Which one of the following situations makes you feel the most uncomfortable?
1. Being the first arriving company on an occupied single-family dwelling fire.
2. Arriving on scene of an auto/pedestrian accident and finding a child has been struck by a car.
3. Talking with the family of a seriously ill or dying patient.
If we look at it from the "comfort zone", most responders will probably agree that talking with the family of a seriously ill or dying patient presents the greatest challenge. Do you agree? Think about your training programs. As fire and EMS responders, we invest a great deal of time learning how to handle structure fires and trauma emergencies. There are courses and classes that are specifically designed to prepare us for those emergencies. However, as (fire) company officers and fire service EMS first responders, we get very little training on communicating with families of the seriously ill and dying.
Statistically, as a society, America is getting older. It is estimated that well over 30% of today's EMS calls involve the elderly. This number is expected to grow as the post-World War II baby boomers age. Over the next 25 to 30 years, nearly one in five Americans will be at least 65 years of age. As these numbers grow, so does the life expectancy. As emergency responders, there is little doubt that much of our business will deal with an "older" crowd. These facts only reinforce the notion that we will be having more frequent on-scene discussions with family members. Are you ready?
Why do we, as fire service EMS providers, need to think or worry about this important communications aspect? Because we are the ones who are there, who are informed, who know what is going to happen on the scene, in the ambulance and to some degree, at the hospital. We experience these types of calls often (are 70 - 80% of your calls EMS?). The family member(s) may be experiencing this for the first time. Emotions are high and outcomes are unsure. You can make a difference by providing reassurance and displaying those professional qualities of compassion and confidence.
Today, many fire departments provide either EMS first responder service (ALS or BLS) to support a separate transporting agency or they provide both the first responding/co-responding companies and the transporting unit/ambulance. Either way, the number of responders on-scene is increased. It is our job, and for some a new concept, to provide a family liaison whose job is to keep the family informed of the events that are unfolding. This liaison serves a critical role in helping the family understand the extent of the illness, the imminent implications, the interventions being performed, and the expected actions that are to follow, i.e., CPR/defibrillation, need for airway support and/or intubation, medications, and transport considerations. Recent changes in the American Heart Association's Advanced Cardiac Life Support Course recognize the importance of informing and including the family during critically ill patient resuscitation. The idea of a family liaison is another role that the fire service needs to embrace as we provide more EMS services and our exposure to these types of calls increases.
You need to decide which member of the team will serve this role. This person does not need to be a paramedic or ALS provider. Many times, the ALS hands are needed for the critical skills being deployed. The person selected should have a good understanding of the EMS modalities including Do Not Resuscitate (DNR) and termination of efforts guidelines, a familiarity with the EMS system (what can and cannot be expected), a background sufficient to explain the procedures and answer questions regarding them, and probably as important as anything else, the ability to communicate effectively, with understanding and compassion (the "be nice" principle) and will represent the department properly.
Being the team member to serve this role is not an easy position. Not everyone is "cut-out" for the job. It is important for those of us who serve as company officers and squad leaders to cultivate members for this role. The benefits gained by properly assigning this role and utilizing the position will have a positive impact for the patient and family, as well as the EMS providers involved in a difficult emergency.
