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

2. 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 ( )

3. 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
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4. 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
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5. The Grieving Process Denial & Isolation Anger Bargaining Depression
Acceptance
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6. Denial and Isolation At first we tend to deny loss
Manifests into withdraw
This stage varies in length
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7. Anger Anger at the deceased Anger at “the world” Anger at themselves
Anger towards you
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8. 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?”
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9. Depression The stage of many emotions Anger can still linger
There is a complete feeling of “losing it”
An inability to cope
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10. Acceptance The final stage Anger, depression, denial have tapered off
Acceptance of reality, a greater powers plan, that death is a celebration of life
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11. Understanding the Five Stages of Grief will allow you to be better prepared to…

12. (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?)

13. 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?
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14. 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!
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15. 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?
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16. With all that said, why are we transporting the dead?
FEAR

17. 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?
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18. What we really fear is INACCEPTANCE!
That brings us to the last factor

19. 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
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20. The Field Termination Protocol

21. 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
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