With over 140 million Emergency Department visits in the US alone each year, about 15% of those are brought in via ambulance. Among those, the most common cases leading to patient death in the ED are cardiac, traffic accidents, cancer, and other traumas. [Data sourced and linked from CDC, JAMA, and NIH respectively.]
There’s no escaping that patient deaths occur in the ED, and it’s not uncommon for EMS to be present during a code. Trouble is, ED visits are at an all-time high and staffing is at an all-time low. Both ED staff and EMS are scrambling to the next job with little time to acknowledge death.
Alexandra Jabr writes for EMS World:
Disenfranchised and complicated grief has been linked to mental stressors, occupational burnout, and compassion fatigue in physicians, nurses, and, yes, even first responders… the persona and uniform we wear carry the weight of expectation. We are supposed to be more capable than the average person and expected to remain unscathed by the chaotic environments of 9-1-1 calls. (It’s Complicated: Grief and the First Responder, 2019)
While we’re used to rushing to the next job mechanically, we need to pause and process patient death, if only for a short time. Jonathan Bartels recognizes that and puts it to action. Bartels is a palliative care nurse liaison currently. He has over 30 years experience in healthcare including trauma/emergency care, post-op organ transplant, medical/surgical nursing, and oncology. He’s the 2018 recipient of the American Association of Critical Care Nurses Pioneering Spirit award.
In 2009, Bartels started implementing the Medical Pause. The Pause allows others to process events before moving on and just pushing it down. “As a nurse, I wanted to find a way to formally capture this moment and respectfully reintroduce an age-old practice of stopping and honoring after someone dies.” The Pause is now being used in many hospitals around the US and the world.
How to Pause
The theory of the Pause has been around for ages. Perhaps by giving it a name we begin to use it more and gain the benefits. Truthfully, it’s short and simple. After an attempted resuscitation and patient death, anyone can ask for a pause. Those uncomfortable are free to opt out. This should be optional. Families are even able to join as it shows respect for both the deceased and those remaining. Anyone can ask for a Pause and it looks like this:
“Could we take a moment just to Pause and honor this person in the bed. This was someone who was alive and now has passed away. They were someone who loved and was loved. They were someone’s friend and family member. In our own way and in silence let us stand and take a moment to honor both this person in the bed and all the valiant efforts that were made on their behalf.”
45 seconds to a minute of silence.
“Thank you everyone.”
Pausing in the Field
You may be wondering, “This is great for hospitals but we can’t possibly implement this in the field as first responders.” For EMS, they may well be present at the moment and able to join. The event doesn’t even have to take 45 seconds. Taking as little as 30, 20, or even 10 seconds may help give one closure to this patient death experience.
“A lot of times, EMTs will hang around while we work a code and they’ll be present when time-of-death is called.” – Emergency Department nurse
In truth, it can’t always be done in the moment in the ED either. Sometimes the pause needs to happen longer after a patient’s death, when the flow of the shift calms down or other protocols are completed. It’s important to invite back everyone involved if that’s the case.
Other ways first responders could use the principles of the Pause may be:
- While waiting for others to finish the scene, console the family and say, “I’m so sorry for your loss, I’d like to offer a short moment of silence for your loved one.”
- While driving to the next call, ask your partner, “Hey, can we pause for a moment for that patient death?” (Doesn’t matter if you’re already silent; now your silence has purpose.)
- Back at the base or station or breakroom, ask for a pause for the loss of a life that just occurred that moment, hour, or day.
Pause to Process
It may seem small and meaningless to some, but the short acknowledgement of a patient death is a milestone toward processing the trauma and stress the job puts on first responders every day. Over time, that stress builds and compounds. Processing sooner rather than later will not only help with coping but will build resiliency for the future. You might even consider pausing after a trauma or particularly stressful call.
Talk about the Pause. Offer a Pause. Make Pausing normal practice starting now. Check out thepause.me for more information.