Dealing With Death Suddenly and After the Fact

[tniuqs]

WHAT ??? No where is the rope, where is the tree or screaming for guillotine .. I am buzz busted !

Seriously this taking an EMT course to become a Bucket Fairy is like baking a cake and expecting a roast beef to come of of the oven. (ok that's the best I have today)

Dood new guy, straight up you present yourself very well, excellent questions that many just don't know how to ask nor answer. I really hope to let us follow along with you if you choose the EMT B program someone is always here in EMT City to help. I can not add much myself to the excellence in advice prior... except one thing .

When the Pain exceeds the Coping Mechanisms you have intrinsically ... go to friends for help .. they will get you through.

cheers

ps I think we should have a EMT Student of the Year award ? What says the rouges gallery ?

Edited August 19, 2011 by tniuqs

[PCP]

tniuqs how would that work having an EMT Student of the Year award? I am all for it if we could figure out a way of making it work.

[DFIB]

Do not worry about working with deathly ill pt.'s. Sometimes the outcome is not ours to decide. I'm not religious, but sometimes I think someone else is making these decisions. With time in the field, you will become more comfortable.

You don't have to be religious to be pretty sure that the outcome is never our to decide. We do our job and the science gives us stats on what the outcome should be but nothing is sure. Someone else is always deciding the outcome.

I have a little different take on this subject. The dead are very low on my priority list. The truth is that we really don’t get to save that many. I don't think about or worry that much about the dead. I don't get to decide who lives or dies. If I do my job well I get to sleep at night.

The idea that we would have to dehumanize our patients to cope with their pain in my opinion is flawed. I never want to forget that my patients are real people that are usually in a desperate situation, possibly the most desperate situation of their life. To dehumanize them in their time of need is to dehumanize myself. I am enormously gratified to think that I was able to make their life better.

I don't want to feel my patient’s pain, but I don't seek denial that I cannot empathize with each one. It helps me be a better provider. If I can empathize with their pain, fear, uncertainty and sometimes even death, I can be a better help to them.

I have no problem with shedding a tear with the hurting although when the call is over it is over. I don't take it home.

Everybody copes a little different. I am sure you will find your own way to deal with your own experiences.

I wish you the best.

[DwayneEMTP]

I'm up for the emt student of the quarter, or semester?

To many strong folks showing up these days to pick one a year. As well, I think that there are many different ways to be strong, all could be rewarded..

Dwayne

[PCP]

Good point Dwayne. How would we go about picking someone for student of the quarter, or semester?

By the number of posts and how strong the posts are?

[Bernhard]

Another question would be in any of the EMT-B classes you guys have had do they go over talking about coping with death and/or gruesome scenes?

In my own class long ago: no. Meanwhile it's a mandatory topic in classes ("Stress & Coping"). In our district, this topic usually is teached by me . However, it covers only around 30 minutes, more or less as a pointer in the right direction and to further information (next course here starts in September).

For our local staff we have an information sheet about stress symptoms/coping/helping possibilities given out and on permanent display, sometimes we will address this issue in our regular training sessions or just before some known stressfull events (hey, Oktoberfest is coming...).

Personally I once attended an additional course for crisis intervention providers, just to have some clues about how to deal with left behind relatives. Gave some great insights and I'm more confidential to condole someone on-scene now and to handle the emotional stuff. It sure helped me to deal with it, simply by not beeing emotionally helpless any more when nothing hightech medical is left.

We're glad to have a volunteer Crisis Intervention service (experienced EMTs/paramedics with additional training) to take over the relatives, so I have just to bridge those 10-20 minutes until they arrive. They then will stay around 1 or 2 hours, until situation is stable and/or other relatives or social network can take over.

And i have seen dead bodies before, i've seen relatives in hospital beds pass away and at their funerals, they made me feel a little uneasy but for the most part it didn't bother me to much. But then again i wasn't interacting with them a whole lot either.

My point of view is: I'll give all my best to help the patient survive (and I'm investing a lot of time and effort to be able to do so). If this won't work, then it's simply not up to my decision. After all, in the very first place, it's not my fault that the patient is seriously ill, the heart stopped beating or the patient is victim of a severe accident.

That is a lot more difficult with own relatives or friends and neigbours, where I had some more contact before. One of my coping strategies: I never went to funerals of neighbours I worked on myself, would do it and sadly already had to do it only for close friends (and relatives of course).

[Vorenus]

thanks pcp, jake, and ugly emt

That helps alot. its crazy but just posting stuff on here and talking with people in the field who have had similar experiences helps a lot. I worried thinking i was not suited for the job by having emotions about this stuff. But like stated we are all human and its going to happen, emotions are in everyone.

Yeah im just gonna take it one step at a time and learn from everything, good bad or indifferent. And in the end just know that you are there to help people.

Again thanks, this site is unbelievably helpful.

As said in your next sentence - we all have emotions.

I can`t really give you an advice, how to cope with death, everybody`s dealing with it in their own way.

But I wouldn`t worry too much about future possible "traumas". There`s just no sense in it. I`m sure most of us have been worried/thinking about how they will react, when their first death in the field occurs, me too. But you can`t really know before you`ve been there. And most important - you gotta remember that after all, it`s just a job, regardless of how much it may mean to you! Sure, you do your best and wanna save them, but it`s not your emergency, it`s theirs! And if you`ve done everything you can, and still can`t help them, it`s not your fault.

[DwayneEMTP]

...The idea that we would have to dehumanize our patients to cope with their pain in my opinion is flawed. I never want to forget that my patients are real people that are usually in a desperate situation, possibly the most desperate situation of their life. To dehumanize them in their time of need is to dehumanize myself. I am enormously gratified to think that I was able to make their life better...

I'm not sure if you're responding to my post or not, but if not, you probably should be. And if so, I'm afraid that I've not made myself very clear.

When I talk about dehumanizing (I don't remember if I used that term or not, but it's not inaccurate.) I think that I'm talking more about necessary focus. In fact it has a nearly perfect inverse relationship to the severity of the pts pathology. As the patient gets better, their humanness comes more into focus.

For example I once has a young boy that had been ejected from a vehicle and skidded down the asphalt. He had multiple fractures to both arms, and one leg, lots of skin missing, his nose nearly gone. In my mind I don't see a wounded child for more than just a second or two. I see a set of pathologies that is trying to kill a kid, and trying to defeat me. And that really pisses me off.

I was told later, when everyone was worried for my metal health, about his horrible screaming, but to tell the truth, though I remember being supremely confident that his airway was not my immediate priority, I don't really remember the screaming.

I remember trying to figure out what I was going to do about all of the fluid loss. Start plugging holes, or focus on an IV and get fluids running first? I was running L/S with only unskilled volunteers in back so I didn't really have an option to hand off responsibilities.

My little pea brain was cataloging leaks as I finished cutting off his clothes, lining up in my head decent IV sites, had someone crank up the heat in the back, all because I saw this child being attacked from all of these areas, and was attacking back.The pathology was trying to drain him dry, so I stopped it with bandages and fluids, it was trying to cheat him out of his arms and legs, so I made sure I kept them straight-ish and had distal pulses, and stopped it, the pathology was trying to make him hypothermic, so I shut it's ass down with heat..

Man, it occurs to me that I must sound like a complete moron...But, there you have it...It truly is the way that I see forggy calls..like a mini war.

As I started to gain on the situation the child just sort of started coming into focus and I went immediately to pain management (Approx.40 min transport with no helicopter avail.) Up to that point you could have asked me his race, age, hair color, and I would have had no idea. But as I got some good vitals, and got the bleeding slowed, and had my fluids running, that changed. I had time now to be emotionally kind. But I don't believe that being emotionally attached at any level, in any way would have been productive to my care prior to that time.

Anyway. I think that it's because I love my patients that I become so focused, not the opposite. Of course, like all of us, I could just be bullshitting myself.

Do I believe that it's impossible to do all of those things in a reasonable amount of time and still be emotionally attached? Sure, I believe better medics/nurses/doctors than myself do it every day. But that is the way my mind works...good, bad or indifferent.

And if it sounds as if I was offended by your statement, man, that's just the weakness of my communication here. I liked it a lot, but wanted to try and make sure that I left no one with the impression that I believe being an ice cube is a good way to do medicine. I think love is awesome medicine for every patient, if you have time.

Dwayne

[Vorenus]

Man, it occurs to me that I must sound like a complete moron...But, there you have it...It truly is the way that I see forggy calls..like a mini war.

You don`t sound like a moron at all. That`s quite a good way to work a patient!

I`m sure up to some level, we all experience this. I actually only recall a patients features really good (if good at all, I`m not good at remembering names for instance, just not a priority - though it angers me, `cause it`s always emberassing to look at your papers to give the doctor in the ER the name, instead of just memorizing it in the first place. Or to have to ask the patient a second time.) when he`s only minor or middle injured.

[Just Plain Ruff]

My first day on the job was a bad one. My first call out of the box, no drivers training, just get your ass on the truck type of day was to a pediatric non-breather. SIDS, nothing we could do.

Cleared the scene and went on to do several other mundane calls and my last call of the day was a elderly gentlman who collapsed at the local restaurant in front of his wife, two sons and grand children. We coded him to the hospital, got a pulse back but it was only his heart that didn't know it was dead. His brain knew it though.

Went home that night, almost didn't come back the next day. Cried most of the night with the image of that blue baby on the kitchen counter where we found her.

You never know how you will react to a dead body, I felt I did really well. I hid it awfully good that my stomach and heart were reeling.

So you will have to learn this lesson the hard way young one. No-one can tell you how to act on the scene of a dead body.

AS for wanting to be a fireman - well I have a friend in a major metropolitan fire department who is a fire fighter paramedic who is paramedic through and through and if you heard how he talked about the lazy fat asses on the fire department he works with you might be swayed to steer clear of the EMS to firefighter route. IF you want to be a fire fighter, get your fire fighter 101 classes and your emt class and go that way. But don't use EMS as your stepping stone to become a firefighter. It cheapens EMS.