MCIs: Patients who ask about other patients

[DMM4047]

Newbie here. During my basic class, we touched on ethics/death/etc for a very very brief time. I've got a question I've wanted to ask the folks on this website as I'm sure this is a (somewhat) common situation. I recently thought of this after seeing a news story about a MVA w/entrapment and fire where there were multiple fatalities.

Situation: MVA with multiple patients. A/some patient(s) are DOS. A patient that is being treated and transported to the hospital inquires about their friend/family member/girlfriend/etc. If you were a provider and knew that the person who was being asked about was deceased, what are some good strategies to use?

I've got my own opinion on this, but I'm curious to hear from others. I can't imagine *lying* to a patient would be right (I mean...we wouldn't lie and tell a critical STEMI patient that they're "alright" now right)? There's always the option of saying "I don't know. There's other providers taking care of them; I'm focused on you." but what if a patient is 100% adamant about knowing prior to transport (perhaps a mother inquiring about her child for example)?

Just wanted to start a discussion. I hope I'm not beating a dead horse here. Needless to say, the condition of the patient who is inquiring about another person must be considered. Surely we would evaluate our choice of words when talking to a stable vs critical patient.

[paramedicmike]

Welcome. And good question.

I'd like to say, before we get started, please be careful with abbreviations. This is an international forum and not everyone will always understand local abbreviations. Take "DOS" for example. Based on the context I'm assuming you mean "dead on scene". It is not, however, an abbreviation I've ever seen before and could easily be either misunderstood or not understood altogether. Assuming is generally bad. This is just a friendly comment.

The answer to your question is as varied as the providers here on this forum. I have been in this situation many times and I have never told a family member, friend or significant other the status of the person about whom they're inquiring. Especially if I know the person they're asking about is dead. My patient's reactions are unpredictable at this point and the last thing I need while trying to provide care to him/her is for that person to lose what little composure s/he might have.

Your answer of, "I don't know. There's another crew taking care of..." is a good approach. It is widely used and from my experience works pretty well. There's a difference between holding back information and outright lying. Generally, lying to your patient is a bad thing. Sometimes, though, withholding information is perfectly acceptable and made easier if you're only getting second hand information about the other patient(s). After all, you didn't see the other patients so how do you know for sure?

[BEorP]

Your answer of, "I don't know. There's another crew taking care of..." is a good approach. It is widely used and from my experience works pretty well. There's a difference between holding back information and outright lying. Generally, lying to your patient is a bad thing. Sometimes, though, withholding information is perfectly acceptable and made easier if you're only getting second hand information about the other patient(s). After all, you didn't see the other patients so how do you know for sure?

Couldn't have said it better... especially the last part. Often, we might not be 100% sure on all of the details so it is better not to say anything other than what you know for sure, which is that you don't know but you're focused on them. It may sound like a cop out to them (or even to ourselves), but it also happens to be the truth.

That being said, just for the sake of discussion I will mention a call that I was on as student. A driver who had been drinking was involved in an accident that killed the driver of another vehicle (pronounced dead on scene). Our patient (the driver who had been drinking and had gone into oncoming lanes) was repeatedly asking about the other driver and the attending paramedic did eventually tell him that he had died. This paramedic had actually pronounced that patient dead before this, so there was no uncertainty about the information in this case. In this situation, the patient's reaction was not positive, but he seemed to settle down a bit at least knowing that was he feared had happened had really happened. Maybe sometimes the uncertainty is worse for the patients.

I'm not saying that I would take the same approach, but this anecdotal example at least makes me reluctant to say it is never appropriate to answer the question directly in some cases. How you identify those cases, I'm not entirely sure, so I'll probably default to the "I don't know" and "we're focused on you."

[Eydawn]

Depends on the scene. If your patient won't calm down because they need to know, tell them what you know... if you're not sure how they'll react, focus the care and interaction on them and tell them once everyone's stabilized/transported will be a better time to figure out what's really happening.

If I myself had in fact triaged and determined someone's child was a code black, and they knew it but needed confirmation from me, I wouldn't withhold that information. I would, however, make sure they were safely on the stretcher, in the ambulance, and stable enough for me to take the time to tell them.

Not an easy question! Great place to ask it! Bring us more, young padawan... this is the place to stretch those mental wings and pick stuff apart.

Wendy

CO EMT-B

RN-ADN Student

Edited September 3, 2012 by Eydawn

[island emt]

Never lie to your Pt. they may already suspect that a family member has been killed and are looking to you for confirmation. Tell them what you know , but spare the details. Work to help them understand that everything possible is being done for those that need our help.

In the drunk driver scenario BEorP gave: Tell the drunk driver not to worry as the state will be providing room & board for a while at the jail.

Not a lot of sympathy there.

[Arctickat]

I tend to tell them that they are my priority at the moment and that I will check on the condition of the person they're asking about as soon as I can. Then I keep busy until a Next of Kin is able to tell them.

[Lone Star]

I don't believe in lying to a patient, but in the scenario presented by BEorP, I think i would have to intentionally withhold information from the inquisitor.

I could cite HIPAA rules and regulations to have a way out of explaining to them that they've just killed someone because they chose to drive drunk, or I could just tell them that I'm focused on treating them and the patient they're asking about is being seen by another crew.

In the event that the patient being asked about is a family member, that opens up a whole new barrel of connundrums. Will breaking this news to my patient complicate my ability to be able to treat them? Will this end up in a life threatening situation for me/my partner because they've decided to do a 'murder/suicide'? Will I/my partner become the next victim(s) because I/we weren't able to save that family member?

[Bernhard]

Depends a lot, several reasons already were written here.

You need to be sure about the relation the patient is with the other victim he asks about, since confidentiality obligations apply in this case as well.

IF you're deciding to tell, two important things:

1. be ABSOLUTELY sure to know the confirmed death first hand;
   
2. say it with great confidence, straight on, no hedging around the subject.
   

I did it sometimes and it takes a lot of uncertainity away, more calming the process than not. But, it depends, and you have to develop a feeling for this - and take the consequences. Don't tell too much and know what you're doing. If you're not the highest level of medical care on the team, point this question to her/him in charge.

[Arctickat]

I could cite HIPAA rules and regulations to have a way out of explaining to them that they've just killed someone because they chose to drive drunk,

Oh....I wouldn't have any hesitation at all about telling someone like that that they've managed to kill their three kids.

[DwayneEMTP]

It depends mostly on the condition of the patient that I'm currently treating.

If they are calm and for the most part uninjured we'll have different conversations than if they have an active MI, are significantly traumatized or emotionally out of control for any reason.

In most significant cases anxiety and aggitation are my enemies. If I have to lie to effect those variables then, within limits, I will. I've often told an active MI, "Susan, you know that you're having a heart attack, but we've got a pretty good handle on it now...I can see your stats improving quickly now so I want you to just relax, breath, and trust that I have this under control, ok?" Do I see any significant improvements? Do I really have it under control? No...but knowing that doesn't help her and believing that I do won't effect any decisions that she'll make concerning her care and almost always drops their anxiety level significantly. Is this a slippery slope? I don't know...

If I know that my aggitated, bleeding, freaking out, traumatized patient's family member was killed on scene will I tell them the truth? No. "Mike, you are in danger now Brother. I need to get some things done so that I can keep you safe. When we left the scene another team was looking after your daughter/son/wife and I know them, they're really good. I know you're terrified, I truly get that, but right now you have to be strong enough to care for yourself so that you can be strong enough to care for your family when we get to the hospital, ok?" Honest? No, not really, but I believe it to be good medicine.

"Always tell the truth" is a decent rule, but sometimes, depending on your motivation, not the best medicine.

And I, at least I hope, would never deliver the news to the drunk driver about the people that he killed to punish him/her. My committment has to be to improving patients within my limited ability. Choosing to purposely queer their condition for the satisfaction of punishing them them for their bad behavior is just to far into the murky areas of morality and ethics for me to try and figure out. And once you've chosen to injur a patient for personal satisfaction, how do you come back from that?