Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

A Trilogy on Termination

There is a group of posts by three different bloggers on some of the problems of termination of cardiac arrests.

At Everyday EMS Tips, Greg Fries asks Do you ever go through the motions? I wish I could state that I never go through the motions, but I cannot. Some days my brain appears to be on vacation and by going through the motions of an assessment, I hope to come across something that will help me to figure out what is going on. A cardiac arrest usually is a wake up call.

At The EMT Spot and Life Under the Lights there are two great post on decision making in high stress environments. The high stress comes from the calls, where we know we should be considering termination on scene, but because the cardiac arrest patient is a baby we feel the need to “Just Transport The Baby”, as opposed to performing “CPR Theatre,”.

They point out the fear of family notification. I actually am just the opposite. I would rather be the one to break the news to the family. Not because I like breaking bad news – I definitely do not. The reason is that I see so many people do this so badly. They seem to be more focused on their own feelings, rather than the feelings of the family.

Breaking bad news is much more about listening, than about telling.

Breaking bad news is much more about letting them know that we are there for them.

Whether they want someone to hug (and these can be rather long hugs), to hold their hand (and the hand holding can be for a long time, too), to just sit with them, et cetera. Maybe they want to tell us about the life of the person who just died. Maybe they just want to sit in silence, but they do not want to be alone. Maybe they alternate between talking/reminiscing and silence.

The point is that we are there for them. We just need to pay attention to what they want.

The easiest way to do this is to not speak, except when necessary. There is not a lot for us to say.

Figuring out the right words is usually starting with something like, I’m sorry. Maybe the lawyers do not like that kind of wording, but saying I’m sorry, not I’m sorry for your loss, is honest and allows them to realize where things may be going. I usually end up just answering questions at that point.

The most important question I have for them is Is there anyone you would like us to call? If a neighbor comes over, I will ask the neighbor for their name (not I’m their best friend, or I live just over there). I tell them they need to wait until I talk with the family. If they refuse to wait, they need to leave. If that is not to their liking, they probably are only going to make the family even more uncomfortable. Since police are usually on scene, I can ask the police to keep the neighbor with them while I ask the family if they wish to see Neighbor X. Maybe that neighbor is very last person they want to see at this most painful moment. Maybe the neighbor is the person they most want to see. Either way, an extra minute is not too much to ask. If it is, they do not seem to have the interests of the family in mind.

I do not demand to be the one to break the news to family. If the person expected to break the news is very uncomfortable with the idea, that suggests that they may not be good at listening to the family, and notification is all about listening. The other person can always accompany me.

In Bringing Out the Dead, Joe Connelly describes feeling as if he is a grief mop. I can understand that perspective. It isn’t that I go looking for grief to absorb, but I would rather be the one absorbing the grief of notification, than watching someone increase the family’s grief and have to deal with the guilt of having allowed things to become even worse, in addition to everything else.

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