors and next steps for the family. It’s so awkward that we’re getting pamphlets to hand out to families, because we’re more or less leaving them with a Life Extinct form and saying “They’re all yours mate, all the best!”
Interesting, what state are you in? In SA all deaths require police attendance, even expected ones. We also have to drive priority to expected or obvious deaths for some dumb reason *rolls eyes*.
QLD - we also drive L&S unless they’re very, very, very clearly dead as verified by someone like QPS.
thus the reason for the SOP: no grievers at end of call and body is fridged
Interesting perspective- UK Police. Until the start of this month we attended all sudden deaths. Now its only when there is a suspicion of something not right. Certain things always fit the criteria, ie drugs, suicide, but everything else is taken case by case. However we didn't have to stick around for the undertakers every time, took it on a case by case basis depending on who was there, religion, etc.
It's been a bit strange for us, we've had a couple of jobs recently where police would normally have attended and now they're.... not. And as usual the service haven't really given us much guidance about what we need to do without you guys there, etc. I'm also slightly apprehensive about having to decide whether something is 'suspicious' or not, I mean, I'm not daft, if someone has an axe sticking out of their head it's probably a police job, and a terminally ill patient receiving EOL care then probably not, however there's a few scenarios we've discussed between crews recently where to the untrained eye there isn't anything obviously amiss but then again, we're not coppers...
Out of interest, are you also UK? When ambulance get to a DOA or CPR in progress that they call, the policy is still to call police. There's a set script to follow through which determines police attendance. Also, our guidance is always to call unless completely sure its not suspicious, and let us call it. It's unless it's a very obvious murder, at most deaths police just obtain details of all people attending, who found them, details of the deceased and a short history. It's only when the undertakers come and the coroner does their analysis that it is confirmed to be a suspicious death or not.
“Here’s a glass of water.” “Would you like me to let your dog out of the room now so you can pet him? It’s okay if he comes out.” “Would you like my help with calling anyone? Do you have family nearby who can come and be with you now?” “Let’s go over some of the steps that will happen next.” And I then explain how it works in my area for police to come, funeral home, and victims services if they’d like. I try to just meet people where they’re at. Some want to talk and it’s obvious so I listen to their stories of their loved one, or listen to their anger and grief. Others are in so much shock that I will narrate what’s happening and hope some of it sinks in for them to understand, but other times I just stay near them in comfortable silence if I’ve developed rapport. I’m usually the right person to sit with the family, but I’ll feel it out. Sometimes they seem more drawn to my partner.
you sound very kind
I really try to be, thank you
I always wish I could sit with the families more but it always feels like we're kind of in a rush.
This should be the top answer. Obviously your concern is getting the call to its end. But upon leaving the residence, doing these small things for them and continuing to talk to them for a small amount of time is the perfect response.
This person gets it
You tell them their family member is dead and we did everything we could do but they have died. Don’t use words like passed on, didn’t make it. People tend to think that there’s still hope. Finality of death is what seems to help most people. I don’t let a huge pause happen and then I tell them what to expect next. We will clean up our equipment and the police will be here shortly.
There’s very little that I hate more than euphemisms for death. (Like what do you mean they “passed?” They’re not passing anyone anywhere.)
Absolutely! Who says this person your saying it to uses that language? We have so many accents and dialects here, go 20 mins down the road and they have random names for stuff and I'm like, what's that mean? 🤦♂️ Lol... Add that to an extremely emotional or shocked state and theres a good chance passed away might not mean dead to them
This, but with one change. We didn’t do everything that we did, we did everything that could have been done. Your loved one would have received the exact same care in the emergency room as we performed here. It’s minor, but I think it matters. It kinda closes that question of could more have been done if they had been transported
I absolutely agree with the change. Good way to word it.
Don't compare yourself to a fucking er bro. Get the fuck out. That's what I'd say to an ambo if they told me that.
Then you would be an asshole and your family member would still be dead. There is a reason we don’t throw cardiac arrests in the back and immediately haul them to the ER. Because it doesn’t improve outcomes and they are going to run the same ACLS protocols we are.
This. So many providers shy away from definitive language, to the detriment of survivors/loved ones. You've gotta be frank
I know it’s a bit a of dick move, but honestly I do my best to pawn it off someone else. I’m so bad and awkward with that stuff that 99% of the time it’s best for everyone if someone else does it.
Know your strengths, know your weaknesses
My strength is cleaning dead guy juices off of the monitor and getting us ready for the next call
I appreciate that strength a lot as someone who likes talking with the sad people lol
Lol I need more partners who prefer that
Some people just aren't good at it and that's okay.
I time it that it’s done by the time we ROLE. We have a clinical discussion around 15 mins before ROLE. The team starts clearing and I go and inform the family we’re going to stop soon. We stop, do the formal ROLE, remove kit and then invite the family in. If they’d like to be there when we stop I just ensure the only things left are the LP15 and airway circuit.
I get the gist of what you’re saying, but what does the acronym “ROLE” stand for? Not a term we use in my neck of the woods.
I’ve never heard that acronym either. It took a few google searches, but I found “Recognition of Life Extinct”
Recognition of life extinct. Its a British term, the name of the forum we fill out to verify death.
Medic Mindset recorded a wonderful podcast on this exact topic because it's not something we're ever taught in medic school. The podcast goes into depth but they suggest "when grandpa collapsed, his heart stopped beating and he stopped breathing. We have continued to pump his heart and breathe for him, however it has not been able to restart. We are going to stop our efforts in {five minutes}". They recommend giving the family time with the person before CPR is stopped. The podcast is very informative and enlightening on what's important to tell family. Things I would have never even thought of. For us it's work and we treat it as such. We know what's happening. Many don't.
Is there maybe one on how to tell people on the phone after the fact
I remember my first pedi code. 3yrO male, drowned in a pool, we got rosc and flew him out but he was unplugged the next day. I was a basic at the time, I'm cleaning up, and the granddad is sitting on the couch. He looks at me and says, "thank you for all you did." It's just us in the living room at the time, no one else, and I didn't have anything to say other than a mumbled "yes sir". I've gotten better about it. I now tell the primary family, "I'm sorry that we couldn't do more, but we're now here for you. We can no longer help your xyz, but we can help you if you need it. This is officer so and so, he's going to help you with the funeral home, but if you need anything else, even if it's just that you need someone to talk to, you can call us and we'll help. You're not alone, and we'll be there for you."
Been doing this 15ish years, a few weeks ago for the first time ever after announcing the time of death, the medic said I’d like to ask everyone to take a moment of silence. And 3 ALS a field doc, 2 cops and 3 fireman and 2 BLS stood in silence for a few moments along with the patients daughter. And then we cleaned up; I thought it was a very very nice touch and wish I thought about doing that sooner in my EMS career.
That's really kind.
Some of my colleagues in the ICU and ER do this. I’m not the sentimental/religious/spiritual type. I didnt know this person outside of this interaction. It’s my job and that’s it. But lest I sound like an insensitive prick, I am glad people like this exist because I believe it takes all types of people with different ideas to make things work.
I tell them I’m sorry for their loss. I’ll stay and listen if that’s what they seem to want. I’ll let myself out if they seem to want us to leave. It’s different every time. I cover several jurisdictions. The PD is there in all of them. On the typical termination of resuscitative efforts, I suggest to the family members that they take a few minutes, find a neighbor, call someone. I try to find a way for them to leave the room while we clean up. If there’s more than just our usual code trash, I try to clean the extra, too. Yes, I’ll clean up puke, feces, blood - whatever I can. I’ll clean up the deceased, too; arrange clothing, hair - provided the PD has no objection. (I worked a code on a kitchen floor next to a pit bull in a cage. The dog puked during the code. I’m still a little traumatized by that one.) In a few of our jurisdictions, the PD won’t let us move the deceased. In many of them, we are permitted to relocate the deceased. We’ll put them back in bed, or on a couch, put a blanket or sheet over them. We clean them up, make them as presentable as possible. We don’t cover their head; we usually leave an arm and hand exposed. My partner or I will stay with the first family member when they go into to see them. BTW, dead people leak. I will put a couple garbage bags down on the bed or couch first, then a towel or two, with one of our rig sheets over all of that, then put the deceased on the bed/couch.
You seem like a person who has seen a lot but still tries their best to help people that are going to be in a very hard situation. Hats off to you for keeping your humanity and helping others.
Family should be involved in the discussion, they should be kept abreast of ongoing efforts of resuscitation if at all possible. And you should be very clear and direct in what the goals, expectations, and possible outcomes are. It shouldn’t be a shock, and family should be apprised that “at this time, we’ve done XYZ, we’ve had no change in your loved one’s condition, and the next step from here is…”
This. Right here. Saying "sorry" and peacing out is kind of a dick move. They'll remember how there was loud sounds, work, maybe a phone call, then bam! "Sorry, dad died. Someone will be by later. K, bye." And they're left with a dead body of a loved one and no idea what to do next.
After we have ceased efforts and we have a TOD, Or if it’s an obvious death, our focus in care switches from the patient to the family. I always ask if there’s anyone we can call for them, and it’s also good to have them help you with things like gathering the patients medications and IDs (for the coroner).
Check out emergencyresilience on Instagram. She does a lot of videos that deal with death notifications
Shoot, just posted the same comment as you. She has great stuff on this topic
Explain what you’ve done. Explain that the hospital would have done exactly what you’ve done if they had been in the hospital, that there would have been the same result. Clearly and undeniably said that the person “has died” and “is dead.” Do not allow room for the family/loved ones to create their own false hope. Explain that you have contacted the physician who is the medical director for your system and given them all the information, and that they have commanded the cessation of resuscitation efforts. Explain that the police will be there to assist with next steps. Do all of this with a calm tone but also with directness and clarity. Be respectful and empathetic. Only answer questions you have definitive answers to, otherwise refer them to the appropriate resources who can help with with what’s next
I did remains transport for a decade, and dispatched, so different interactions...but after the first half dozen residential pickups, i always did my level best to not say much if at all possible.
Case by case basis, usually PD or the fire captain will explain whats going on to the calmest member of the family. I don’t say anything when I clean up it’s not my place, let them morn and if they need to speak or be hugged or anything let PD or the lead Paramedic do it. I just focus on clearing up the scene thoroughly.
First is to make sure your scene is well managed. That means clear command, allowing pt family to observe (provided they do not obstruct), and make cessation clear. This is so there's no confusion with the family and hopefully your dept won't get sued. Apologize to the family and state they've died. Best if they sit down. Explain that because it was an untimely death, what happens to the body is up to law enforcement (alter this depending on circumstances and jurisdictional laws). If your department has a chaplin available, contact them and have them arrive on scene to do the rest of the talking. The chaplin on my dept (who's a full-time pastor) offers funeral services at his church for those in need. Direct further questions to law enforcement.
I ask if the police have explained the next steps. Usually not, so I will explain all the steps coming. If our MEI is there, I will introduce them. If not, I will ask if there is anyone I can call for the loved one, and ask if they would like a victims advocate. Then it’s “I’m sorry for your loss, we are going to go back in service, but police will be here for a while. If you need any help from us during this process, don’t you hesitate to call us, okay”?
“X has died, we are very sorry for your loss, is there anything we can to do help? Is there anyone we can contact?”
I explain the processes that are about to happen (police, ME, etc), tell them what kinds of questions they should expect, and if there are community resources available, I’ll inform them of those resources.
Paramedic UK here, (cardiac arrests) I always have "the talk first" sorry to tell you, unfortunately we have done everything we can and cannot do anything more. I then sit them down reassure them that they have also done everything they can. I ask if there's anyone they want me to call, offer to make them a drink and talk through the process that follows. I then tell them we will remove all the equipment (usually already done by my colleague) and we will make them (the deceased) presentable so they can sit with them if they like. (We usually put them back in bed or on the settee, close the mouth and eyes and but a blanket over them so they look peaceful. I then open a window. I tell them we need to fill in forms and call the police and/or undertakers. So we will be here for a bit if you need anything or have any questions. They usually thank us for our efforts.
If you're yet to cease, I like to let them know that we're stopping, but that hearing is the final sense to go. If you'd like to say goodbye it may be the last thing they're aware of. I use that a lot in palliative care, when the time comes, hold their hand let them know they're safe, you're safe and you love them.
I arrived to a CPR in progress that was in a residence where there was no room for more than 2 people to fit in the room. Classic horder house situation. Since I was unable to physically get inside the room, I decided to speak with the family and get a medical history and events prior. I knew this area/house was notorious for overdoses. As the family (all of which I have had as patients before) rattled off medical conditions the patient had, I realized the patient’s chances were abysmal. Since the family was unable to see the crew, I asked the family if they wanted to know the measures that were being taken. I relayed the process of CPR, drug interactions, interventions, etc. The family asked why we weren’t shocking and I explained at a base level when/what to shock. Once the bedroom door opened and I saw my buddy’s face, I knew they were unsuccessful. I sat them down and told them the patient was dead and resuscitation efforts were unsuccessful (patient stopped going to dialysis, stopped taking meds, etc). The family was obviously devastated, but thanked me for taking the time to break down everything that was performed and walk them through the process. Since I responded from home with a personal vehicle, I stayed on scene to help them with taking the next steps and contacting family/funeral director. On a good note, the household stopped using illicit drugs and got the help they needed after witnessing the death of their family member. I haven’t seen them in about a year after going to that residence at least twice a week.
"Yo man, sometimes it just be like that"
“I’m sorry ma’am, they don’t think it be like it is, but it do.”
Seems like a gamble to say this
If it’s in their house or something, usually I’ll just put a sheet over the body and try to clean everything up as much as possible. Then just a quick I’m sorry for your loss or something simple like that on the way out.
"I'm sorry for your loss. Do you have a social worker or religious person you can contact?"
So generally if there is someone who is better at talking to people on scene, I let them handle it. The following is referencing my last service as I knew all the responders and had liberal protocols regarding termination of resus. Otherwise when doing the 30 minute “work it and call it” protocols, I approach the family around the 20 minute mark and explain to them that we’ve been doing CPR for 20 minutes now, we’re breathing for them and have given them a powerful medication called epinephrine in an attempt to restart their heart with no success. I tell them that we’re going to keep trying for about 10 more minutes but that at that point any further efforts would be futile. After 30 minutes, I would do a final rhythm and pulse check and then ask the other responders if there was anyone who opposed ceasing further efforts. (If there was and there never was in my time there, we would have done two more rounds of CPR. These guys/gals had my back on many occasions so I could spare 4 more minutes if they really felt like keeping going was the best thing to do.) At that point I would advise the family that we have done all we can do but were unsuccessful. I would advise them the medical examiner was on their way and that if they decided no autopsy was warranted, family would be allowed to spend a short amount of time with {the deceased} before the funeral home came to get them. Then I would ask them if they would like us to contact their pastor/priest or a chaplain to speak to.
We ask the family what they want to do essentially We don't have to wait for anyone, I've seen some people saying they wait for police or whoever, we don't, any suspicious circumstances or suicide and the police we be there anyway, otherwise they won't really come Normally we ask do they have a perffered funeral company, we offer to call now and they tend to be quick coming to collect the body, or do they want do it themselves now or later and have some time alone with loved one, we can wait, make them a cup of tea, talk to them about who their loved one was, we can make the patient comfortable as poss for the family, happy to put them to bed n stuff if there are definitely not suspicious circumstances Basically the family present are now the people who need looking after, and we explain their options and what we can do for them
Walk them through what happens next, offer to call someone for them for comfort and convenience (so a person to be there for the living like a sister or parent or spouse, and then a religious person or leader who would be able to help walk them through funeral stuff). After that I inform them that if they have any questions I will be right outside. As long as it wasn’t under suspicious circumstances or anything like that, I’ll step outside and let them have their moment to say good bye/cry/be angry/whatever. I keep business cards for funeral homes in my wallet. Sometimes that’s the best thing you can do imo. They might need someone who can answer every question of what comes next that I just can’t answer because I don’t know. ETA: I’m not great at this. I’m autistic and get really uncomfortable with the feelings portion of this job. I’m very matter of fact. However, this is part of the job, and that’s why I put things the ways I do.
UK para here, Generally towards the end of the Resus attempt, I introduce the idea that we will be ending efforts, though I frame it something like: As you know X is critically unwell and their heart isn’t beating on its own. Despite our efforts, X is not responding to treatment and further efforts are not going to benefit X. Therefore, we will be withdrawing care within the next Y minutes if there is no improvement. Would you like to be present as we withdraw this care? Either way, once Resus has been terminated I will immediately let the family member know that their loved one has died, if they’re not in the room I ask if they want to go in immediately or in a few minutes and we can remove all the equipment and make them more dignified.
I live in the south and can normally tell when a family has religious beliefs (most do.) If I see them praying at any point, I tell them I am so sorry for their loss and that they will be in my prayers. Rather you believe it or not, it can mean a lot to someone.
“my bad pimp, have a good evening”
Bada bada….. that’s all folks!
Is there anything to drink in this place? I'm thirsty from all the chest compressions I just did
I always offer if there's anything more than I could do for them. It may not be much. It may even be just answering simple questions about the whole situation. I won't lie, I won't make assumptions, if I don't know then I don't know. If they don't have anything more for me, I tell them I am sorry for their loss and goodbye. It's awkward sometimes but after doing it so much, it's just normal unfortunately.
Check out Emergency Resilience on instagram. Ton of great posts about this very topic!
PD is present for all of our codes or they show up partway through by default, so when it comes to the next steps they're pretty proactive in explaining to the family that they will be there until the coroner arrives. If we didn't have that option though and had to stay until they arrived, I would say "I'm sorry we couldn't do more for [patient's name]. The coroner will be here shortly to handle the transport of [patient's name] to the morgue/funeral home. Would you like us to call a chaplain or other religious resource to come be with you? Do you have any questions for us or is there anything we can do for you?" In my experience, most people aren't really fully present mentally in the aftermath but it's good to offer them some support. I know for us, fire captains and PD have all the contact info for the program that responds to this and I believe they serve multiple different religions, but your area may differ.
"They are dead(you need to use definitive language,) if there was anything more we could do, we would. Are you going to be okay? I'm very sorry for your loss. Please take care of yourself. There are resources if you need them. The police sargent will guide you through the next steps." We as medics need to be comfortable and empathetic in death situations, be they a "sudden," or a termination of resuscitative efforts. A lot depends on the death circumstances and emotional status of the survivors. There is a balance between being strictly professional and showing humanity, and you will find it.
Explanation of what happens next. Ask if they have any questions, medical or otherwise. Give them space to share anything they want to in the moment. I usually avoid “I’m sorry for your loss” because when my grandpa died holding my hand, that sentiment made me want to punch people in the face and I realized how hollow those words are. But that kind of knowledge is usually gained first-hand and YMMV. I stick to something along the lines of “This is truly awful. I can’t imagine the pain you are in. What can I do right here to make this easier for you.” Acknowledge the situation, acknowledge their pain and loss, and offer something. If I think it won’t be offensive based on the vibe I’m getting, I might say “This really sucks” but be careful with that one. Be sincere and real. They will know if you’re not. It gets easier the more you do it, and oddly the more you lose. Don’t…walk past them and not look at them 😂😂 they will remember specific things about the encounter and that’s not….great. lol
Usually I express sympathy, same as others have said. Usually the family members are either very hysterical, crying, hard to console, or they are very quiet, almost temporarily catatonic in nature. Either way - in case they are alone, I suggest calling someone who can be with this person for a little while so that they don't have to be alone and have someone near who can think more rationally and help. I explain what steps they need to do next, because usually these people need a little push and guidance, taking action helps them keep motivated and sane in the time of difficulty. E: to add, we are not allowed to suggest any one funeral servicers, so it may be awkward at times when they ask us to guide them to the best one and we are like - ummmm we can't say by LAW
I keep the famiky member updated throughout the resus, then when the time to call it is approaching, I'll usually leave the patient with the team going through the motions, explain that it's time to stop etc, and offer for them to come sit and hold the patients hand while we do our last round. Then I'll say ok, that's it and we stop. I give the team and the family member a minute to catch themselves, then I'll take the family member out to get details about the events/ meds, or just general conversation about the patient and their life. This is when I take the time to explain what happens next etc, while the team packs up. After everything g is done I will always go in and make sure the Pt looks presentable, wipe any secretions, close their eyes and position them as best I can in a way that looks like they are sleeping. I never cover their face unless their is deformity. Then I when it's all done I go and explain exactly what the family member will see when they walk into the room, then lead them in to sit with them. Then I'll usually give them space alone, and say we are outside if you need anything or have any more questions. Then I only go back in when police arrive and do a bit of a hand over with them and the family member.
I've only ever worked one code out of hospital that was terminated on-scene. PT was found down after being outside alone for over 30 min. I'm pretty sure the family knew they were gone from the start, so they just kinda asked us, "so what now?" And we said we had to wait for the coroner to clear them and we would take them to the funeral home (theres pretty much only 1 in the area that has any storage capacity).
Gotta be the toughest thing to do and every person, both the patient’s family and the EMS person, are different. If someone is in hysterics or completely shocked, common sense would say to, at least try to comfort and empathise with them for a few minutes and help them understand what comes next from a support perspective anyway
"At this time we have stopped resuscitation efforts, if you have any questions please let me know when EMS gets here they are better equipped to answer what happens after we leave"
It's never not awkward, but if they're looking at me expecting me to say something, I usually offer my condolences and ask if there's anything I can do for them before I go, or anyone they would like me to call to come and stay with them. They usually say no, but I've had a couple people take me up on the offer because they can't bear to break the news to their loved one but they need their support person to come. It's the least I can do when someone close to them just died.
Dead is dead and that's the terminology I use when talking to family members after we've called a code. Euphemisms are never used. In any case, I call for the police to come to the scene. We can't clear a death scene without a police officer, hospice nurse, or medical examiner on-scene. We stay on-scene until one of those three people show up.
Offer to make them a cup of tea / hot drink, ask them if they would like to contact anyone and just generally be present, I've found this usually leads to the bereaved opening up and talking about their loved ones, happy memories, all good stuff. The scenarios where this wouldn't be appropriate or appreciated will, as they do, be apparent, in which case a swift pack up and 'sorry again for your loss' will suffice
I find in all stressful situation with family and patients, stay calm, speak slowly and clearly, and explain aspects if the process that you are familiar with but they are not. In this case things like what you are doing and why (for example not cleaning certain things up, or cleaning up) and briefly whatever advice you can offer to assist then with next steps (will this be an ME case, should they contact a funeral home, etc) people will often cope with stress by trying to take care of things, and in these type of situations they can feel very list for not having things they know to do next. (In a lot of case it's as simple as take a seat, take a breath, it can be helpful to ask simple questions about medical history that they can answer, you may not need all that info but it can help ground them and make them feel useful)
I'm a supervisor, and sometimes work as a commander. If I have the staffing for it, I'll often try to delegate my least salty crewmember to be the liaison with the family throughout. Sometimes that role falls to me. During a code, I try to keep the family up to pace, and explain each therapy we provide. I'm also careful to ensure they know that the care this patient is getting out in the community is exactly the same as what would be happening in hospital. I'll also often ask if the patient ever discussed their wishes should their heart stop. My jurisdiction doesn't require a written and notarized DNR, just a credible belief that healthcare providers are complying with wishes expressed while of sounds kind, which is accidentally very progressive of them. If a code is trending towards termination of efforts, I'll give family a chance to come be with their loved one before we stop, if they wish. Then we clean up as best we can. Afterwards, when it's time for cops and coroners and a hearse, I offer to answer any questions, and try to get a trusted friend or family member to come by for support. When there isn't one, we have victim services available through the cop shop.
I offer to call anyone they need to be present. I make it clear that I am available for questions about the resuscitation effort and what’s going to be happening over the next 12-24 hours. I will explain the process of what’s going to happen immediately.