I Ya HORBACHEVSKY TERNOPIL STATE MEDICAL UNIVERSITY Disaster

I. Ya. HORBACHEVSKY TERNOPIL STATE MEDICAL UNIVERSITY Disaster medicine and military medicine department • Lecture 1 Organization of medicare at pre-hospital stage. Primary inspection of a casualty

• DEATH AND DYING IN THE EMERGENCY DEPARTMENT

Who should notify the family that someone has died? Many families have stated that they want a physician to inform them about the death. However, family members prefer that a nurse stay with them to answer questions and provide comfort. Nurses are perceived as more compassionate, acknowledging the significance of the death for the family.

Can anyone else help with death notification? Yes. You may want to explore developing a collaborative group who can be called upon to assist families in the ED when death occurs. Team members may include social workers, clergy, psychiatric staff, and trained volunteers.

What's the first thing I should say to the family when I have to tell them someone has died? You should not start with "I'm sorry" or "I have bad news for you. " Statements like these do not give families enough time to assimilate and process information. Sit close to the family and speak directly to them. Use the sequential notification process to tell families about the death or any other critical situation. This notification process provides guidelines to help inform family members of deaths and critical situations in a short period of time. The staff member should:

• Find out what the family already knows. • Give them a brief description of what has happened during the time the patient was receiving care, bridging their knowledge of events. Begin with simple information and then provide more complex details. • Explain what resuscitation efforts were made. • Conclude your description with a statement that describes the patient's response to treatment and explain the cause of death.

How do I tell someone about a death over the telephone? Try any way possible to have the person come to the ED. If you must notify someone of a death over the telephone, you may find that using the sequential notification process works well. Each case is different and you may have to rely on your "sixth sense. " In some situations you may want to call with very basic information such as, "There has been an accident and the staff is working with Mrs. X. I'll call you back in 5 to 10 minutes to tell you how things are going; can you call someone to stay with you? "

When you handle the notification using this two step process, the person whom you have called may then have someone with them when they are told about the death. If you have a list of resources, such as counselors, support groups or clergy, who are available to go to the survivor's home, contacting them will provide an additional source of support for the bereaved.

Should I call someone during the middle of the night or wait until a reasonable hour? Family members prefer to be called as soon as possible, no matter what the time. Waiting to notify a family of a critical injury or death may make it harder for the family to trust the care givers. Moreover, the family may feel that they were cheated out of precious last moments to spend with the deceased.

How do I prepare the body if the family wants to see it? The body should be cleaned of all blood, secretions, and dirt if forensic evidence is not needed. Gelfoam can be applied to oozing wounds to decrease the amount of drainage, and clean dressings applied. Intravenous lines, catheters, and endotracheal tubes should be removed if approved by the medical examiner. Medical equipment should be cleaned but left by the bedside. This helps families to know that appropriate interventions were performed.

What should I tell the family before they go in to see the body? Clearly describe everything they will see, including endotracheal tubes, obvious wounds, and medical equipment. You may need to repeat this information several times since people need time to understand new material, especially during an extremely stressful situation such as this.

Is there a "best way" to position the body? Yes. The body should be positioned with the head elevated. Placing a small towel under the head will bring the chin closer to the chest; this helps to keep the mouth closed. Place the body near the door, feet first. This prevents the family from having to walk across a large open area to approach the body.

How should I prepare the room and adjust the lighting when a family wants to spend some time with the body, especially if it is a child who has died? Although a child's death is tragic, every death may be thought of as a significant loss and all people, regardless of age, can experience death in a supportive way with the help of health care personnel. If time and space in the ED permit, the family should be allowed to stay as long as possible.

Should I stay with the family when they see the body? Every case is different. You need to assess the situation; the best way to do that is to ask. Most often, staff will stay the first few minutes to answer questions, and then ask the family if they want to be alone for a while.

What should you tell children when someone they care about dies? Children should be told the truth. It is important that the adults who are with the child hear what you say so they can repeat the explanation later to the child. Use simple terms and speak directly to the child. Be careful to avoid common phrases, such as "Gone to sleep, " since the child may become afraid to sleep, or "You're the man or woman of the house now, " which places tremendous stress on a grieving child.

Is there anything special we can do to help parents when a child dies? Yes. The most important thing you can do is provide the family with as much time as they need to say good bye, even if this means the child must be moved out of the ED to a quiet place. It can be very hard for families to leave a loved one's side because they don't want to leave the deceased person alone in a morgue. Parents sometimes find comfort in leaving a child's favorite toy or blanket with him or her. Offer the parents the opportunity to comb their child's hair or wash their child's face while they spend time with their child.

How do I know when it is appropriate to transport the deceased patient to the morgue? First, the body must be released by the medical examiner. Second, you will need to know if the family is coming in and their approximate arrival time. If there is time and space in the ED, you may want to keep the deceased there until the family has visited. If time and space are not available, you may need to move the body to another location for family viewing if the morgue is not designed for family visits.

Who arranges for the body to be picked up from the morgue? This arrangement is made by the family. Because the death of a loved one is a stressful event, the family may need to be reminded that they need to call the funeral home so that all final arrangements can be made.

Who determines whether or not an autopsy will be done? This decision is usually made by the medical examiner's office or the patient's attending physician. Several factors determine whether a patient has an autopsy. First is the cause of death. Any death associated with a known or suspected criminal activity is usually cause for an autopsy. Second, autopsies are done to determine the cause of a sudden, traumatic, or unexpected death. Third, a family member may request an autopsy in certain situations.

Regulations regarding autopsies vary from state to state and among different law enforce ment agencies. Medical examiners and private physicians may also have individual preferences regarding autopsy decisions. ED staff should consult with all of the agencies and physicians making autopsy decisions in their area to determine local regulations and preferences.