Paramedics are trained to treat burned flesh, staunch profuse bleeding from raw wounds and restart damaged hearts.
But until the British Columbia Ambulance Service developed a new course that is thought to be the first of its kind in North America, they were never really taught how to deal with the toughest job of all – telling people that someone they loved had just died.
"This is something you have to do when there is nothing left to do," Colin Fitzpatrick, an ambulance service training officer, said of the moment that faces paramedics when a patient has become a fatality.
The death notification program uses scenarios taken from real life to help paramedics understand the right and wrong ways to say the words no one ever wants to say, Mr. Fitzpatrick said.
The program was launched in September, and about 60 per cent of the paramedics in B.C. have taken it so far.
"What makes this program vastly different is that it's experiential in nature. We take the paramedics and put them … through role playing exercises with each other … so they have a chance to actually practice these skills," he said. "The impact on the students is amazing to watch."
Marilyn Oberg, who works from a busy ambulance station near Vancouver General Hospital, has been a paramedic for 25 years, but it wasn't until she took the course that she openly spoke with colleagues about the experience of delivering death notifications.
"The most powerful thing in it for me was that in a safe situation, where you are not faced with a catastrophe in front of you, there was an open dialogue between the paramedics, young and old," she said. "The most important thing … was the intergenerational thing of us sitting together … sharing common fears, common experiences and … being honest with each other rather than saying 'Ah, no it didn't bother me,' you know, because it does bother you, it totally bothers you. You know the stuff we see, it's not normal."
Ms. Oberg described delivering a death notification as an emotionally searing moment.
"You know, the look in their eyes … it is as raw as it gets," the paramedic unit chief said. "There are times when you walk out of the call and you are empty. You are just like a deflated balloon, because the family has lost a baby, lost a mom, you know harm has been caused to somebody, like somebody has been murdered. It is just brutal. Because they search you. The family searches your eyes."
Ms. Oberg said when she started as a paramedic, there was no instruction on how to do this.
"It was never covered in any of the training that anybody went through, and basically you were faced with these terrible situations," she said. "There was really no guidance other than mentorship and the experience of just going into hot scenes and trying to be as effective and professional and caring as you could [be]. Sometimes you were just flying by the seat of your pants."
Ms. Oberg said a paramedic who has been fighting to save someone's life, in a ditch beside a wrecked car, or in an alley behind a burning building, is pumped full of adrenalin and is focused on the immediate medical issues.
But when the patient suddenly dies, the paramedic has to stand up, turn and deal with the family or friends at the scene.
"You have to slow down … it takes … a lot to be able to stand still. Your mind may be running a million miles an hour but you have to have the courage to stand still and face what's in front of you," she said.
Lloyd Grahame, a retired Ontario police officer and a consultant for MADD, helped develop the death notification course for B.C. Ambulance, drawing on his 30 years of experience.
"I've had the opportunity to talk to a lot of people since being involved in this training, and I found that a lot of the things I believed about notification … aren't necessarily the best things to do. The things we say. The cliché about 'time heals all wounds,' and 'I know what you're feeling,' 'I know what you're going through.' None of these mean what we want them to mean … people hear them differently and they don't help," he said.
Mr. Grahame, who still remembers how he was trained on the job to "just go in and do it and get out," said he tells paramedics to use direct, final words when they are telling someone about a death.
"I don't think people want to accept the fact that a loved one has died," he said. "If you say someone is passed, or gone, or didn't make it … I think people subconsciously want to shut out the fact they have died. It delays the process. To avoid this misunderstanding, we need to use the words 'dead,' or 'died,' or 'has been killed.' And we need to do it in a sensitive way. In a soft-spoken way, use the words. But use them."
Mr. Grahame advises paramedics to not talk too much, but to keep the message simple and wait for questions, which sometimes will come in statements of denial or confusion.
"People do the stereotypical things. They cry. They become hysterical. They lash out verbally and physically sometimes," he said. "That can be all over the map. I talked to someone who was at a death notification scene and they had to tell a husband that his wife had died in a car crash. When they told him he said, 'Well, that can't be, because tonight's our bowling night. She can't be dead.' Some things don't seem rational to us …but if people ask a question, you have to try to give an answer. … Often it is how did it happen? Where did it happen? Are you sure it's them? How do you know it's them? Maybe it's somebody else who had their identification. Maybe a mistake was made. They need confirmation," he said.
Asked if any experiences stuck with him from his long career, Mr. Grahame is quick to respond: "It was a young woman who had died as a result of a car crash and she was in her 20s. She lost control of the car and slammed into a tree and a big cement gate and we had to go and tell her husband …they had only been married for a few months, a period of weeks. …That was a pretty heavy-duty thing to see what that young man went through with the loss of his love," he said.
"What makes this difficult for us, as police or paramedics, is the fact that we can all identify with the pain of losing a loved one because it happens to us all," he said. "I can tell you from a personal perspective, when I got the call that my father was dead, I'll remember that. It was at 7:21 in the morning. I was in Toronto on a case and I got a call from my wife at the time. She said your dad has been taken to hospital, he had a massive heart attack and he's dead … you have to get home. That will stay with me for the rest of my life." Mr. Grahame said he tells paramedics that when they deliver traumatic news of someone's death, they will become fixed in the memory of those hearing it.
"From that point on, you are now part of that family's history and they will tell the story over and over again to family and friends and you'll be part of it. Like I say, if you get it right, they'll never forget you. If you get it wrong, they'll never forgive you."