Those who practice paramedicine excel at following the pathogenic model—flow charts, protocols, standard medical operations, standing orders—to best triage, treat and transport patients.
On the other hand, many of us who practice emergency medicine have little to no experience in pastoral care. How do we deliver the news that a loved one died, without seeming awkward, cold or robotic?
Compassion
Must everything that we do be in a protocol? After all, this is about death and dying and how first responders can arm themselves to better deal with human suffering.
“A protocol doesn’t serve a family,” Wendy Lund, who is the founder and CEO of Wellth Management Inc., says.
With its roots in resilience training for first responders, Lund’s company helps organizations to understand the science behind stress, mindfulness and compassion.
Lund argues that first responders must be taught about suffering, empathy and self-compassion. “Once you can tap into that as a first responder, you’ll be better equipped to handle death and dying.”
Empathy can be difficult to do, but compassion can be measured by offering a grieving family support through action.
“Ask yourself, ‘What would I want in this moment?’” Lund says. “Compassion isn’t a protocol; it’s a state of mind.”
She believes that when you teach first responders to approach the family of a deceased victim considering what those people need in that moment, the family members will remember that more than they will remember the protocol.
There are simple things that you can do to practice compassion (i.e., offering a grieving family member a glass of water or placing a blanket around that individual’s shoulders), and you don’t have to wait until you’re on scene of, say, a cardiac arrest to start practicing. Lund says “run-of-the-mill” calls provide perfect opportunities to practice compassion.
“When you practice mindfulness, you automatically develop your ability to be compassionate,” Lund offers.
“The spiritual crisis isn’t even discussed in the [paramedic] program,” she adds, “and I think it’s stigmatized. Of course, the ‘save’ matters, but we’ve not attended to what happens around that suffering spiritually and psychologically.”
Beyond the routine
Lund, who works with paramedic students, says a pathway or a protocol approach is too narrow and doesn’t keep the lens of what’s needed and, more importantly, what’s missing. She says first responders must be trained to be somatically and emotionally intelligent and to address suffering skillfully.
Perhaps EMS can better utilize first responders in roles in which they possess the appropriate skill set. For example, Tom Howard, who is a firefighter paramedic with the Evanston, IL, Fire Department and the executive director of Illinois Firefighter Peer Support, possesses a master’s degree in divinity with an emphasis on pastoral care. In most scenarios, Howard is the best choice to deliver a death notification. That said, his role as a paramedic during a cardiac arrest is to follow the medical protocol.
“Let’s be more open to see who the best person is to work with this family,” Howard says.
Also, we tend to downplay how death and dying can take an emotional toll on our personnel. If we can practice compassion with our patients, perhaps we can better recognize when one of our own is struggling.
“For years, we have just completely ignored the emotional aspect of what we do,” Howard notes. “We are given the mechanical tools, but we never talk about the mental aspects, whether dealing with the public or dealing with ourselves and our coworkers.
“How do we go about depersonalizing that call [that involves a victim death]? The person that’s going to be in trouble is going to be the person who cannot detach from it.”
Howard believes that it’s imperative that EMS and the fire service openly acknowledge that handling other people’s grief is an issue. “I’m aware of the emotions and feelings I have in the moment. It’s when we don’t pay attention that it sneaks up on us.”
Lund’s perspective: Teaching first responders how to manage a difficult airway saves patients’ lives; teaching first responders how to manage difficult emotions saves their own life.
