Pediatric Death Resources

Immediately notify family of your plan—The moment you make contact, tell the family how long you and your crew intend to remain on scene and put them at ease by informing them your crew is doing everything the hospital would be doing if its staff were there. You can add that their loved one’s heart is not beating, so it is very important that your work not be interrupted by transporting them too soon.

Be clear, even if it’s uncomfortable—It is appropriate to hold off on using the words dead and died until the patient has been pronounced (or determined DOA), but when you do finally break the news, it is important to be clear with your delivery. While it might feel rude to say, “Your husband has died,” the use of euphemisms such as “passed away” or “we lost him” do not fully process in the acutely stressed mind of a survivor. Sugarcoating the message may create unnecessary distress or confusion, and sometimes resentment, for not being more straightforward.

Silence is still golden—It is perfectly fine to say nothing at all. This is especially true once the foundation of treatment has been applied and you have informed your immediate point of contact of everything they need to know, plus answered any questions they might have. Please resist the urge to fill the silence and trust that your presence on scene is enough for that family member to feel comforted that you showed up and responded to their call for help.

Invite them to say good-bye—If possible, welcome the family to say good-bye to their loved one before terminating resuscitation efforts. To the first responder the patient has been clinically dead throughout the call, but family members do not process their loved one as dead until the first responder tells them. Consider easing them into this final delivery by notifying them every few minutes when the patient has not responded to treatment. If efforts continue to appear futile, you might tell them, “We are going to try [giving a medication, two minutes of CPR, another shock] one more time, and if it does not work, then we will have to stop.” If that last treatment fails to change the patient’s status, you can then invite them to say good-bye while the crew continues to perform CPR and then discontinue efforts shortly afterward.

Your job is not to fix their grief—It can feel incredibly difficult for first responders to step back and feel as if they are doing nothing by allowing the survivors to react emotionally and cry. First responders are conditioned to fix another person’s suffering, so it is understandable why standing there can feel unnatural. However, it is exactly what they need from you. Grief is the healing of the wound the loss of their loved one has inflicted on them. Simply allowing the grieving process to occur, without interrupting or suppressing it, creates an ideal environment for their healing to begin.

Resource adapted from https://www.emsworld.com/article/1225347-ems-death-communication

NURSE acronym: Naming/Understanding/Responding/Supporting/Exploring

Naming: "It looks to me like you are overwhelmed/sad/angry"

Understanding: "Given what happened, I can understand how you feel" or "I cannot imagine how you feel"

Respecting: "I can see how much you care for your child"

Supporting: "We will be here for you through all of this"

Exploring: "Tell me more about how your are feeling"

Adapted from VitalTalk Conversations of a Lifetime program

“Notification of Death” Telephone Call Suggested Script

Introduce yourself and be clear about where you are calling from. Don’t just say EMS but state which county and department. State “I’m calling about [child name]"(if calling other community member, also use "the child of [parent's names]").

Pause

If it is the middle of the night or it sounds like the person you are calling may have been sleeping, ask, “Did I wake you up?” “Do you need a moment?”

Pause

I’m afraid I have some sad news. (try not to say bad news).

Pause

I’m sorry to tell you that [child's name] died. We did everything we could to help [him/her.]

Pause

“I have given you such terrible news. Would it help to see [child’s name] now, or do you have any questions for me, anything that I can explain better?” ---or--- The family would benefit from your presence. Would you be able to come to support them?

I’m sorry. Will you be okay? We will be in touch and I can have our social worker (or chaplain, or psychologist, decedent affairs, or nurse manager) call you to help assist you with arrangements if you like.

Pause

Then you just need to confirm this and express your sympathy.

Resource adapted from https://palliative.stanford.edu/transition-to-death/appendices/telephone-call-script/

You have experienced a traumatic event (an injury, loss of a loved one or property or a serious threat, or any overwhelming emotional experience). Even though the event may be completed, you may now be experiencing or may experience later some strong emotional or physical reactions. It is very common, in fact quite normal, for people to experience emotional aftershocks when they have passed through a horrible event.

Sometimes the emotional aftershocks (or stress reactions) appear immediately after the traumatic event. Sometimes they may appear a few hours or a few days later. And, in some cases, weeks or months may pass before the stress reactions appear.

The signs and symptoms of a stress reaction may last a few days, a few weeks or a few months and occasionally longer, depending on the severity of the traumatic event. With understanding and the support of loved ones, the stress reactions usually pass more quickly. Occasionally the traumatic event is so painful that professional assistance from a counselor may be necessary. This does not imply craziness or weakness. It simply indicates that the particular traumatic event was just too powerful for the person to manage by themselves.

Tips to take care of yourself:

• Try to rest a bit more
• Contact friends
• Have someone stay with you for at least a few hours or period for a day or so
• Recurring thoughts, dreams or flashbacks are normal – don’t try to fight them – they’ll decrease over time and become less painful
• Maintain as normal a schedule as possible
• Eat well-balanced and regular meals (even when you don’t feel like it)
• Try to keep a reasonable level of activity
• Fight against boredom
• Physical activity is often helpful
• Re-establish a normal schedule as soon as possible
• Express your feelings as they arise
• Talk to people who love you, call for counseling if problems persist

First Responder Support Network: http://www.frsn.org

The mission of the First Responder Support Network (FRSN) is to provide educational treatment programs to promote recovery from stress and critical incidents experienced by first responders and their families.

Resource for First Responders: https://www.safecallnowusa.org

Safe Call Now provides public safety employees, all emergency services personnel and their family members nationwide with a simple and confidential way to ask for help.

International Society for Traumatic Stress: https://istss.org/home

ISTSS Mission Statement: ISTSS is an international, interdisciplinary professional organization that promotes advancement and exchange of knowledge about traumatic stress. This knowledge includes: Understanding the scope and consequences of traumatic exposure. Preventing traumatic events and ameliorating their consequences. Advocating for the field of traumatic stress.

National Center for PTSD: http://www.ptsd.va.gov

National Center for PTSD is dedicated to research and education on trauma and PTSD. We work to assure that the latest research findings help those exposed to trauma.

https://www.ptsd.va.gov/professional/treat/care/toolkits/provider/workingWithTraumaSurvivors.asp - Working with Trauma Survivors: What Workers Need to Know

"Accommodation to Unnatural Death": Article by E.K. Rynearson, MD

This is written for someone who has experienced the death of a friend or family member by an unnatural dying—accident, suicide, or homicide.

International Critical Incident Stress Foundation: Training website: http://www.icisf.org/get-cism-support/

ICISF is to be the leader in providing education, training, consultation, and support services in comprehensive crisis intervention and disaster behavioral health services to emergency responders, and other professions, organizations and communities worldwide.

Substance Abuse and Mental Health Services Administration: http://www.samhsa.gov/

SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities.

US Department of Labor: https://www.osha.gov/SLTC/emergencypreparedness/resilience_resources/index.html

US Dept. of Labor: Federal and federalized employees involved in emergency response may be physically and emotionally impacted by this experience. Emergency response can be both rewarding and stressful, and it is important to recognize that some emotional reactions are to be expected. Support can be provided by family, friends, and consider utilizing community or faith-based organizations.

Training for emotional survival:   http://www.911salt.com/resources.html

SALT is a philosophy and approach designed to help agencies create an organizational culture of wellness that sustains their officers' individual wellness practices, improves officer safety, and supports community security.