Targeted Issues Grant Program Update -- EMS Coping After Scene Death of a Child
Emergency Medical Services (EMS) providers are highly trained and skilled at managing the scene of a medical incident, i.e. action under pressure. However, when the best course of action is to hold back medical care, such as when a person dies or is already dead at the scene, the situation shifts; stepping aside can leave providers feeling unprepared, and their key purpose may seem unclear. EMS providers receive little formal training to equip them for sudden emotionally charged events, including field death. Most often, it is the provider who is positioned to communicate with parents whose child dies due to severe trauma or illness that occurs out of hospital. This responsibility can be overwhelming and carrying out this task often triggers stress that is likely to impair one’s ability to cope in home, work or social settings. Consequently, this scenario can impact what is already a high turnover and suicide rate in EMS professionals, attributed to occupational stress.
Recently, a team led by Mary Fallat, M.D., a pediatric surgeon in Louisville, KY, was awarded federal funding (HRSA TI Grant) to develop a searchable, mobile delivery system to equip EMS personnel before, during, and after they encounter an out-of-hospital pediatric death. The training system includes scenario-based videos that review communication essentials, point-of-care options for EMS to assist families with “next steps” after a death, and a section on self-help skills to mitigate personal secondary trauma that can lead to Post Traumatic Stress Disorder (PTSD). The delivery system incorporates principles of good prehospital communication skills referred to as “teaching moments”. The materials developed with the prior funding can be viewed on an open access website at Kentucky Board of EMS: https://kbems.kctcs.edu/emsc/cope.aspx.
The team has published several manuscripts and obtained permission from each journal for a direct download from the website (listed under COPE Publications). An additional publication is still in draft. Other resources include relevant topical references and books, targeted websites that afford grief counseling, and a model for developing a personalized EMS service page that lists relevant community resources needed by EMS and families after a death (police, coroner, social services, OPO, clergy, grief counseling) and could be posted for easy access on a phone or website. The team extends special thanks to Mike Poynter, the KY EMS Executive Director, who allowed COPT to use the EMS network in KY for assistance with the project and posting on the KBEMS website.
Currently, the EMS Agenda for the Future is being rewritten, presenting an opportunity for input into the educational process. A current goal is to gain support from stakeholders willing to assist in developing a mobile app and upkeep of the platform. This tool could be used for skill maintenance, which could readily be updated with new content and scenarios as information changes. The intellectual content could also be built into an EMS education module as part of the EMS curriculum during initial training.
This project was supported by the Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB), Emergency Medical Services for Children (EMSC) Targeted Issues grant program, Grant No. H34MC26204 for $849,246. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
Most EMS providers who find themselves the first to communicate with parents whose child dies due to severe trauma or illness that occurs out of hospital agree this responsibility can be overwhelming and a stressful part of their job. This initial conversation with grieving parents is a situation that EMS providers are often inadequately prepared to carry out. The task to console parents and loved ones is only part of the struggle; EMS providers must also find steps to help themselves "cope" after the event. This site was developed to assist EMS providers with an approach to comfort families and to better understand how to provide “next steps" including self-care for themselves.