ER24 paramedics understand that the death of some patients is an inevitable part of their work.

Here’s how they handle it.

“As emergency medicine students, we are taught to expect – and accept – that despite our best efforts, we will lose some patients,” says Tao Carstens, Branch Manager for ER24 Southern Cape. “When breaking the news to family members, we know the importance of getting straight to the point. Our trauma counsellors explain that using the word ‘dead' is the best way to tell loved ones. This is the quickest way the family can understand and start the grieving process.”

Students are taught that using ambiguous words or phrases, such as ‘I’m sorry, he’s gone" or “He is no longer with us” can cause more pain and confusion for relatives.

“At this point, the family is often wanting miracles and will assume the deceased has been taken to hospital or has been moved to another location. There is no point in using pretty words to make it better. We normally explain that we’ve done everything we can to save the person’s life and what we’ve done. We then tell them that unfortunately our best efforts have been unsuccessful,” says Tao.

On-the-road experience

Learning how to deal with the death of a patient doesn’t happen in the lecture room – it happens when paramedics are working on the road. “Once we graduate and start working, we develop relationships with other paramedics and mentors,” Tao says. “If we’ve had a hard case where the patient has died, they help us to debrief. This is to reassure us that we did everything we could and is an opportunity to learn from the experience.”

Student paramedics accompany qualified ER24 first responders to a scene and can watch them break the news to family. Afterwards they’re encouraged to ask questions. As they move on in their studies, they can break the news themselves if a more experienced paramedic is with them for support. By the time they qualify, they tell families the difficult news themselves.

Every situation is different. “For example, if we arrive at a motor vehicle accident scene and there are mass casualties, we immediately start triage. We assess how critical each surviving patient is and where resources are needed,” Tao explains. “Once we’ve determined someone is dead, we have to move on to help the next patient so our focus is not on the fatality. We always check for signs of life, using an ECG to check if there is an underlying heart rhythm. If so, we immediately start full-blown resuscitation. These efforts can include CPR, medication, intubation and more. We do everything in our power to give patients a fighting chance.”

If the patient dies at happens at home, ER24 will contact the police and advise the family to contact an undertaker of their choice. “As a rule, we don’t transport bodies to mortuaries, but if we get the patient to hospital and they’re declared dead on arrival, we will transport the body to a state mortuary and the family is then notified and can contact their chosen undertaker.”

Reading the situation

After a patient’s death, the scene can often get fraught and occasionally violent. “Knowing how to deal with an angry crowd comes with experience,” Tao says. “We learn how to read situations and how to decide on the best course of action. For example, if the scene is hostile, we request support from SAPS while we’re performing resuscitation. If we deem it too dangerous to stop performing CPR and declare a patient dead at the scene, we will drive the patient away in the ambulance before declaring the news.

“If we’ve been called to a home to declare a loved one has died, relatives are often in a heightened state of emotion and may direct their anger at us. We retreat and call for back-up from the police before going in again to complete the necessary paperwork.

“At the end of the day, we need to protect ourselves, our equipment, and our vehicles in order to help other patients in the future.”