148. A Guide to Skillful Death Communication with Alex Jabr, PhD

Delivering the news of death is one of the hardest yet most overlooked skills in emergency medicine. Many learn by watching others or through trial and error rather than structured training (or just make it up as they go). This lack of preparation can lead to discomfort, stress, avoidance, and even systemic failures in how death notifications are handled. In this episode, we explore the critical components of death communication, how to navigate these difficult conversations with clarity and compassion, and why avoiding or mishandling these moments can have lasting consequences for both providers and families. Finally, we discuss the emotional toll of secondhand grief and the importance of proactive mental health care for those on the front lines of healthcare.

Guest bio:  Alexandra Jabr, PhD, EMT-P, is the founder of Emergency Resilience and a leading voice in the overlooked aspects of first responder training. With nearly 15 years of experience as an EMT, paramedic, cardiac tech, EMS coordinator, and educator, she saw firsthand the emotional toll of the job—especially when it came to death communication. She went on to earn a Master’s in Death, Grief, and Bereavement, followed by a Ph.D. in Depth Psychology, focusing on how first responders can maintain their mental health while supporting grieving families and colleagues. Through her work, she’s redefining continuing education, ensuring first responders get the training they truly need—not just another CPR recert.

We Discuss:

Why On-Scene Death Notifications Are So Difficult

• 93% of first responders have transported a deceased patient due to discomfort with on-scene death notifications, a practice driven by lack of training rather than family needs.
• Medical training rarely includes scenarios where patients die unless a mistake is made, reinforcing the false belief that death is a failure rather than a natural outcome in emergency care. This contributes to avoidance behaviors when dealing with families.
• Avoidance is common, with EMS providers relying on hospitals or law enforcement to inform families of a patient’s death rather than delivering the news themselves. This deflection can prolong family distress and erode trust in emergency services.
• Families perceive a patient as alive until explicitly told otherwise, even if medical providers recognize clinical death. This cognitive gap means that providers must be clear and direct when delivering the news.
• The chaotic nature of prehospital environments makes structured communication more difficult but also more essential. With no private space, a lack of formal procedures, and emotional family members present, providers must learn to navigate unpredictable situations with professionalism and compassion.

Challenges in Death Communication Training

• Most training conditions providers to see death as failure. Medical simulations often allow patients to survive if the correct steps are followed, unintentionally reinforcing the idea that death results from error rather than being an unavoidable reality.
• Experiential learning leads to avoidance. Many providers learn how to deliver a death notification by watching senior colleagues—who may also be uncomfortable with the task. This perpetuates a cycle of avoidance.
• Hospitals provide a structured system for death notifications, but EMS lacks this support. In hospitals, social workers and chaplains can assist, while EMS providers often have to handle the situation alone, leading to increased stress and uncertainty.
• Death notification training should focus on psychological preparedness, equipping providers with coping mechanisms to handle their own emotions while supporting grieving families. Simply memorizing a script is insufficient when dealing with the unpredictability of human grief.

Practical Steps for Delivering the News of Death

• “Death communication” is more than just delivering the news—it includes tone, body language, presence, and post-notification coping strategies.
• EMS providers work in uncontrolled environments, without the privacy or structured support available in hospitals, making clear and compassionate communication even more essential.
• Family reactions vary widely, and providers must be adaptable while maintaining a calm, supportive presence.
• Engaging with family early in a resuscitation helps build trust and gradually prepares them for the possibility of death.
• Avoiding euphemisms like “passed away” and using clear, direct language (“dead,” “died”) prevents confusion and fosters understanding.
• The first interaction with the family should not be when delivering the final news—gradual updates help ease the shock.
• There is no single script for death communication, but providers should have a mental “toolbox” of strategies to use based on the situation.

A Structured and Compassionate Framework

• Identify the main family contact and introduce yourself. Establishing a direct point of communication prevents confusion and ensures information is delivered effectively.
• Provide brief but clear updates on what’s happening. This helps set expectations and avoids an abrupt or shocking notification.
• Be direct when delivering the final news. “I’m sorry to tell you, your loved one has died” should be stated clearly, without euphemisms.
• Pause and allow silence. Families need time to process the information, and rushing to fill the silence can interfere with their initial grief response.
• Offer support but do not try to “fix” their grief. Let them react naturally, whether that means crying, screaming, or asking logistical questions.

Handling Determination of Death

• When no resuscitation is attempted, the approach to death notification differs. If a patient is already deceased upon arrival, EMS providers must be prepared for different reactions from the family.
• Avoid performing “show CPR” just to comfort the family. Unnecessary resuscitation efforts often serve providers more than families, prolonging false hope rather than offering clarity.
• Families may insist their loved one was alive minutes ago, even when there are clear signs of death. This denial is a natural part of grief, and providers must remain firm while showing empathy.
• EMS providers must balance compassion with clinical reality. Being clear and confident in the determination of death prevents unnecessary distress and confusion.

Common Mistakes

• Using unclear or technical language instead of direct words like “dead” or “died.” Phrases like “expired” can feel cold and dehumanizing, while euphemisms can create confusion.
• Delaying the news with excessive medical details. Families should not have to wait through a step-by-step recap before hearing the critical information.
• Avoiding eye contact or physically withdrawing. This can make providers seem detached or indifferent, even if they are simply uncomfortable.
• Trying to “fix” grief instead of holding space for it. Rushing to offer comfort or explanations can feel dismissive. Instead, providers should allow families to process in their own way.
• Not preparing families for bad news before delivering it. A lead-in like “I have bad news” helps them brace for what’s coming.
• Talking too much after delivering the news. Silence is uncomfortable but necessary. The instinct to keep talking can dilute the message and overwhelm the family.

Secondhand Grief and Provider Well-being

• Repeated exposure to death notifications can lead to “disenfranchised grief” for providers. Suppressing emotions over time can contribute to burnout and emotional detachment.
• Many providers struggle to acknowledge their own grief. Seeking support and engaging in debriefing exercises can help process these experiences in a healthy way.
• A brief pause after a death notification—even just 30 seconds—can help providers integrate emotions rather than suppress them.
• Providers should seek mental health support proactively, not just in times of crisis. Therapy or peer support groups can provide essential tools for managing cumulative emotional stress.

Proactive Mental Health for Providers

• Providers should seek mental health support before they feel they need it. The emotional toll of repeated death notifications can build up over time.
• Unprocessed grief often manifests in unhealthy coping mechanisms like alcohol use or emotional detachment. Addressing these feelings early helps prevent long-term consequences.