How to cope with peds deaths

[u/[deleted]]

I worked my first peds arrest yesterday. He was under a year old. I can hear his family’s screams echoing in my head and see the defeat in my team when we called it. I know it’s part of the job we do, but it sucks and I know they don’t get easier. Does anyone have any advice or coping skills to offer? I could use it.

[u/Consistent-Fox2523]

Hi. PEM physician here. Even if you do everything right they still hurt like hell, and you are correct, it doesn’t get easier.

Here are some things that help us process it in our department:

1) “The pause”. I think it’s fairly common practice at this point, we recently started doing it and it has been life changing for everyone. After declaring time of death, i ask the parents if we could say a few words for their child. I keep everyone in the room, including parents, people who helped resuscitate, EMTs and police who may have brought the kid to you.

Here’s how ours goes:

"Everyone let's pause as a team"

"Before we leave the care of this patient let's take a moment to stop as a team and honor the person we have been caring for. (name of patient) was loved and gave love and is important to others. Lets take a moment to recognize that and honor (Name of Patient) with a moment of silence" 30-45 seconds of silence

"Thank You"

"Know that as individuals and as a team we put froth our best effort to give (Name of patient) his/her/their best chance. Move forward in your day knowing that you were (Name of patient's best chance and that everyone here did their best. Thank you for everything that you do, today and every day"

Usually, everyone in the room cries and i have found that parents respond very well to it. It’s actually printed on our badges so that we dont go looking for it, and there’s a few on our crash carts.

2) warm debrief with nurses/docs/pcts. It helps to talk about what we could have done better, but vital that no one goes around blaming people. It’s ok to talk about these because you know everyone will go home and play it over and over again im their heads. I do it after i’m done with all the death documentation which takes a few hours, then page the entire ED to let them know that there will be a brief happening in a quiet room.

3) cold debriefs. We host these every month through palliative care, people can join voluntarily. Obviously, if you don’t see multiple pediatric deaths every week they can also be in an as needed basis, but it really helps.

4) go home and watch netflix until your brain gets really numb and you don’t hear the screams anymore. Crying is ok too.

[u/sourpatchdispatch → u/Consistent-Fox2523]

I've been wondering about this a lot lately. I'm a newer EMT, but I got into this career later in life after working retail and then sales through my twenties. A few years ago, around age 30, I decided to change careers and finish school, and I got my EMT-B and have been working in dispatch and as an EMT for over a year now. I've worked a few codes, all were called in the field or the ED. No pediatrics yet but I work in an urban setting, and my first due area covers the poorest parts of our city and we get a decent number of peds respiratory and cardiac arrests, especially at night when I work. So I'm expecting to have one eventually.

So far, I've been a little surprised that I haven't had too many negative emotions about all the grief and death I've seen so far. I sometimes wonder if there's something wrong with me if I'm not having nightmares or feeling haunted by dead pt's faces or family's screams. It's not that I'm not sad that these things happen and I feel bad for the pt and their loved ones but I also know I did all I could to help and it was out of my hands at that point. I'm generally just happy when I can show up and do anything to help and give the pt a chance, even if we are ultimately unsuccessful in resuscitation efforts. (I have more thoughts and feelings on this but I'm having a hard time articulating them so I'll make this on the shorter side.) I might take a minute or 2 to think about the patient as an actual person and grieving for them and their family but then I do try to just take a deep breath and move on to the next call. I feel like if I dwell too much on it, or if I had a "pause" like this, I would probably feel some deeper, stronger emotions, and likely cry and then the experience would somehow be harder to move past; basically, it would be more traumatic to me? But, it could also be that I think what I'm doing now is working for me, but it isn't and will lead to burnout some day. I am certainly not trying to discount the experiences and wisdom of my more senior peers.

I experienced a lot of mental health issues and substance abuse issues in my twenties and went through tons of therapy to recover, and I do feel that has been a benefit for me in this field. I've seen a lot of death from being in that lifestyle and experienced a lot of grief around me. But through therapy, I've developed a lot of healthy coping skills, and better ways of managing emotions and thoughts. And I now have a very solid understanding of the things in this life that I can control and the things that I can't. I was starting to think maybe that is why I haven't had a difficult time with this aspect of our jobs but I'm really not sure and I don't want to wait til I'm burned out to be sure.

[u/Consistent-Fox2523 → u/sourpatchdispatch]

You make a good point. These conversations and debriefs are always voluntary. it’s for people who need to talk it out. It’s ok if you’re not that kind of person. I find that the ones most affected by these deaths are people with children who are around similar ages, so your feelings may change someday, just knowing something like this is in practice may help if you ever need to talk it out.