EMS personnel are routinely confronted with no win situations. Despite the expectation that EMS can bring anybody back from the dead or at least prevent the inevitable in the nearly dead, medics eventually understand that not everyone will make it. Feelings of invincibility and invulnerability will likely fade away after an EMS crew member has been on the job for some time.

We Do Alive… We Don’t Do Dead

Many times EMS will arrive at the scene of a call and be confronted with a patient who is already obviously dead or has signed a Do Not Resuscitate (DNR) order. Obviously dead people will present with no pulse, absent heart tones, body will be at room temperature, display lividity (redness caused by blood pooling after the heart stops beating) and rigor mortis. Rigor mortis is a stiffening of joints the occurs shortly after death. Rigor mortis should be able to be seen in more than one joint. Attempting resuscitation in such patients is futile and possibly harmful the responders.

The patient is dead, but what about everybody else. EMS still has a role in comforting the grieving witnesses, bystanders, or family. The typical response to death and dying by those in it’s wake are:

1. Denial – The affected will refuse to believe the death actually occurred in the first place
2. Anger – The affected will project feelings of anger toward other people, especially those closest to them. All responders should be alert in the event that the anger becomes physical and is directed at the EMS crew.
3. Bargaining – The affected may attempt to negotiate for the return of the departed or even negotiate with the EMS providers to extend the patients’ life for just one more moment.
4. Depression – The affected will exhibit sadness or grief. The affected will be withdrawn and cry. It is important to let the grieving express their feelings.
5. Acceptance – The affected have accepted the situation. It is helpful to listen to the grieving and possess a non judgmental attitude.