The right words

wannabeHFD said:
You think it's funny when people die...?
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Some people will naturally develop laughter as a defense mechanism. I wouldn't judge right away. Although he does need to work on controlling it...
 
DEmedic said:
You were instructed to leave your trash? When you work a code? Seriously? Empty boxes, ET tube wrappers and the other flotsam and jetsam from a code?

Wrong and disrespectful.
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Oh yes. It was part of our skills, especially with peds. I would assume someone in Home Hospice is different. But the idea was not that we leave it for the family to pick up, but LEO or ALS.
 
Family witnessed cardiac arrest is very well supported by the literature... And as recently as two weeks ago, a French study showed decreased rates of depression and grief among family, without affecting providers or outcome. Not transporting non-viable codes from the scene is also well supported by the literature (for many reasons already mentioned, although this ?may change with increased use of autopulse and Lucas). What seems to be missing here is formal training for providers, or member of the rescue team on how to console family, how to describe what's going on, and how to discuss death.

In my experience, the best outcomes come when there is a senior person assigned to stay with family, explain what's going on, recognize when family is feeling faint, etc, and be supportive with the outcome, including a dignified discussion of cessation. In the hospital, this is frequently a nurse, social worker, etc. with the final discussion of death being with a physician. In the field, it can easily be a paramedic not involved in care, a fire lieutenant, or perhaps a chaplain dispatched to the call. I would love to see formal scripts and training developed for this, because, again, we recognize that it is optimal, but many agree we don't know how to do it (right).

IIRC, the PALS video had a good segment on this at the end, which I wish I could track down and watch again...

Does anyone have a formal policy for this out of hospital, do you know of any formal programs in-hospital? Can you envision this becoming a part of state protocols for field termination?
 
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emt.dan said:
Family witnessed cardiac arrest is very well supported by the literature... And as recently as two weeks ago, a French study showed decreased rates of depression and grief among family, without affecting providers or outcome. Not transporting non-viable codes from the scene is also well supported by the literature (for many reasons already mentioned, although this ?may change with increased use of autopulse and Lucas). What seems to be missing here is formal training for providers, or member of the rescue team on how to console family, how to describe what's going on, and how to discuss death.

In my experience, the best outcomes come when there is a senior person assigned to stay with family, explain what's going on, recognize when family is feeling faint, etc, and be supportive with the outcome, including a dignified discussion of cessation. In the hospital, this is frequently a nurse, social worker, etc. with the final discussion of death being with a physician. In the field, it can easily be a paramedic not involved in care, a fire lieutenant, or perhaps a chaplain dispatched to the call. I would love to see formal scripts and training developed for this, because, again, we recognize that it is optimal, but many agree we don't know how to do it (right).

IIRC, the PALS video had a good segment on this at the end, which I wish I could track down and watch again...

Does anyone have a formal policy for this out of hospital, do you know of any formal programs in-hospital? Can you incision this becoming a part of state protocols for field termination?
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This would be a great program to develop for your service. Why not develop the program, have it vetted and then lead some training on it at your department? That's how this stuff gets changed...

FWIW, I usually make the contact with the family at least three times during an arrest. The first time to quickly explain what's going on, that they can watch if they feel comfortable and that I'll be back in a few minutes to talk to them more. The second time contact is the update, "His heart still not beating on it's own and he is not breathing. We're doing both of those for him and we'll continue to do everything we can to restore his heartbeat, but I want you to know that the situation is very critical right now." The third contact is the end result. Either ROSC and we're leaving ... or "...despite our best efforts, we were unable to restart his heart beat and he has died."

It's important that you know what you're talking about, that you're calm and sincere. Anecdotally, I dated a woman who had a child die and all she remembered from the whole event was the calm paramedic who sat with her, held her hand and explained what was going on while they attempted to resuscitate her child.

I'm pretty passionate about the human side of being a paramedic. It's the most important part of what we do.
 
DEmedic said:
It's important that you know what you're talking about, that you're calm and sincere. Anecdotally, I dated a woman who had a child die and all she remembered from the whole event was the calm paramedic who sat with her, held her hand and explained what was going on while they attempted to resuscitate her child.
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This is important to bear in mind. Although this stuff isn't rocket science, many of us in this job have pretty minimal brain-to-mouth filters, and we have to remember that anything we say and do in these circumstances may be burned into someone forever -- good or bad. Think before you speak.

Thom **** shared this story in People Care:

When I was 14, I had a little brother named Francis. Francis died of SIDS in the early 1960s. In those days there was no CPR, no 9-1-1 to dial, and no EMS system to contact. Right after dinner one night, our parents discovered Francis blue, cold and unresponsive. They called Dr. Tom Maguire, who arrived at our home a few minutes later. Dr. Tom was a good man, and he was probably a good doctor, but he never talked to my mom or to us kids -- only to dad. "Carl," he said, "it looks like this baby smothered in its blankets."

At that my mom just plain lost it. She collapsed in a heap on the floor as my dad stood there talking to the doctor. She sobbed pathetically, and despite the fact that we got down on the floor with her, threw our arms around her and tried to console her, she simply would not be comforted. As of this writing, three members of our family have had medical careers. We've explained SIDS to her and done our best to convince her she did nothing wrong. But to this day she believes the words of Dr. Tom, and we can't seem to do a thing about it.
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DEmedic said:
This would be a great program to develop for your service. Why not develop the program, have it vetted and then lead some training on it at your department? That's how this stuff gets changed...

FWIW, I usually make the contact with the family at least three times during an arrest. The first time to quickly explain what's going on, that they can watch if they feel comfortable and that I'll be back in a few minutes to talk to them more. The second time contact is the update, "His heart still not beating on it's own and he is not breathing. We're doing both of those for him and we'll continue to do everything we can to restore his heartbeat, but I want you to know that the situation is very critical right now." The third contact is the end result. Either ROSC and we're leaving ... or "...despite our best efforts, we were unable to restart his heart beat and he has died."

It's important that you know what you're talking about, that you're calm and sincere. Anecdotally, I dated a woman who had a child die and all she remembered from the whole event was the calm paramedic who sat with her, held her hand and explained what was going on while they attempted to resuscitate her child.

I'm pretty passionate about the human side of being a paramedic. It's the most important part of what we do.
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Thanks. This goes on my long list of projects i'd love to do, if/when I had the time, but likely won't happen any time soon. I also don't know that I have the education to do it right, so would go directly to the "vetters" for advice. This can't be that ground shattering, it must exist somewhere, if nothing else, in hospitals, as a script for social workers. Does anyone know of it being written out somewhere?
 
emt.dan said:
This can't be that ground shattering, it must exist somewhere, if nothing else, in hospitals, as a script for social workers. Does anyone know of it being written out somewhere?
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You can't speak from a script. You have to speak from your heart.
 
Disregard.

Wrong thread.
 
DEmedic said:
You can't speak from a script. You have to speak from your heart.
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Okay, how about starting talking points, "preferred language"? Maybe I have little confidence in some providers to speak with the right attitude and language... I envision mature, experienced rescuers speaking the family, both knowledgable about the procedures in progress, but also sensitive enough to be comforting. I've been indoctrinated into the Donabedian framework for measuring and improving quality, "Structure, Process, Outcome", and think we need this structure or scripting in order to be successful.
 
emt.dan said:
Okay, how about starting talking points, "preferred language"?
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Check out the Psychological First Aid stuff I mentioned, they have a lot to say about these subjects.
 
Wheel said:
This (or he's a psychopath) :unsure:
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Yes, thanks.

If you seriously believe that, you need to go and re-read what I wrote.

Do I think situations like this are funny? No.

Do I laugh at people's grief purposely? No.

Is it some sort of weird psychological response that I need to work on? Yes.

Apparently this was the wrong place to ask for advice. I simply thought someone else may have been in a similar situation and would have some clues. As I said, I've known several cops who've had this issue, but it appears as though EMS personnel don't have such problems. Mods, please feel free to delete my replies in this thread.
 
Stoked said:
Apparently this was the wrong place to ask for advice. I simply thought someone else may have been in a similar situation and would have some clues. As I said, I've known several cops who've had this issue, but it appears as though EMS personnel don't have such problems. Mods, please feel free to delete my replies in this thread.
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Laughter is not an unusual response to stress and tension. That's been widely documented and understood in the literature.
 
Stoked said:
I guess the question that comes to mind for me is something like "how does one notify when they know they can't"?

Explanation- in my former career I had to do many death notifications, and over the years I developed a slight issue with it- uncontrolled laughter. Along the lines of "I'm sorry to have to (snicker) tell you (giggle) this, but (guffaws commence)..." I knew a couple other cops that also went through this, but most of them seemed to block it out. Not so here, sergeant eventually banned me from doing them. Someone complained; I had a notification on an MVA where the teen driver came out a crispy critter (head-on vs. Semi at highway speed) and when the father opened the door, I was laughing so hard I was nearly in tears.

I know this will be part of the job if I end up in EMS full or even part time, so I've been pondering it.

Thanks.
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When I have identified areas that I totally suck at whatever is necessary to be done, I work hard to overcome the "can't."

I don't accept "can't" in the line of work. This sounds like a channelling of anxiety to me. It's real, well understood, and can be overcome.

I would rehearse with a friend, over and over. Take it seriously, and practice empathy with eye contact, because when you're struggling with this, it's the eye contact that's so hard.

Overcoming a mind game like this requires some strategies, and some digging within yourself to figure out what the problem is (and not being able to control grossly inappropriate laughter is a problem). Maybe a bit of counseling might help, with the counselor giving you some strategies.

Either way, this is something that CAN be overcome, and MUST be overcome if you are going to work in this field. There is no telling what situations you'll find yourself in, and you have to be able to at least be socially appropriate in every situation, if not competent with communicating all information you might have to communicate.
 
Stoked said:
Yes, thanks.

If you seriously believe that, you need to go and re-read what I wrote.

Do I think situations like this are funny? No.

Do I laugh at people's grief purposely? No.

Is it some sort of weird psychological response that I need to work on? Yes.

Apparently this was the wrong place to ask for advice. I simply thought someone else may have been in a similar situation and would have some clues. As I said, I've known several cops who've had this issue, but it appears as though EMS personnel don't have such problems. Mods, please feel free to delete my replies in this thread.
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I never called you a psychopath. I'm sorry if you feel that I did. I'm almost positive that its a defense mechanism for you as it is for most that have this problem, and my word choice was probably in poor taste. For that I'm sorry,
 
I happened across a guy who had committed suicide in his garage - his Mom had just found him so I helped her call EMS (i am not qualified yet - the guy was a neighbour) kept her out of the fume filled garage and helped her call her husband. She was relatively calm, ambulance and fire truck arrived, the paramedic checked on the dead guy, came back out and said to the Mom - 'as I am sure you have realized your son is dead', which funeral home would you like him to go to?' At which point the Mom collapsed in hysterics - not the most tactful way to handle the situation!
 
Wheel said:
I never called you a psychopath. I'm sorry if you feel that I did. I'm almost positive that its a defense mechanism for you as it is for most that have this problem, and my word choice was probably in poor taste. For that I'm sorry,
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No apologies necessary; I've had a long week and let my emotions dictate my response, and for that, I apologize.
 
To the medics out there...if you're running the code, do you prefer to be the one speaking to the family? Do you want your EMT partner speaking to the family, especially if you're concentrating on working the arrest and aren't able to pay constant attention to the family?
 
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