As EMS providers, we have a very limited scope of tools to help our patients. We are obligated to follow our protocols and treat was is evident from our assessment. This means your assessment is likely the most powerful tool you have in providing medical care. Ironically our most powerful tool, communication, is often completely forgotten by EMS providers.
The hardest part about our job is being honest with patients and their families. Often times we are present in end of life situations. These are difficult in controlled atmospheres–let alone the seemingly claustrophobic nature of EMS scenes. When a patient is dying we need to be honest with them and their loved ones. We need not be brutally honest, but most certainly we can not allow false hope.
False hope is a natural defense mechanism in the grieving process. Denial. Even as EMS providers we sometimes hold on to false hope in difficult calls to get by–but this is neither practical nor healthy in the end. Allowing and providing for false hope will create more shock when reality strikes. Death is a natural process–not always a pleasant process–but natural none the less.
As providers it is our duty to assist our patients and their families in understanding the reality of their situation. Does this mean saying “you’re going to die”? Not at all. But it does mean being clear that the patient is very ill, and you are doing all you can but 1) they need higher level of care 2) they may not make it to that higher level.
Does this make the process of dying easier? Absolutely not. For patients and their loved ones knowing their impending doom can be equally troubling. But it is still our duty to be truthful with our patients. Where I believe this honesty to provide an important relief to EMS is in the all to difficult cease or withholding of resuscitation talk we find ourselves in during these types of calls. Being honest with a patient and their family gives them more time, possibly only seconds, for reality to sink in.
When termination of resuscitation becomes part of the discussion, patients families are often unprepared. Giving them the truthful answers to questions about the reality of the condition of their loved ones will certainly help them to make the decisions to terminate care when necessary.
How do you handle these difficult moments in patient communication?