A child who presents to the ED in cardiopulmonary arrest or after a life-threatening illness or injury may or may not be accompanied by their parents. The ED staff should anticipate the arrival of the patient and the parents (who may arrive separately). Upon arrival, the parents are likely going to be anxious and distressed and should be met by someone who is comforting. In the situation when the parents arrive first they should be greeted and placed in a private, quiet room, with adequate seating and lighting, tissues, and access to a phone for local and long distance calls. A staff member should be designated to communicate with the parents. Ideally this is an individual who can provide emotional support for the family and is trained in delivering bad news. This could be a nurse but more likely would be a social worker or chaplain. In addition, there may be other young children to consider if the parent is alone initially. It may be necessary to provide someone, such as child life specialist, to entertain siblings.
A member of the healthcare team should explain the scenario; preparing them for how many people might be there, what their child may look like, and how the process works. The parents should be told of the resuscitation as soon as possible and interviewed including details about the child's medical, family and social history, and about the events leading up to their child's demise. At some point it is important for the ED physician to speak with the family to get information and update the parents on the child's status.
If the resuscitation is unsuccessful, it is the responsibility of the ED physician to tell the parents that the child has died. In a private setting, the physician should be sitting facing the parents making eye contact. Using a calm voice, the parents should be informed in a direct manner that everything was done to save their child but that he or she has died. It is important to use as little medical terminology as possible for fear they will not understand. Instead of using phrases such as “passed,” “gone to a better place,” or “gone,” the physician needs to be clear and direct with the parents. If an interpreter is used then they should stand behind the physician, so that the physician eye contact can be maintained with the parent. The initial reaction will be one of shock and disbelief. Parents should be given ample time for grieving and questions.
One study12,13 interviewed parents of those who had experienced the sudden death of a child. They found five themes related to how the parents processed death: (1) the need to reconstruct the death scene of the child; (2) feeling of a loss of control and shattering of the world parents knew before the death; (3) the need to say goodbye; (4) the attempt to make sense out of the death and find meaning in it; and (5) attempts to carry forward a new relationship with their deceased child in their lives. The types of interventions parents found helpful following the death of their child included providing assistance, providing information, and displaying compassion and empathy. A study by Lehman et al.14 found that the most common helpful support was contact with others, the opportunity to ventilate, expression of concern, and presence (“being there”). The most common unhelpful support was giving advice, encouraging recovery, rude remarks or behavior, minimization or forced cheerfulness, and identification of feelings (“I know how you feel”). A survey study by Leash15 asked participants to rank the relative importance of four key elements in the death notification process—where, how, and when they were told of the death and who told them. How they were told was considered the overall most important variable, followed by when they were told and where they were told. The least important variable was who told them of the death.