Breaking Bad News in the Prehospital Setting

There are roughly 1000 prehospital cardiac arrests in the US daily with a mortality rate approaching 90%1. In 2011 and the national association of EMS physicians position statement supporting prehospital termination of cardiac arrest has led to an increase in the number of patients dying in the prehospital environment. EMS clinicians responding to these emergencies are often tasked with breaking bad news (BBN) to families that their loved one has died. Currently no national curriculum, standardized training or mandated education around this subject exists for EMS clinicians. Recent research suggests that EMS clinicians are breaking bad news with frequency, are not receiving training on how to break bad news, are motivated to receive additional training around this subject and are suffering negative sequalae directly related to these conversations. Current existing curriculums around breaking bad news are designed for in hospital and clinic-based settings and are not wholly applicable to the dynamic prehospital environment. The following paper is a guide created by clinicians with EMS, palliative care, pediatric palliative care, and emergency medicine backgrounds to better help EMS clinicians navigate these difficult conversations. This guide is a step wise approach including dos and don’ts to help them navigate these challenging conversations as well as to help them navigate special circumstances such as topics around anger and pediatric patients. Currently no such guide exists, and it is the authors hope that this guide will be utilized to help EMS clinicians successfully engage in these conversations as well as help to inspire future research and education around this topic.