Death Notification Education

Delivering a death notification is one of the most challenging tasks an EMS clinician can face, yet many are called to perform it without prior formal training. In this episode of Registry Insider, Bill Seifarth sits down with Dr. Maia Dorsett, New York State Medical Director and National Registry Board Member, to discuss the critical importance of educating Clinicians on death notifications before they enter the field. Dr. Dorsett outlines how applying a structured framework, such as a grieving algorithm, provides Clinicians with a fundamental roadmap to navigate these compassionate conversations effectively while maintaining their own resilience. Tune in to discover how structured training, practical tools, and evidence-based strategies can transform a daunting procedure into a professional standard of compassionate care.

Transcript

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SPEAKER_00 0:15

Welcome to the Registry Insider. I'm Bill Seiferth from the National Registry of EMTs. And I just want to say this is our first episode inside of our modified studio here at the National Registry Headquarters in Columbus, Ohio. And on today's episode, I'm joined by Dr. Maya Dorset, who is from the state of New York and it's a board member on the National Registry VMT's board of directors. So, first of all, Maya, thanks for joining me for today's episode.

SPEAKER_01 0:41

Always happy to do so.

SPEAKER_00 0:43

So today we're going to briefly just talk about the importance of education and training of EMS clinicians related to death notification and the effects it has or impacts, not impacts, the potential benefits as far as having that education for the EMS clinicians before they have to give their first death notification.

SPEAKER_01 1:07

Yeah, I think there's research been done on this, and I want to touch on 2021, right?

SPEAKER_00 1:12

Yeah.

SPEAKER_01 1:12

So in 2021, um there was a paper actually published by the National Registry research team that used data from a 2017 survey of EMS clinicians, and it basically assessed whether they had delivered death notifications in the field and had they received any training in death notification. And then interestingly, the participants also took a validated scale of burnout. And what they found is that there's people who are delivering death notifications, a lot of people who are delivering death notifications in the field had not actually received much training. And when they looked whether or not there was an association between the risk of burnout, those people who had delivered, sorry, those people who had received some training in death notification and had then had to give death notifications were less likely to have experienced burnout. And I think that this is something that makes fundamental sense. And it really gets to from an education perspective, is are we preparing for people for what they're going to have to do as part of this profession?

SPEAKER_00 2:19

So you've obviously done some a little bit of writing on this and referenced that 2021 article. But you also, um, as a physician, some people may not know this, but you're a passionate educator as well. So how do those two roles intersect with you? Obviously, as a as a as an educator and writer, um referencing this article, but also in the classroom. So what do you do as a physician educator for paramedic students?

SPEAKER_01 2:47

Well, I think this fundamentally goes to whenever we're developing curriculum, right? Like we should be thinking what are the end competencies of what people need to be able to do. And very often we think, okay, they need to be able to, I don't know, like run the cardiac arrest, right? And people do tons of cardiac arrest simulations. Um, and those things are extraordinarily important because I need to put out somebody who can save the people who can be saved, right? And be able to choreograph that well. Um, but the question is in the way that we educate people to do that, the reality is the majority of cardiac arrests are not gonna end with ROSC and survival. The majority of the cardiac arrests, um, if you take like what's the probability of a unwitnessed asysole in the field, right? Like you already know that. I'm not talking about like witnessed v fib, um, are gonna end uh with cessation of resuscitative efforts and a death notification. And I think I learned over the course of my career that being able to do that well, like being able to deliver bad news or news such as death notification in a compassionate way, um, is one of the things that as a physician I learned to take the most like pride in. Um, and that's where you realize like, how do you take care of people after these terrible events? And to me, it was I think one of these really like healing things that actually allowed me to kind of process all the terrible things that you see and will kind of like accumulate with you in this field, unless you have ways to actually process um and make sort of do the most amount of good in really tough situations. And so actually, like very, very early on um when I became the medical director of a paramedic program now over eight years ago, um, when I thought about curriculum, and actually when we we interviewed um new program directors, I created a lesson for them to which was on um termination of resuscitation, where you know we're shifting that language around cessation of efforts or discontinuing resuscitation. But what I was looking for when they delivered that lesson was somebody who wasn't just gonna talk about these are the criteria by which you do it, but somebody who was gonna think about how do we teach that so that you navigate that with the family.

SPEAKER_00 5:07

Um in a human way too, because obviously you're dealing with people one of the worst days of their lives.

SPEAKER_01 5:12

The worst days of their lives. And when it comes to, you know, I think death notification, death notification and family presence during resuscitation are two interrelated, very overlapping things. And um if around family presence of resuscitation, uh there was this phenomenal article that was a randomized controlled trial that basically compared when they just the invitation to a family to be present during resuscitation, not even whether or not they took you up on it, but the invitation to be part of that resuscitation and then looked at long-term outcomes for that family, the amount of uh depression, medication use, uh, the about to like grief for those family members significantly decreased, right? And this is this is not an intervention that requires some sort of like fancy equipment or new supply or like a capital budget, but it is something that you can't just say, oh yeah, just like invite somebody, but not teach them how to interact with that family and take them down this journey, um, which I say is actually like the one of the most privileged things that we do is we give people the opportunity to say goodbye in those circumstances. And death notification could be like they were there or they're not there, but in the paramedic program, I really focus on this choreography. But if you think about the way that we design curriculum, right, very often it's like you have cardiac arrest resuscitation day and we do ACLS. Um, but like if you take ACLS and that's what you're doing, there is no scenario, right, that takes people through the process of death notification. And so very early on, like they have a day they do cardiac arrest resuscitation. Um, one of those is right, an unwitnessed asystolic right where like you know there's nothing you can do. You yeah, and you're gonna go through it. And maybe there's maybe you're gonna get ROSC, but I know it's like a less than 2% chance if I look at the CARES data. Um, but you know that that's not your duty there is to one, right, like continue to attempt resuscitation if that was in within the goals of care of that patient, that family. Um, but teach people how to choreograph that death notification and take them through that process. And when I talk about this, um, and for those who are interested, I record like a whole hour-long.

SPEAKER_00 7:31

That's gonna I was gonna ask if you can reference that because a lot more than that.

SPEAKER_01 7:34

Yeah, through for medic mindset, I did it with Ginger Lock, death notification choreography, and Alex uh Jabber has like courses online. There's like, I think lots of places you can get this education. Um, but I think that it's a procedure, right? And I don't like send paramedic students out into the world to like intubate people without giving them the micro skills of the procedure from like the setup to the different ways that you do that to how they do psychomotor. Just like when you're doing these notifications, you have to think about the setup and the body language and very carefully about kind of the words you use. Um, but they all have a, they all go through a scenario where they actually have to do death notification in the field and we debrief and we talk about how you choreograph it. I think one of the most satisfying things for me professionally as a medical director is when I started, right? There was a certain culture that existed, and we'd run the scenario and you'd have, you know, a family member crying as is normal, right? Which is a total normal response. And I had students being like mimicking what they'd seen, like, get the police, get them out of the room, I need this, like all these behaviors that, right, was something that they'd seen that I think was causing like great harm to family members, and fundamentally, right, like moral injury to the clinicians. And now, right, there's people who kind of graduate through the program, and people just have to like see it once. I think you kind of have to see it to believe it. Like I kind of teach how you choreograph and how you create space to bring family in and to create, like, I mean, the final words, which I'll get like a little bit choke up because I get choked up every time. Like those final words where you create opportunity, be like, you know, I have this line that says, like, I never know what somebody can hear in a moment, but like I can say, like you should always say the words. Like, what a privilege we have to like be there for people saying, I love you, you know, like the last I love you, you know. It's all right, I was checked up. But like I do, I do even with my students because I because I really like I feel that. Like I feel that like that makes what I do in work and life like so meaningful. Um, so I've had students who do this, right? And then they go implement it in the field. And now, like when this year's class and last year's class went through, nobody ever tried to remove somebody from the room, right? And then we had work to do. We had work to do on, there's a couple times you know, I played the family member doing CPR. I got like trapped up against a wall, like where to put the family. And there was things about body language and the words that are used. And and I give them an algorithm, the grieving algorithm, which was public, you know, published on and like a way to do it, and they get work ahead to do. Um, but there wasn't a single student who had to be taught that this was valuable and that this was meaningful, and that families should not be invited to be there because the culture in our system had changed, right? Because the behavior that they've seen. And so it's interesting me. Like, I feel like I want that study to be done again. So, like, oh shot, if you're listening, you know, with your registry day, because that was that was published in 2021, but that was based on 2017, 2017 data. And a decade later, um, I think that there's a lot to learn around what are the practices people are seeing around family presence and resuscitation. Have we changed our training paradigm? Have people like advocating for this actually changed um the demographics of whether or not preparing our workforce? And the answer is I don't know, because I like live in my own little bubble. Um, and I know what things look like in Monroe, Livingston, in upstate New York, but I don't know what they look like in other places. Um, but I think to the to the educators out there, if you're not thinking about what people actually have to do as part of their job, um, then you really need to because there's so much, I think, I mean, I think about this in terms of also like there's so much trauma that people are going to be exposed to that if we don't teach them not just on how to excel within those situations, but then also kind of talk about the emotions that go along with it and their natural reactions to that. We're setting people up for failure and we are And potentially for more with for more burnout as well. For for for burnout. Um and and we're also not serving our patients. And and it's this um kind of like feed forward, it's not a balancing cycle, it's a feed, it's a vicious cycle, right? Because the vicious cycle is um we don't create compassionate care for our patients, we don't prepare people, they get more burned out. They people who are burned out give less compassionate care to patients. And so if you think about like our overall purpose as like the delivery of excellent, compassionate care to our communities, um like this is I think directly related to that in so many ways that are not that even are outside of this kind of microcosm of you know an individual patient case of a death notification.

SPEAKER_00 12:54

So um repeat the resources again that you were talking about in terms of the course and then the other podcast, the longer podcast you did.

SPEAKER_01 13:01

Yeah, so um with for I did it, it's with medic mindset, it's called death notification choreography. Um and Alex Sandra Jabber, I'm probably saying her wrong. Jaber.

SPEAKER_00 13:14

I I'm not sure, to be honest.

SPEAKER_01 13:15

J-A-B-R, and I'm terrible, and I'm gonna apologize. Um, I've really admired everything she's done, and she has an online course. Um, and I think she's become like the true national expert in education around this. Um, and there was also a paper published um out of North Carolina that talks about it, it was like the the one study of kind of the application of the grieving algorithm, which is what we ended up basing kind of the education that we do, because I think you have to give people a framework. They can adjust the framework, just like I can teach you the steps of doing an IV, and then you have like your little tweaks, right? That make it yours. Um, this is going to be the same way, but I think you have to give people like this fundamental roadmap of how to do the procedure.

SPEAKER_00 14:00

Excellent. Well, thank you for joining me. Um, this is, I believe, your second episode you've been.

SPEAKER_01 14:04

Might be.

SPEAKER_00 14:05

Or third. Third, third episode.

SPEAKER_01 14:07

I think.

SPEAKER_00 14:07

All right, you're a better now. Well, thank you, Mai, for taking time out um while here in Columbus to uh chat with me a little bit about this. It's a very important subject.

SPEAKER_01 14:15

All right, thank you for having me.

SPEAKER_00 14:16

Thank you for joining us as well. And as always, stay safe. Thank you for joining us for this episode. If you wouldn't mind, please click the like and subscribe buttons as well as the notifications so you can get notifications of upcoming episodes. Also, for the latest and greatest happenings of the National Registry, feel free to go to nramt.org. Thank you very much, and again, stay safe.