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Death notification is perhaps the most difficult, emotionally laden communication that physicians must perform. In 2006 alone, there were >119.2 million ED visits, and, of these, 249,000 resulted in patients who were dead on arrival or died in the ED.1 Fear of being blamed, difficulty dealing with families’ emotional reactions, and personal fears of death contribute to physician stress when performing a death notification.2 Delivering difficult news in the ED adds a unique set of challenges because the emergency physician has no prior relationship with the deceased individual’s family. A prolonged and difficult resuscitation may leave the emergency physician emotionally and physically drained, making the task of communication even more difficult.

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When an ED patient dies, the emergency physician acquires a new role and relationship with the family. Management of that relationship appropriately is particularly important for the surviving family. For survivors, the death notification is a life-altering event. Although death notification is stressful for the emergency physician, for the family, the words and phrases used in communication, the physical setting, and the characteristics of the individual delivering the news constitute memories for the family that are never forgotten.3 Skillful death notification is particularly important in the ED, where many of the deaths are sudden, untimely, premature, or violent. All of these characteristics are qualities that have been linked to complicated bereavement or post-traumatic stress disorder (PTSD) in survivors.4 As many as 21% of persons exposed to the news of sudden death met the Diagnostic and Statistical Manual of Mental Disorders, revised 3rd edition, criteria for lifetime prevalence of PTSD.5 There are data which demonstrate that properly performed death notifications may mitigate the impact of substantial negative effects on the surviving family members.6 For example, well-delivered death notification may reduce the incidence of PTSD in sudden death, particularly those involving the loss of a spouse or the death of a child.7 As emergency physicians, we must begin to think of death notification not as a difficult conclusion to an already difficult case but as an opportunity for prevention: reducing the incidence of secondary trauma to the family by the way in which they learn of a death.

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Well-delivered death notifications may also have a substantial effect on our own well-being as clinicians. Most ED physicians find death notification to be emotionally draining.8 Although the number of studies specifically focused on emergency physicians is limited, there is compelling evidence from the bereavement literature that is directly applicable to the practice of emergency medicine. Emergency physicians charged with informing families often have little knowledge of the family’s social or cultural value system, and lack an awareness of the family’s expectations about the death, or about their relationship to the deceased. Compounding the difficulty of this situation for the physician is the need to transition rapidly from the emotionally detached leader of a resuscitation team charged with saving a life to that of an empathic informant ...

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