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PTSD: National Center for PTSD

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Casualty and Death Notification

 

Casualty and Death Notification

Following a traumatic event or disaster, it is frequently necessary to notify family members of the casualty or death of a loved one. Mental health personnel may be asked to serve on coroners' or medical examiners' notification teams (1). What follows is a curriculum on compassionate casualty or death notification for professional counselors and victim advocates (2). It was developed by Mothers Against Drunk Driving (MADD) and is summarized and printed below with the permission of MADD.

Death notification procedure

  1. The coroner or medical examiner is absolutely responsible for determining the identity of the deceased.
  2. Notify in person. Don't call. Do not take any possessions of the victim to the notification. If there is absolutely no alternative to a phone call, arrange for a professional, neighbor, or a friend to be with the next of kin when the call comes.
  3. Take someone with you (for example, an official who was at the scene, clergy, and someone who is experienced in dealing with shock and/or trained in CPR/medical emergency). Next of kin have been known to suffer heart attacks when notified. If a large group is to be notified, have a large team of notifiers.
  4. Talk about your reactions to the death with your team member(s) before the notification to enable you to better focus on the family when you arrive.
  5. Present credentials and ask to come in.
  6. Sit down, ask them to sit down, and be sure you have the nearest next of kin (do not notify siblings before notifying parents or spouse). Never notify a child. Never use a child as a translator.
  7. Use the victim's name... "Are you the parents of ________?"
  8. Inform simply and directly with warmth and compassion.
  9. Do not use expressions like "expired," "passed away," or "we've lost __________."
  10. Sample script: "I'm afraid I have some very bad news for you." Pause a moment to allow them to "prepare." "Name has been involved in __________ and (s)he has died." Pause again. "I am so sorry." Adding your condolence is very important because it expresses feelings rather than facts, and invites them to express their own.
  11. Continue to use the words "dead" or "died" through ongoing conversation. Continue to use the victim's name, not "body" or "the deceased."
  12. Do not blame the victim in any way for what happened, even though he/she may have been fully or partially at fault.
  13. Do not discount feelings, theirs or yours. Intense reactions are normal. Expect fight, flight, freezing, or other forms of regression. If someone goes into shock have them lie down, elevate their feet, keep them warm, monitor breathing and pulse, and call for medical assistance.
  14. Join the survivors in their grief without being overwhelmed by it. Do not use cliches. Helpful remarks are simple and direct. They validate, normalize, assure, empower, and express concern. Examples: "I am so sorry." "It's harder than people think." "Most people who have gone through this react similarly to what you are experiencing." "If I were in your situation, I'd feel very ___________ too."
  15. Answer all questions honestly (requires knowing the facts before you go). Do not give more detail than is asked for, but be honest in your answers.
  16. Offer to make calls, arrange for child care, call clergy, relatives, employer. Provide them with a list of the calls you make as they will have difficulty remembering what you have told them.
  17. When a child is killed and one parent is at home, notify that parent, then offer to take them to notify the other parent.
  18. Do not speak to the media without the family's permission.
  19. If identification of the body is necessary, transport next of kin to and from morgue and help prepare them by giving a physical description of the morgue, and telling them that "Name" will look pale because blood settles to point of lowest gravity.
  20. Do not leave survivors alone. Arrange for someone to come and wait until they arrive before leaving.
  21. When leaving let him/her or them know you will check back the next day to see how they are doing and if there is anything else you can do for them.
  22. Call and visit again the next day. If the family does not want you to come, spend some time on the phone and re-express willingness to answer all questions. They will probably have more questions than when they were first notified.
  23. Ask the family if they are ready to receive "Name's" clothing, jewelry, etc. Honor their wishes. Possessions should be presented neatly in a box and not in a trash bag. Clothing should be dried thoroughly to eliminate bad odor. When the family receives the items, explain what the box contains and the condition of the items so they will know what to expect when they decide to open it.
  24. If there is anything positive to say about the last moments, share them now. Give assurances such as "most people who are severely injured do not remember the direct assault and do not feel pain for some time." Do not say, "s(he) did not know what hit them" unless you are absolutely sure.
  25. Let the survivor(s) know you care. The most beloved professionals and other first responders are those who are willing to share the pain of the loss. Attend the funeral if possible. This will mean a great deal to the family and reinforces a positive image of your profession.
  26. Know exactly how to access immediate medical or mental health care should family members experience a crisis reaction that is beyond your response capability.
  27. Debrief your own personal reactions with caring and qualified disaster mental health personnel on a frequent and regular basis - don't try to carry the emotional pain all by yourself, and don't let your emotions and the stress you naturally experience in empathizing with the bereaved build into a problem for you.

References

  1. Sitterle, K.A. (1995). Mental health services at the compassion center: The Oklahoma City bombing. National Center for PTSD Clinical Quarterly, 5(4), 20-23.
  2. Lord, J. H. (1996). America's number one killer: Vehicular crashes. In K. J. Doka (Ed.), Living with grief after sudden loss (pp. 25-39). Bristol, PA: Taylor and Francis.
Date this content was last updated is at the bottom of the page.

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