- The death of a child in an emergency department (ED) has profound effects on physicians as well as surviving family members.
- The language used when telling parents their child is dead should be direct and nonjudgmental.
- The dead child should always be referred to by name.
- Most parents would like a memento of their child.
- A miscarriage in the ED should be considered the loss of a child.
Informing family members and friends of a loved one's death is a fact of life for the emergency physician. Such deaths are often sudden and unexpected, and survivors are confronted with the loss of a loved one with no prior psychological preparation. They usually receive the news from strangers in a potentially chaotic and intimidating environment, and are required to make heart-wrenching decisions in a brutally short period of time. The situation is particularly difficult when the dead patient is a child. The interaction between the emergency physician and the ED staff and the dead child's family can be an important first step in recovery, or can have long-lasting destructive effects.
The majority of emergency physicians feel that managing the death of a child is far more difficult than managing the death of an adult; some consider it the most difficult aspect of their job. Many feel guilty or inadequate after a failed pediatric resuscitation, even if they realize that the patient had no chance of survival. Many feel impaired for the remainder of their shift. Few have had any formal training in how to tell parents that their child is dead. There is no information on how this particular traumatic experience affects emergency physicians or other members of the ED staff in the long term.1
The immediate reaction of family members to the sudden loss of a child is disbelief, even though many say that they knew before being told that their child had died. On the part of parents, a sense of failure or guilt is probably universal. Many describe the experience in the ED as one that is replayed in their minds “like a tape,” thousands of times. They can often recall minute details of their experience and can remember verbatim exactly what they were told, and by whom. This is typical of how people process traumatic events.
One of the most common complaints of families whose loved one died in an ED is that they were not kept informed of the progress of events. Given the reality that the vast majority of pediatric patients who arrive pulseless and apneac will die in the ED, the process of dealing with the patient's death should be considered part of the resuscitation; the family is the patient. Parents should be placed in a private, quiet room, with adequate seating. A staff member is designated to communicate with the family; ideally this is an individual who is experienced in delivering bad news. There are some families ...