Field Termination by Emergency Medical Services Presented by Thomas Beers EMS Coordinator Huron Hospital & Trauma Center

Life is pleasant. Death is peaceful Life is pleasant. Death is peaceful. It's the transition that's troublesome. Isaac Asimov US science fiction novelist & scholar (1920 - 92)

Objectives of this course Identify the stages of the grieving process Become more suited and able to communicate to families once their loved one is dead Understand the origins, reasoning, and application of field terminations Become aware of the science that supports EMS Field Termination Become more comfortable in the application of field termination protocols/SOP’s Presentation Title l January 10, 2019 l 3

The Grieving Process Introduced by Elisabeth Kϋbler-Ross in 1969 On Death an Dying Outlined the “5 Stages of Grieving” Re-verified in 2007 by a Yale research group Note: The stages that follow do not always follow any exact sequence; however, they are all present if only for a few moments Presentation Title l January 10, 2019 l 4

The Grieving Process Denial & Isolation Anger Bargaining Depression Acceptance Presentation Title l January 10, 2019 l 5

Denial and Isolation At first we tend to deny loss Manifests into withdraw This stage varies in length Presentation Title l January 10, 2019 l 6

Anger Anger at the deceased Anger at “the world” Anger at themselves Anger towards you Presentation Title l January 10, 2019 l 7

Bargaining This is a time where many people fall upon their faith Devoutly religious or atheistic “If I do this, will you take away the loss or bring them back?” Presentation Title l January 10, 2019 l 8

Depression The stage of many emotions Anger can still linger There is a complete feeling of “losing it” An inability to cope Presentation Title l January 10, 2019 l 9

Acceptance The final stage Anger, depression, denial have tapered off Acceptance of reality, a greater powers plan, that death is a celebration of life Presentation Title l January 10, 2019 l 10

Understanding the Five Stages of Grief will allow you to be better prepared to…

(and why is it our job now?) So how do we as firefighters, EMS, and police officers tell the living that someone they know and loved is dead? (and why is it our job now?)

The Change in thinking… In the late 1990’s there was a national push to initiate Field Termination protocols across the nation All based upon research in EMS and Emergency medicine Who did the pushing and studying? And Why? Presentation Title l January 10, 2019 l 13

The Statistical Futility 400,000 people die of sudden cardiac arrest annually A 1985 study in the Annals of Emergency Medicine found that survival of sudden cardiac arrest was 0.3% A 1993 study in JAMA found that out of 1,068 found that only 0.4% patients without ROSC in the field were discharged from the hospital… …however, none of them were neurologically intact! Presentation Title l January 10, 2019 l 14

The Safety & Resource Factor Consider the significant financial cost (to the EMS system, the family, and the hospital) Consider the significant hazard of rapid transport to EMS and to other citizens Other safety concerns include blood-borne pathogens and lifting injuries Why transport the dead when we seem to be in constant need by the living? Presentation Title l January 10, 2019 l 15

With all that said, why are we transporting the dead? FEAR

What are we afraid of? Change? The inability to tell family members that their loved one is dead because we don’t understand the grieving process? That the deceased will come back to life? That we are going to get in trouble? Presentation Title l January 10, 2019 l 17

What we really fear is INACCEPTANCE! That brings us to the last factor

The Emotional Factor 1996 study in Annals of Emergency Medicine Determined family acceptance of Field Termination 140 Cardiac Arrests (Urban) 96% acceptance when performed However, of transported patients, 13 of 14 families stated they would have been accepting of Field Termination 2002 study in Prehospital Emergency Care Determined family acceptance of Field Termination Unknown # of cardiac arrests However, 21 of the cardiac arrests utilized a field termination protocol and 100% family satisfaction rate was found Of 12 patients transported, three families stated they would have preferred their loved one die at home if that were an option presented to them Presentation Title l January 10, 2019 l 19

The Field Termination Protocol

Care for the Patient 18 years of age Not the same as DOA Situational Dependant Intubation (Confirmed) Intravenous Access ACLS Pharmacology Persistent Asystole Arrest must not be from hypothermia or OD Presentation Title l January 10, 2019 l 21

Presentation Title l January 10, 2019 l 22

Presentation Title l January 10, 2019 l 23