Death in EMS

[emtcoastie]

I'm a Medic student in Texas and have just this past week I've ran two calls in which the patient past away. These where my first experiences to death in EMS. I really thought i would be more affected by their deaths, but i havent been. Maybe becaue I didn't know them before or never even heard them speak(both were tubed and out before I even saw them). On one call the patient's family was allowed into the room while the team was performing CPR. I like the fact that the doctor let them be in the room for closure. What are some of y'all's feeling on end of life treatment and family involement?

[AnthonyM83]

Seems normal to me. Patient deaths rarely bother me. If they're dead, they're not in pain and cognizant of their death. No suffering, no fear, no nothing. It's similar to not being affected when walking by a graveyard. You never knew them as conscious beings.

Seeing the family grieving for the patient, on the other hand, really bothers me. For me, it's the absolute hardest part of the job.

I will say that the longer you're with a patient and you feel like you're actions might actually affect the outcome of the patient, the more their death affects you. Even more if they were alert and oriented at the start of the call...but even then it's minor. I've taken a personal moment for different patients...usually pediatric arrests...but it's a rare exception, not the norm.

[Arctickat]

Not to nit pick...but I'm gonna. The only time you use the word "Past" is in a chronological reference. ie, Past, Present, Future. Your patients passed away. Literacy is a big part of our job whether we like it or not.

Anthony and I have pretty similar views. I may review a call in my head and on occasion dwell on something that I might have done better; but, when all is said and done either they are revived, or they are not. I learn from it and move on. Once the code is called I turn my attention to the family to provide support until someone else closer to them arrives to take over. Life is a terminal illness, and death is inevitable. Don't be disturbed that you aren't bothered by their deaths. The fact that you're recognising this bodes well that you understand the dying process and won't be deeply affected by it.

I've never forced a family member to leave the area when we are running a code on a loved one, but I have made sure they understand that what they see may be disturbing. For some they need to see it for the closure, to see that we did everything that could be done. For others they choose not to see their loved one being abused in this manner. It's their choice, not mine.

[Guest ~~~]

I've had my share.. Some have effected me, some haven't. The one's the really don't effect me is a transport call from hospital or nursing home to coroner's office, or a old man that was ready to go. The one's that effect me is pediatric trauma calls and they don't make it, makes you think if you could have done something wrong. Or there is the trauma one's that aren't ped's but adults and arriving on scene with family going crazy and you're too late. So in one way, I hate death calls, especially when you aren't able to save the person. In another way, I don't enjoy them, but find them beneficial to our career. The deaths that don't effect you will help you mature in that department so when another case comes you are sort of prepared and you can always learn a life or career lesson out of them.

[emtcoastie]

I have horrible grammer and it's one of the things that I need to work on most!

I haven't had any pedi calls yet but I know my day is coming and I dread that. I knew coming into this career that dealing with kids would be my biggest stumbling block.

I have learned a lot from these two deaths and that's how I've come to look at them, as really good experiences for me to learn from. I also learned from the family and how to interact with others in their time of need.

[wrmedic82]

I like to look at doctors a lot of times to see how they manage, and interact with patients and the patients family. One thing about death is that it is a reality and inevitable. If provided it is safe to do so, I feel it is in the best interest of the family to see what all you are doing, make interface with a physician and be within earshot of the family so that the family can hear the words of the doctor " You have done all you can do, you can terminate resuscitative measures!" That way the family will not doubt that everything was done and done correctly to try and save their loved one, even though a lot of times we already know that the attempt is futile.

I feel very strong about in the field termination of resuscitative measures and I know not all share my opinion. My reasoning going even further is

• Everyone is in a place they recognize
  
• Does not give the perception of false hope
  
• Allows for the best delivery of patient care ( very difficult to do picture perfect CPR in the back of a moving vehicle)
  
• Overall it is safer (no code 3 driving with for lack of better terms a corps)
  

Now will every scene allow you to manage the scene this way. Probably not. But this is what I strive for in code situations in the field.

As far as it bothering you, or not bothering you. People respond to stress in different ways. Some can cope really well in situations like this, where others may cry with the family. I wouldn't let that aspect get to you, but at the same time do not be afraid to say something to someone.

[medicgirl05]

I've learned that you can never have expectations as to how someone will react to a death. I am also a firm believer in field terminations and when notifying the family they may react in all sorts of unexpected ways. I have learned you just have to roll with it. I've had people become very angry and some who actually laugh and some people who don't seem to understand what you are saying.

I had only one experience that really bothered me. We left the scene and drove about 2 miles and my partner pulled over so I could vomit. After I was sick it was all over. I wouldn't say you get used to death but I think people in EMS see so much suffering that we tend to look at death differently.

[island emt]

One thing to remember : VERY few cardiac arrest are brought back to a perfusing rhythm .

Some places claim a 40 % save rate , but they only count folks with witnessed arrests who had immediate CPR and quick AED applications. Even thenI'm sceptical of their numbers

The majority of the arrest calls we see are down 10 -15 minutes or longer before any attempt at care is given. The odds of resuscitating that group are extremely low, and even if you do they will have been hypoxic long enough to have suffered serious brain injury.

In four decades I've had four returns to spontaneous circulation that survived to walk out of the hospital with little or no neurological deficits.

[RuralKSEMS]

I had a code over the weekend as well. Only my second in 6 years in EMS and my the first that I ran as a new AEMT. The gentleman was older. We did get ROSC, 3 times total during the run. He was a witnessed arrest (minutes after we walked in the house, I took enough time to upgrade our paramedic assist and then went to work). He coded for the last time at the hospital. Wife was in the house the whole time we worked on him there. Daughter came in while in the OR and we were working on him. We stayed and helped the nursing staff work the code at the hospital until the wife got there and said it was okay to stop. I'd seen him around town (I live in a town of 500) but I didn't know him. Strange enough, I wasn't affected either. I think it helps knowing we did every thing we could to get his heart going again but he also had a host of health problems. The worst part was seeing his wife come in the room. I had to turn my head so she didn't see me tear up but other then that, i didn't really bother me.

[Just Plain Ruff]

I was taking care of a lady in the ER, had a great rapport with her, was joking with her and got to know her pretty well while we were stitching up her three nearly degloved fingers. I was the on duty first out medic and near the end of fixing her up I got a call on a chest pain call.

I transitioned care to the back up medic and went off to the call.

Arrived on scene to a first responder doing cpr.

We worked the guy for about 15 minutes but we called him. Found out that this guy had lots of health problems.

What happened later while we were still on scene was pretty surreal. My degloved finger patient walks in the doorway and I asked her what she was doing here. "Bob's my father" I said "oh"

She asked what happened and we ran it down for her.

She then asked if he was in any pain and I said I couldn't answer that for her.

She said "I'm so glad it was you who was here"

This was a surreal and emotional moment for me but in the end the job is the job, we said a prayer, waited for the man's pastor and the funeral home and coroner.

Said our goodbyes and that was it.

All sort of like a blur. I know any of my other colleagues would have done just as well but I felt the connection was better for this woman and her family that I had with her.