When someone works as an emergency first responder for long enough, they’re going to encounter a person who is dying. While these sorts of calls aren’t necessarily common (though it varies from place to place, of course), they can naturally be jarring for emergency medical technicians and paramedics when they occur. They can be even worse when the dying person is surrounded by family members who are grieving, panicking, or both. Suddenly the EMT or paramedic is thrust into one of the most intimate, emotionally charged family situations imaginable — an interloper powerless to stop what’s coming.
In a recent paper in The Journal of Pain and Symptom Management, a team led by Dr. Deborah Waldrop, a social-work researcher at the University at Buffalo, sheds some fascinating light on these situations. Waldrop interviewed 43 paramedics and EMTs before and after their shifts to ask them about their experiences with dying patients (paramedics are just EMTs with more advanced training — I’ll use “EMTs” for short in this post), and she found that these encounters are — not surprisingly — rife with emotional intensity, and sometimes tension.
As one EMT told Waldrop, “People romanticize the notion of us swooping in, scooping up and flying to the hospital.” This misunderstanding — people often aren’t fully aware of the limits of emergency care, especially in dire medical situations — is compounded by natural human reactions to the prospect of a loved one dying: The authors write that “Participants described emotional desperation that can accompany imminent death as the demand for providers to ‘do something,’” even when they can’t quite articulate what that “something” is, and even when there isn’t really anything to be done.
A loved one dying is never going to go “smoothly,” of course, but a lot can go wrong, Waldrop’s respondents told her, above and beyond the inherent difficulty of the situation:
Sometimes a dying patient is unconscious and their family tells the EMTs who have arrived that the patient has a do-not-resuscitate order, but can’t produce the documentation. In this case, EMTs “are legally bound to start resuscitation even if a family states that the person does not want it,” which is obviously an uncomfortable situation for all involved.
Sometimes there is a DNR on file, but the family wants the EMTs to resuscitate anyway. Facing the imminent death of a loved one, people panic and ask EMTs to disregard the dying person’s wishes.
Sometimes a patient’s family members want them taken to the hospital, but the patient him- or herself doesn’t want to go. An awkward situation for the EMTs, but not a difficult decision, since there’s a word for loading a conscious, alert person into an ambulance and taking them to a hospital against their wishes: kidnapping.
Sometimes EMTs end up focusing more on the dying patient’s family than the patient him- or herself, given the scary and unfamiliar situation they find themselves in. “I spend more time at the end of life working with the family than with the patient,” said one respondent. “I explain to them what we can and can’t do. The family doesn’t know, they’ve never had Mom die before.”
In a perfect world, of course, Americans would be better at end-of-life care and fewer ambulances would be called for people who are not dying unexpectedly. At the moment, though, EMTs are taking on some of the burdens imposed by a system that isn’t quite working right.