While paramedics across Canada are dedicated to saving patients, death is a reality in the profession. Paramedics can deliver death notifications in the field, at trauma scenes and in homes for reasons as diverse as cardiac arrest, miscarriage, stillbirth or sudden, unexpected death. Now, an innovative, experiential course ‘Dealing with Death and Dying’ created by BC Ambulance Service will ensure that paramedics have the skills to help them speak about a subject that is not easily broached.
Unique in Canada and most of North America, the course focuses on sensitive subject matter that touches on the heart and emotions of its participants, rather than the traditional paramedic educational emphasis on cognitive and psychomotor skills or ‘head and hands’. The intent of the course is not only to address the skills needed to deliver the message but also to engage paramedics in the reality of dealing with their own feelings and values while looking at the situation from the survivor’s point of view.
“The course gives paramedics practical tools to support survivors and next of kin at vulnerable times in their lives,” says Elizabeth Wilson-Tagoe, learning design specialist with BCAS. She and education officers Don Hong and Colin Fitzpatrick, who are also paramedics, created the course from the results of focus groups, interviews and scenario development sessions.
About half of the 2,600 BCAS Primary Care Paramedics have taken the course since its September 2012 introduction. They call it ‘emotionally draining’, ‘very realistic’ and a ‘very emotional course’.
- ‘Painting a picture’ for physicians at the 15-minute mark of resuscitation to ensure there is no underlying cause that would warrant patient transport to a hospital
- Managing the scene at a resuscitation attempt
- Delivering death notification under a variety of circumstances
- Providing comfort to next of kin
Hong captures the spirit of the course when he remarks that survivors and next of kin “will remember this moment for the rest of their lives: the words, the music or sounds in the background, the smells in the air.” He says this begins the healing process “when paramedics need to be as supportive as we can possibly be.”
A key component of the course teaches paramedics how to deliver a death notification to next of kin and how to fill the empty space when no one is talking. This is accomplished through three short video scenarios – created by BCAS training officers, representatives of Mothers Against Drunk Driving and the Alberta Health Services Emergency Medical Services – that show a paramedic delivering a death notification with increasingly emotional responses by the survivor. For example:
‘You’ve just discontinued resuscitation on a 70-year-old male, have informed the wife her husband has died and she says, “Oh, I feel so terrible. The last conversation we had was an argument.” What are you as a paramedic thinking, feeling and doing when confronted with this information? Put yourself in the wife’s shoes and consider what she is thinking, feeling and doing?’
The course is delivered by two facilitators over four hours. “It’s a different kind of course to deliver,” said Colin Fitzpatrick, education officer for BCAS and one of the co-creators. “Because the course leans to the emotional side, it’s heavily facilitated. We allow only 12 participants, and the facilitators must be nimble enough to deal with emotions that arise during instruction.”
BCAS is currently fielding inquires from across Canada and the U.S. about the course. Hong, Wilson-Tagoe and Fitzpatrick are running Skype sessions with interested agencies to explain how the curriculum was designed and used during class. Responses have been positive, and they are now looking at ways to distribute the curriculum, while keeping the integrity of the course intact.
The course is also a hot topic on the LinkedIn group EMS World, as BCAS posts the media coverage – both print and broadcast – that followed the course introduction. One group member said, “Thank you for sharing this touching information with everyone. Working in the field for over 33 years as an EMT/D, having to deal with death never gets any easier. A lot has changed over the years for the better with the education and training that is offered . . . . The curriculum states both “birth and death” are very private experiences. The first one most people prepare for, the second is very rarely prepared for. That’s why this training is essential . . . .”