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Survey of Emergency Medical Technicians' Ability to Cope with the Deaths of Patients During Prehospital Care

Published online by Cambridge University Press:  28 June 2012

Robert L. Norton ,
Edward A. Bartkus ,
Terri A. Schmidt ,
Jan D. Paquette ,
John C. Moorhead  and
Jerris R. Hedges
Robert L. Norton*
Affiliation:
Division of Emergency Medicine, Oregon Health Sciences University, Portland, Ore.
Edward A. Bartkus
Affiliation:
Division of Emergency Medicine, Oregon Health Sciences University, Portland, Ore.
Terri A. Schmidt
Affiliation:
Division of Emergency Medicine, Oregon Health Sciences University, Portland, Ore.
Jan D. Paquette
Affiliation:
Department of Emergency Services, Portland Adventist Medical Center, Portland, Ore.
John C. Moorhead
Affiliation:
Division of Emergency Medicine, Oregon Health Sciences University, Portland, Ore.
Jerris R. Hedges
Affiliation:
Division of Emergency Medicine, Oregon Health Sciences University, Portland, Ore.
*
Division of Emergency Medicine, Oregon Health Sciences University, 3183 S. W. Sam Jackson Park Road, Portland, OR 97201-3098USA
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Abstract

Hypothesis:

Emergency medical technicians (EMTs) find that the death of patients in their care is stressful.

Population:

Random sample of certified EMTs in one state (Levels I–IV).

Methods:

A blinded, self-administered survey was sent to a random sample of 2,500 EMTs. Demographic data obtained were: level of training; hours worked each month; population of area served; age; gender; number of deaths per year; training for coping prehospital deaths; and availability of protocols and on-line medical advice for out-of-hospital deaths. A five-point, Likert scale was used to rate the frequency of perceived stress experienced by EMTs in specific situations and the routine practice for notification of survivors. Univariable analysis was performed using Spearman's Rank correlation, Kruskal-Wallis test, and Mann-Whitney U-test. Multivariable correlations were performed using forward and backward step-wise logistic regression analysis. A significance level of 0.05 was used throughout.

Results:

There were 654 respondents with a mean age of 35.5±8.3 yr; 83% were men. Their highest level of training was: 4% EMT-I, 43% EMT-II, 18% EMT-III, 33% EMT-IV. They saw an average of 9.6 deaths/year and spent an average of 20±17 minutes with survivors. 62 % found treatment of a patient that was dying or died in their care was commonly a stressful experience. Factors that made notification of the family about the prehospital death emotionally difficult included: fewer hours worked/month; working in a smaller community; lower level of EMT training; female gender; and fewer deaths seen during the previous year. The same factors were associated with general emotional difficulty in treatment of a patient who died during prehospital care. Online [direct] medical direction by physicians was common (73%), but did not lessen the difficulty of notification. It did reduce the emotional difficulty for specific clinical situations. Written protocols for not attempting resuscitation were common (66%), but only 44% had protocols for termination of resuscitation. Resuscitation of the clearly dead for the benefit of the family (10%) or for the EMT (5%) was practiced infrequently. Most (67%) respondents had some formal training in dealing with death and the dying patient. Such training did not correlate with less difficulty in notification of survivors or in coping with the deaths of patients in their care.

Conclusion:

EMTs perceive they have emotional difficulty when prehospital deaths occur and survivors must be notified. Less experience and a lower level of EMT training correlate with more difficulty in coping with patient death. Protocols and on-line [direct] medical control can provide support for the EMT in coping with out-of-hospital deaths. Most notification of survivors is handled by EMTs with formal training to cope with patients that are dying or who die during prehospital care.

Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 7 , Issue 3 , September 1992 , pp. 235 - 242
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1992

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Footnotes

Presented at the 6th Annual NAEMSP Meeting and Scientific Assembly in Houston, Texas, June, 1990

References

1. Tolle, SW, Elliot, DL, Hickam, DH: Physician attitudes and practices at the time of patient death. Arch Intern Med 1984;44:2389–2391.CrossRefGoogle Scholar
2. Tolle, SW, Bascom, PB, Hickam, DH: Communication between physicians and surviving spouses following patient deaths. J Gen Intern Med 1986;1:309–314.CrossRefGoogle ScholarPubMed
3. Parkes, CM, Brown, RJ: Health and bereavement: A controlled study of young Boston widows and widowers. Psychosom Med 1972:34:449–461.CrossRefGoogle ScholarPubMed
4. Vachon, ML, Roger, J, Lyall, WA, et al. : Predictors and correlates of adaption to conjugal bereavement. Am J Psychiatry 1982;139:998–1002.Google ScholarPubMed
5. Lewinson, P: On sudden death. Psychiatry 1972;35:160–173.CrossRefGoogle Scholar
6. Dubin, WR, Sarnoff, JR: Sudden unexpected death: Intervention with the survivors Ann Emerg Med 1986;15:54–57.CrossRefGoogle ScholarPubMed
7. Soreff, SM: Sudden death in the emergency department: A comprehensive approach for families, emergency technicians, and emergency department staff. Crit Care Med 1979;7:321–323.Google ScholarPubMed
8. Bates, DW, Tolle, SW, Elliot, DL: Subspecialty differences in responding to patient death: Comparing cardiologists and oncologists. West J Med 1988;148:471–473.Google ScholarPubMed
9. Tolle, SW, Hickam, DH, Larson, EB, et al. : Patient death and housestaff stress. Clin Res 1987;35:762A.Google Scholar
10. Schmidt, TA, Tolle, SW: Emergency physicians' responses to families following patient death. Ann Emerg Med 1990;19:125–128.CrossRefGoogle ScholarPubMed
11. Hammer, JS, Mathews, JJ, Lyons, JS, et al. : Occupational stress within the paramedic profession: An initial report of stress levels compared to hospital employees. Ann Emerg Med 1986;15:535–539.CrossRefGoogle ScholarPubMed
12. Cydulka, Rk, Lyons, J, Moy, A, et al. : A follow-up report of occupational stress in urban EMT-paramedics. Ann Emerg Med 1989;18:1151–1156.CrossRefGoogle ScholarPubMed
13. Whitney, TW, Allison, EJ Jr: Stress in EMS: Opportunities and directions for future research Ann Emerg Med 1989;18:1247–1248.CrossRefGoogle Scholar
14. Bonnin, MJ, Pepe, PE, Clark, PS: Key role of prehospital resuscitation in survival from out-of-hospital cardiac arrest. Ann Emerg Med 1990;19:1216. Abstract.Google Scholar
15. Kellerman, AL, Staves, DR, Hackman, BB: In-hospital resuscitation following unsuccessful prehospital advanced cardiac life support: “Heroic efforts” or an exercise in futility? Ann Emerg Med 1988;17:589–594.CrossRefGoogle Scholar
16. Aprahamian, C, Thompson, BM, Gruchow, HW, et al. : Decision making in prehospital sudden cardiac arrest. Ann Emerg Med 1986;15:445–449.Google ScholarPubMed
17. Parrish, GA, Holdren, KS, Skiendzielewski, JJ, Lumpkin, OA: Emergency department experience with sudden death: A survey of survivors. Ann Emerg Med 1987;16:792–796.CrossRefGoogle ScholarPubMed
18. Jones, WH: Emergency room sudden death: What can be done for survivors? Death Education 1978;2:231–245.Google ScholarPubMed
19. Hamilton, GC: Sudden death in the ED: Telling the living. Ann Emerg Med 1988:17:382.CrossRefGoogle ScholarPubMed
20. Zbilut, JP, Aguilera, HG: Prehospital CPR: Rights and obligations. Medical Ethics 1990:5:1–15.Google Scholar
21. Jones, WH Buttery, M: Sudden death: Survivors' perceptions of their emergency department experience. J Emerg Nursing 1981;7:14.Google ScholarPubMed
22. Doyle, CJ, Post, H, Burney, RE, et al. : Family participation during resuscitation: An option. Ann Emerg Med 1987;16:673–675.CrossRefGoogle ScholarPubMed
23. Ashdown, M: Sudden death. Nursing Mirror 1985;161:22–24.Google ScholarPubMed