This study sought to investigate how prepared emergency care providers are to deal with death, dying and bereavement in the pre-hospital setting in Dubai, and to make recommendations related to such events.
A quantitative descriptive prospective design was utilised. Data was collected using an online self-report questionnaire sent to all operational emergency care providers in the Dubai Corporation of Ambulance Services. The data was analysed using the IBM Statistical Package for Social Sciences version 25.0.
Nearly 65% of participants (n=316) reported that they had not received any formal education or training on death, dying and bereavement. Those that did, reported that the training was conducted mainly by nursing (25.9%; n=124) and paramedic (13.6%; n=65) instructors. One-quarter of participants (25.4%; n=126) reported experiencing intrusive symptoms such as sleep loss, nightmares and missing work as a result of a work-related death or dying incident, but only 4.1% (n=20) had received professional counselling.
This study found that emergency care providers are underprepared to deal with death, dying and bereavement. A comprehensive death education program encompassing the unique challenges that emergency and pre-hospital setting presents should be implemented to reduce emotional anxiety and help emergency care providers cope better with death, and decrease abnormal grief reactions of the bereft. Abnormal grief reactions can include restlessness, searching for the lost person and disrupted autonomic nervous system functions.
Whiting EA, Costello S, Williams B. Measuring trauma symptoms in paramedicine. Australasian Journal of Paramedicine 2019;16.
Lee JY, Kim SW, Kim JM. The impact of community disaster trauma: a focus on emerging research of PTSD and other mental health outcomes. Chonnam Med J 2020;56:99.
Naushad VA, Bierens JJ, Nishan KP, et al. A systematic review of the impact of disaster on the mental health of medical responders. Prehosp Disaster Med 2019;34:632-43.
Smith-Cumberland TL, Feldman RH. Survey of EMTs' attitudes towards death. ibid. 2005;20:184-8.
Myall M, Rowsell A, Lund S, et al. Death and dying in prehospital care: what are the experiences and issues for prehospital practitioners, families and bystanders? A scoping review. BMJ Open 2020;10:e036925.
Lewis-Schroeder NF, Kieran K, Murphy BL, et al. Conceptualization, assessment, and treatment of traumatic stress in first responders: a review of critical issues. Harv Rev Psychiatry 2018;26:216.
Van der Ploeg E, Kleber RJ. Acute and chronic job stressors among ambulance personnel: predictors of health symptoms. Occup Environ Med 2003;60(Suppl 1):i40-6.
Pagidipati NJ, Gaziano TA. Estimating deaths from cardiovascular disease: a review of global methodologies of mortality measurement. Circulation 2013;127:749-56.
Ralapanawa U, Sivakanesan R. Epidemiology and the magnitude of coronary artery disease and acute coronary syndrome: a narrative review. J Epidemiol Glob Health 2021;11:169-77.
Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ, editors. Global burden of disease and risk factors. The World Bank; 2006. Available at: www.ncbi.nlm.nih.gov/books/NBK11812/
Batley NJ, Bakhti R, Chami A, et al. The effect of patient death on medical students in the emergency department. BMC Med Educ 2017;17:1-8.
Edlich RF, Kübler-Ross E. On death and dying in the emergency department. J Emerg Med 1992;10:225-9.
Schmidt TA, Norton RL, Tolle SW. Sudden death in the ED: educating residents to compassionately inform families. ibid. 1992;10:643-7.
Olsen JC, Buenefe ML, Falco WD. Death in the emergency department. Ann Emerg Med 1998;31:758-65.
Ordog GJ. Dealing with sudden death of the emergency patient. Can Fam Physician 1986;32:797.
Brady M. Death anxiety among emergency care workers. Emerg Nurse 2015;23.
Donnelly E, Siebert D. Occupational risk factors in the emergency medical services. Prehosp Disaster Med 2009;24:422-9.
Heiner JD, Trabulsy ME. Coping with the death of a patient in the emergency department. Ann Emerg Med 2011;58:295-8.
Meagher DK, Balk DE, editors. Handbook of thanatology: the essential body of knowledge for the study of death, dying, and bereavement. Routledge; 2013.
Nazeha N, Ong ME, Limkakeng Jr AT, et al. A hypothetical implementation of ‘termination of resuscitation’ protocol for out-of-hospital cardiac arrest. Resuscitation Plus 2021;6:100092.
Lloyd-Jones D, Adams RJ, Brown TM, et al. Heart disease and stroke statistics - 2010 update: a report from the American Heart Association. Circulation 2010;121:e46-215.
Akgün HS, Bilgin N, Tokalak I, Kut A, Haberal M. Organ donation: a cross-sectional survey of the knowledge and personal views of Turkish health care professionals. Transplant Proc 2003;35:1273-5.
Regehr C. Bringing the trauma home: spouses of paramedics. J Loss Trauma 2005;10:97-114.
Kastenbaum R. Death, society, and human experiences. Death Stud 2009;21:100.
Corr CA, Corr DM, Doka KJ. Death & dying, life & living. Cengage, 8th edn, 2019.
Phelps S, Lehman J. West’s Encyclopedia of American Law (Vol 2). Toronto Public Library.
Niemiec RM, Schulenberg SE. Understanding death attitudes: the integration of movies, positive psychology, and meaning management. Death Stud 2011;35:387-407.
Neimeyer RA, Wittkowski J, Moser RP. Psychological research on death attitudes: An overview and evaluation. Ibid. 2004;28:309-40.
Doka KJ. Counseling individuals with life threatening illness. Springer Publishing Company; 2009.
Tomer A, Eliason GT, Wong PT, editors. Existential and spiritual issues in death attitudes. Psychology Press; 2007.
Wong PT, Tomer A. Beyond terror and denial: the positive psychology of death acceptance. 2011. Available at: www.drpaulwong.com/documents/wong-PP-of-death-acceptance-death-studies2011.pdf
Yalom ID. Staring at the sun: overcoming the terror of death. The Humanistic Psychologist 2008;36:283-97.
Smith TL, Walz BJ. Death education in paramedic programs: a nationwide assessment. Death Stud 1995;19:257-67.
Roos S. Chronic sorrow: a living loss. Psychology Press; 2002.
Papadatou PD. In the face of death: professionals who care for the dying and the bereaved. Springer Publishing Company; 2009.
Adamowski K, Dickinson G, Weitzman B, Roessler C, Carter-Snell C. Sudden unexpected death in the emergency department: caring for the survivors. CMAJ 1993;149:1445.
Marmar CR, Weiss DS, Metzler TJ, et al. Longitudinal course and predictors of continuing distress following critical incident exposure in emergency services personnel. J Nerv Ment Dis 1999;187:15-22.
Iserson KV. The gravest words: sudden-death notifications and emergency care. Ann Emerg Med 2000;36:75-7.
Purves Y, Edwards S. Initial needs of bereaved relatives following sudden and unexpected death. Emerg Nurse 2005;13.
Smith-Cumberland T. The evaluation of two death education programs for emts using the theory of planned behavior. Death Stud 2006;30:637-47.
Ponce A, Swor R, Quest TE, et al. Death notification training for prehospital providers: a pilot study. Prehosp Emerg Care 2010;14:537-42.
Douglas L, Cheskes S, Feldman M, Ratnapalan S. Death notification education for paramedics: past, present and future directions. Journal of Paramedic Practice 2013;5:152-9.
Abdel-Khalek A, Neimeyer RA. Death anxiety scale. Encyclopedia of personality and individual differences. New York: Springer International Publishing. 2017, pp. 1-4.
Dadfar M, Abdel-Khalek AM, Lester D, AtefVahid MK. The psychometric parameters of the Farsi form of the Arabic scale of death anxiety. The Scientific World Journal 2017;2017:7468217.
Claxton-Oldfield S, Crain M, Claxton-Oldfield J. Death anxiety and death competency: the impact of a palliative care volunteer training program. Am J Hosp Palliat Care 2007;23:464-8.
Andershed B. Relatives in end‐of‐life care. Part 1: a systematic review of the literature the five last years, January 1999–February 2004. J Clin Nurs 2006;15:1158-69.
Haughey M. Delivering news. Ann Emerg Med 2000;36:68-9.
Roe E. Practical strategies for death notification in the emergency department. J Emerg Nurs 2012;38:130-4.
Critchell CD, Marik PE. Should family members be present during cardiopulmonary resuscitation? A review of the literature. Am J Hosp Palliat Care 2007;24:311-7.
Hobgood C, Mathew D, Woodyard DJ, Shofer FS, Brice JH. Death in the field: teaching paramedics to deliver effective death notifications using the educational intervention “grieving”. Prehosp Emerg Care 2013;17:501-10.
Wass H. A perspective on the current state of death education. Death Stud 2004;28:289-308.
Powar A. Death education in nursing and medical curricula: an integrative literature review. (Doctoral dissertation, University of British Columbia). Available at: https://open.library.ubc.ca/soa/cIRcle/collections/ubctheses/24/items/1.0135667
Barton D. The need for including instruction on death and dying in the medical curriculum. Acad Med 1972;47:169-75.
Jacques AP, Adkins EJ, Knepel S, et al. Educating the delivery of bad news in medicine: preceptorship versus simulation. Int J Crit Illn Inj Sci 2011;1:121.
Sanders MJ, Lewis LM, Quick GMosby's paramedic textbook. Jones & Bartlett Publishers; 2012.
Caroline NL. Emergency care in the streets. Jones & Bartlett Learning; 2013.
Elhart MA, Dotson J, Smart D. Psychological debriefing of hospital emergency personnel: review of critical incident stress debriefing. International Journal of Nursing Student Scholarship 2019;6.
Kusel M. The impact of critical incident stress debriefing on coping in emergency health care providers: a rapid review. (Doctoral dissertation, North-West University South Africa, Potchefstroom Campus). Available at: www.semanticscholar.org/paper/The-impact-of-Critical-Incident-Stress-Debriefing-%3A-Kusel/35a5febe496caafde9e3b8ec19b7ad8690223ee9
Baile WF, Buckman R, Lenzi R, et al. SPIKES-a six‐step protocol for delivering bad news: application to the patient with cancer. The Oncologist 2000;5:302-11.
Makoul G. Essential elements of communication in medical encounters: the Kalamazoo consensus statement. Acad Med 2001;76:390-3.
Galbraith A, Harder N, Macomber CA, Roe E, Roethlisberger KS. Design and implementation of an interprofessional death notification simulation. Clin Simul Nurs 2014;10:e95-102.
Traynor M, Gallagher A, Martin L, Smyth S. From novice to expert: using simulators to enhance practical skill. Br J Nurs 2010;19:1422-6.