Preparing for Sudden Death: Social Work in the Emergency Room

Abstract

In the busy world of the hospital emergency room (ER), sudden death may occur at any time. Family and friends are often unprepared for this traumatic event, which causes extreme emotional distress. Medical and support staff can follow basic guidelines to alleviate anxiety. Although each case must be handled individually, ER staff can use basic protocols to reduce stress while providing compassionate counsel for the family. As the social worker on duty in the afternoon in a busy inner-city ER, my responsibilities range from filing child abuse forms to arranging psychiatric admissions. I often coordinate with doctors, nurses, clergy, and other appropriate staff to provide bereavement counseling for families whose relatives have died in the ER. The guidelines provided here are from the social work perspective but can be used by other health care professionals and staff. Providing for Family Privacy and Accessibility The first rule for social workers when dealing with ER work is to place the patient's family in a private area while sharing as much information about the patient as possible. Whether the patient is brought to the ER by ambulance and is suffering from respiratory arrest or whether the patient decompensates (becomes more acutely and seriously ill) after his or her own arrival, the family should be aware of the patient's medical situation, although this does not justify the presence of the family or any other nonmedical personnel in the treatment area. Ideally, clergy may offer direct support to the family while other staff--social worker, nurse, or other designee--provide information from the treatment area. In our hospital ER, the family can wait in privacy in a separate "quiet room." A phone is provided, tissues are available, and a window allows the family to watch for the arrival of others. This room provides a meeting place for the family and makes them easily accessible to ER staff. In an emergency medical situation, the doctor must have immediate access to any pertinent information that the family can provide. With this known location, the ER staff can easily find family members and receive and dispense information while keeping the family as comfortable as possible. Keeping the Family Informed A positive aspect of keeping family informed in an emergency medical situation is reducing the element of surprise. If the patient's family members are informed of the seriousness of the situation, they are better able to handle news of a death when resuscitation is unsuccessful. Use of denial as a defense mechanism is less prominent when family members are gradually prepared for the pronouncement of death. Even when the patient survives, anxiety is often reduced when family members are aware of the medical procedures being used. Using Understandable Terminology Choice of words is an important consideration when dealing with a patient's family. Excessive use of medical terminology may escalate anxiety as laypeople attempt to put meanings to unfamiliar words. Whereas a word such as intubated is very familiar to the physician, its meaning may be vague or misleading to a family member. Family members need to hear that "Mr. Smith has had a tube placed in his nose extending to his lungs. In this way, we are helping him to breathe by forcing air into his body." Then family can be informed of further treatment options depending on the patient's progress. For example, the patient may stabilize and breathe on his or her own, or the patient may decompensate and need to be placed on a ventilator. Family may also need to be informed about a "no-code" status, that is, when no extraordinary measures are taken to resuscitate the patient. All options should be stated in clear, understandable language, and further clarification should be provided as needed. In addition, family members need to be aware of the degree of severity of the patient's situation. Phrases such as "very serious" are preferable to "critical" or "grave" because exact meaning may be vague. …