Table of Contents

BACK TO GRAVE WORDS

INTRODUCTION: The Problem
1: The Problem
Why Sudden, Unexpected Death Notification Is Unique
Expected versus Sudden, Unexpected Deaths
Why Use Protocols?

SECTION 1: Notifications
2: Communicating With The Living
Para-verbal and Verbal Communication
Non-verbal Communication
Working through Interpreters
Dealing with Anger
Using Humor

3: A Protocol For Sudden-Death Notification
Deliver the News Quickly
Use the "D" Word
The Final Steps
Cultural Differences
Implementing the Protocol

4: "Helping" Phrases: The Good, The Bad, and The Ugly

5: Telephone Notification
What to Say
Telephone Notification Protocol
Local Calls
Long-distance Notification

6: Survivor Information Forms

7: Requesting Organ & Tissue Donations & Autopsy Permission
Organ or Tissue Donations
Autopsy Permission

8: Viewing The Body
Viewing Procedures
Children: Bodies and Viewings
Viewing Photographs

9: Follow Up With Survivors

10: Acute Grief Reactions
Losing Someone Very Close
Unfinished Business
Medication for Acute Grief Reactions
Relationships after a Death
Crisis Characteristics
Patterns of Grief
Complicated Grief: Psychosis, Guilt, and Hostility
Aspects of Grief
Helping Survivors Deal with their Grief

11: Support Groups
National Support Group Organizations

SECTION 2: The Survivors
12: Telling Parents
Sudden Infant Death Syndrome (SIDS)
Child Abuse Deaths
Death in Childhood
Parental Grief
The Memory Box

13: Telling Children
Children's General Reactions to Death
Children's Normal Responses to Death
Basic Principles for Dealing with Children following a Death
Protocol for Delivering News of Sudden, Unexpected Death to Children
Saving a Parent in Memory

14: Notifying Friends, Lovers Co-Workers, and Students
Ripples of Notification
Notifying Friends
Notifying Lovers
Notifying Co-workers
Student Deaths

15: Notifying Other Incident Survivors

SECTION 3: The Notifiers
16: Physicians
Medical Errors
Notification about Deaths due to Medical Errors

17: Emergency Departments, Critical Care, and Trauma
The "Family Room"
Viewing Resuscitations
Barriers to Effective ED Notifications
Notifying Survivors in the ED
The Stress of Notifications
The Nurse's, Resident's, and Student's Roles

18: Obstetrics
Miscarriages (Spontaneous Abortions)
Intrauterine Deaths and Stillbirths
Protocol for Obstetric Deaths

19: Police
Unusual Situations

20: In Prisons

21: Medical Examiners and Coroners

22: Nurses

23: Chaplains and Clergy
The Chaplain's Role
Religious and Cultural Beliefs

24: Medics, Firefighters, and Search and Rescue
Prehospital Advance Directives
Death Pronouncements
The EMS Demeanor
Resuscitations in Progress

25: Military
Brief History of Military Death Notification
Current Notification Procedures
Military Notifications-Survivors' Reactions

26: Disasters: Survivors and Workers
Airline Crashes
Helping Disaster Survivors
"Handling" Disasters: Critical Incident Stress Debriefing (CISD)

SECTION 4: Important Information
27: Survivors' Questions/Some Answers
Are you sure s/he's dead?/it's him/her?/there's nothing you can do?
How did s/he die? (medical, legal, circumstances)
Did you, the staff, the medics do everything that they could?
Why did s/he die?
What could I have done differently? "If only . . .
What happened to the other person (people) involved?
What is SIDS?
What is "brain death?
I'm sure there will be a miracle. Okay, when is s/he coming home?
Can we see the body? When?
What happens to miscarried fetuses and stillborn infants?
Is an autopsy required? Possible?
What is an autopsy? How do I get the report? How much does it cost?
If there is an autopsy, can there be an open casket?
When can we hold the funeral?
Do I have to speak to or notify the police?
What forms do I have to sign? What forms do I need to find?
What alternatives are there for disposing of the body?
Can we donate organs and tissues?
How are organs and tissues obtained?
How are tissues donated? Which can be donated?
What happens after donation?
Can the whole body be donated to a medical school?
How do we select and contact a funeral director or funeral home?
What costs are involved in body disposition?
What will a funeral director do for us?
How can we transport the body to or from another city/state/country?
What is a death certificate? When can I get a copy?
How does the decedent's name get in the newspaper?
How can I get more help?

28: Dealing With The Media
Pan Am Flight 103: The Media Response
Planning for Media Interactions

29: Learning More/Educating Others
The Problem
Adult Learners and Uncomfortable Subjects
Sudden-Death Notification: A Course Outline
Evaluating the Students and the Course
Continued Learning

Index

List of Tables
1-1: Expected versus Sudden, Unexpected Deaths
2-1: Non-verbal Messages
2-2: Ways Survivors Express Anger
3-1: Protocol for Delivering News of Sudden, Unexpected Death
4-1: Helpful Phrases
4-2: Comments to Avoid
5-1: Telephone Notification Protocol
6-1: Survivor Information Sheet
6-2: Hoja de Información Para eI Sobreviviente
7-1: Discussing Organ and Tissue Procurement with Survivors
10-1: Acute Grief: Actions, Attitudes, and Coping Strategies
10-2: Issues that affect Different Relationships after Death
10-3: Signs and Symptoms of Psychological Reactions to Combat
10-4: Aspects of Grief *
10-5: Factors That May Complicate the Grief Reaction
13-1: Common Reactions Children Have to Death
13-2: Protocol to Notify Children of Sudden, Unexpected Death
14-1: How to Help Friends after a Death
14-2: Student-Death Protocol
17-1: Potential Barriers to Effective ED Notification
17-2: Protocol for Notification of Death in the Emergency Department
17-3: Emergency Physician Stress and the Frequency of Topic
Discussions during Death Notifications
18-1: Protocol for Obstetric Deaths
19-1: Responding To Line-of-Duty Police Deaths
19-2: Police Line-of-Duty Death Policy
2O-1: U.S. Federal Bureau of Prisons' Death Notification Protocol
22-1: Nurse Interactions that Survivors Find Helpful
23-1: Protocol for Death Notification by Chaplains
23-2: Religions' Beliefs about, Rituals for, and Attitudes toward Death
24-1: Protocol for Emergency Medical Services In-home Death Notification
25-1: Protocol for Military In-Line-of-Duty Death Notifications
25-2: Protocol for U.S. Navy Death Notification
26-1: Protocol to Support Disaster Survivors
26-2: United Air1ines' Emergency Response Protocol
26-3: Federal Family Assistance Plan for Aviation Disasters
27-1: Criteria for Organ and Tissue Donors
27-2: Procedure for Organ Recovery Team
29-1: Notifying Survivors: Fears, Learning Needs, and Methods to Learn
29-2: Principles of Effective Adult Education