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Death Notification Tips Minimize Trauma

DALLAS, TEXAS -- Making a death notification is never a pleasant task for any law enforcement officer or medical provider. There are, however, things that responders can do to help minimize the trauma on the person being notified and those making the notification.

Janice Harris Lord, a professional counselor and author on the subjects of death notification and coping with tragic deaths, spoke at the co-located EMS Expo and Enforcement Expo in Dallas on Tuesday. She offered tips and words of wisdom from her years of experience.

View more conference coverage at EMSWorld.com/expo.

"Often, the family will want to talk to you about the event because you as the EMT, or the law officer were the last one to be with their loved one at the time of death or just before," said Harris Lord, who lives in Arlington, Texas.

Harris Lord said compassion and honesty will go a long way to minimizing the trauma of the news being delivered. Very likely, the news will be the worst they've ever received in their lives, she said, which is why it's important to have the receiver be sitting down and comfortable with as many support people and advocates as possible.

"If they are sitting down, they'll be less likely to hurt themselves if they faint, and sometimes people do because of the emotional trauma," she said. It's also good for the person making the notification to be seated as well. The dynamic of two people sitting, eye to eye, makes the delivery and the receipt of the news better for all involved, she added.

Even the manner in which it is delivered is important, Harris Lord said. "Often, it's difficult for officers to get out of the jargon mode," she said. "They want to say things like 'vehicle one intersected with vehicle two.' It's much better to use, clear, simple language."

She offered an important caveat to the whole notification process, and that is to be absolutely certain you have the right person - that you know the victim is positively identified and that the right people are being notified. It's also important to communicate with all agencies to be clear who will be making the notification, whether it's the law enforcement agency, the medical provider, or the medical examiner's office.

She cited one instance where a medical examiner called an elderly father asking for dental records for his son before any notification of death had been made. The man suffered a fatal heart attack. "Then, the family had to deal with two funerals and two tragic deaths," she said.

When the notifying agency has been identified, it's best if two officers, or two providers go to the home, she said, noting that a personal visit is required.

"That's not something you can phone in," she said. "Especially not to the next of kin."

It's also never a good idea to bring personal belongings of the loved ones when making a death notification, she said. That can come later when the family has come to grips with the reality of the death. Many times, especially when there are crimes involved, personal belongings are part of evidence and can't be released until after the legal process has been completed.

People don't always understand that belongings are often damaged or destroyed during treatments, like rings that are cut off or clothing that's been hacked away for treatment, she said. There are times, also that items may have been covered in blood or bodily fluids, and the next of kin can't handle that when death notifications are being made. When it comes to notifying the right person, she added that it's never OK to notify a child of a death.

"Kids, even a teenager, shouldn't be the first to be notified," she said. "They are going through their own trauma and they shouldn't be then also required to pass along that information."

It's also a good idea to isolate the kids from the adults when notifications are being made, Harris Lord said. The reaction of the adult might be unpredictable and the children, who look up to and count on the adult for stability and guidance, won't know how to respond to a complete breakdown of the adult.

"They have a right to cry. They have a right to scream and carry on and you must let them," she said.

An exception to that rule comes into play when the individual starts to physically hurt themselves or others, or if their children need them to be strong, she said.

Those who do the notifying should never say things like "toughen up," or "you need to get through this," she said.

"They need to ventilate their feelings and you should be prepared to stay as long as they need," she said. "No one cries forever. No one screams forever." However, when there are children who need a parent, it's OK for the person making notification to say something empathetic and encouraging and asking them softly to gain composure for the sake of the children.

Those who make notifications should also be prepared to notify more than just the next of kin and be ready to help, or at least offer, to notify other significant people in the deceased person's life, such as a father who might be at work. It's also tricky on who should be notified first and when, especially when step-parents and divorced parents are involved. There are no right answers in that situation and common sense must prevail, she said.

Next of kin often want to know if their loved one suffered at the time of death, and Harris Lord said the best answer in all cases is to be as honest, but as tempered as possible. Officers and EMTs might say something about research shows that people who recover from near-death traumatic injuries remember no pain, suggesting the body insulates itself from pain.

"That's honest and that give them some hope," she said. Families also need to know what happens next after notification. They don't need to know about an investigation and a trial, or court dates, or anything else, and in many cases don't have the capacity to process all that information, she said.

"They just need to know what happens next, like the body will be taken to the medical examiner's office," she said.

There are times that families want to see photos of the accident or crime scene as a way to make the event real and to be certain that it was their loved one who really did die, Harris Lord said.

There are times when it is appropriate to do that with some guidance and support. She said the individual must have a support person available for the viewing of the photos.

"Never just sit a stack of photos in front of the person," she said, recommending that the least offensive photo, preferably black and white, be presented first in an envelope. The officer should describe what the photo shows, and let the support person see it first. That will give the family member the choice to see the photo or not based on the facial reaction of the support person and his or her guidance, she said.

Seeing photos, especially if the parent or loved one wasn't able to see the deceased in a funeral home, or any other time, provides some closure.

"Often people create this fantasy of what must have happened and often it's much worse than really happened," she said, noting that parents and family are often relieved to know the injuries and their loved one's appearance was not as bad as they thought or imagined. After the notification has been made, it's important for the people who made the notification to debrief for their own mental health, Harris Lord said. That's why it's a good idea to have two people make the notification so they have a shared experience that they can talk about and share.

Follow ups the next day, or in the future are always a good idea too, she said, adding that in criminal cases, follow up with the family is necessary.

Officers should have an understanding that news of a loved one's death can often disrupt short-term memory and cognitive thoughts, she said. Patience should be exercised when interviewing loved ones because even simple things can be difficult to remember when the individual is overwhelmed with the news.

"The day a person receives a death notification is probably going to be the worst day of their lives," Harris Lord said. "And they don't have to be strong for anybody...You need to be compassionate and be there for them and offer your help any way you can."

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