Why EMS Providers Need More Death Notification Training

“I’m sorry, but your daughter is dead.” The thought of having to deliver this kind of news to someone even once is heartbreaking. Now imagine having to deliver that news multiple times a day to someone’s best friend, spouse, sibling, parent, or child. For many EMS clinicians, this was a daily reality during the height of the COVID-19 pandemic.

In the ESO EMS Index 2022, we assessed the number of instances in which an EMS provider likely faced the difficult task of providing death notification before COVID versus during COVID. We recognize that there has been an increase in out-of-hospital deaths, during the COVID period, both directly due to COVID disease and indirectly due to other causes, including drug overdose. The measure highlights the increase in the number of patients in whom resuscitation was not attempted, or resuscitation efforts were interrupted on the spot. This substantial increase in on-scene deaths during COVID means that EMS clinicians likely issued 47% more death notifications compared to the pre-COVID period.

The increase is staggering and the burden has not been evenly distributed as the areas hardest hit by COVID have seen a much larger increase in deaths.

The impact on EMS burnout

The medical community has observed a correlation between COVID rates and out-of-hospital cardiac arrests. In the graph we see the difference in EMS encounters with a patient where no resuscitation was attempted, or resuscitation was attempted but the patient was pronounced dead at the scene and not transported to hospital in the pre-COVID period (June 1, 2018 – March 15, 2020) vs during COVID (March 16, 2020 – December 31, 2021). This demonstrates a significant increase in the number of encounters where an EMS clinician likely should have issued an on-site death notification.

Notifying a family of the death of a loved one can be a difficult and stressful task for providers, especially EMS clinicians who may have to issue a death notification on the spot for what is often a sudden and unexpected death. Providing on-site death notices has been independently associated with EMS clinician burnout, particularly when the EMS clinician has not received formal training.

We don’t talk enough about the obituary


Unfortunately, EMS clinicians typically receive little or no training on how to issue death notices, although they are likely to find themselves in a situation where a death notice will be required. Even a little training can help EMS clinicians feel better prepared to handle a death notification. A study showed that a 90-minute training session consisting of a lecture, breakout sessions, and role-playing helped EMS providers increase their confidence and skill in issuing death notifications. Meanwhile, avoiding this type of training can not only be harmful to EMS clinicians, but can also worsen the healing process for survivors.

Although death notification is linked to EMS clinician burnout, research also shows that death notification training, especially when integrated with ongoing EMS training, reduces the risk of burnout. professional EMS clinicians. By providing death notification training, agencies can play a vital role in helping EMS clinicians reduce burnout and gain the knowledge and skills to confidently perform their role.

EMS Clinician Support

  • Invest in training and ongoing education on issuing obituaries specific to EMS professionals. Sending obituaries is linked to EMS clinician burnout, but appropriate ongoing training can help mitigate this effect.
  • Ensure that all levels of EMS clinicians receive training on obituary reporting.
  • Track the number of obituaries that EMS clinicians have given. Ensure that EMS clinicians have access to resources and support to help them manage the emotional toll of delivering death notifications.
  • Foster a culture of support within your agency and actively work to eliminate the stigma that seeking mental health help is a sign of weakness. Offer evidence-based counseling resources tailored to EMS and encourage providers to seek help when needed.

While we may be witnessing the end of the COVID pandemic, the effects will linger for some time to come. First responders are still affected – especially based on the evidence above. Track the data and provide the support needed to keep EMS clinicians healthy and safe.


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Richard V. Johnson