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Emergency Psychology: The Burden Of Delivering Bad News

On the scene
On the scene
Anne-Ev Ustorf

MUNICH — Traffic collisions. Heart attacks. Even terrorist attacks. Tragedies strike every day, tearing people away from their loved ones forever. But events like this have a collateral impact beyond the victim's next of kin. They also affect the messengers, the proverbial bearers of bad news.

People with certain chosen specific vocations — police officers, for example — are particularly responsible for delivering this kind of heart-wrenching information. In Germany, if a person dies outside of his or her residence, police are automatically notified. It's their job, then, to inform the deceased's loved ones.

Paramedics and other first responders at the scene of an accident have similar responsibiities, as do human resources managers in some cases, particularly in the risky construction industry, where work-related accidents are not unusual. Human resource heads also have the unenviable task of informing employees that they've been fired or laid off.

All of these occupational groups face the challenge of having to convey these messages in a gentle, sensitive but also clear manner, though they typically do not have the proper training to do so. Few apprenticeships or advanced training regimes teach psychological first aid. People who want this kind of specialized training must seek it out on their initiative — from charitable organizations or emergency services.

A shoulder to cry on

Franziska Lipka has been an ER (emergency room) doctor for 15 years at the Hamburg University Hospital in Eppendorf. Traffic collisions, heart attacks and brawls are part of her daily routine. Sometimes she quite literally saves people's lives. But she says the emotional side of the work — standing by patients and their families in critical situations — is at least as important as the medical treatment she provides.

Lipka describes her job, in fact, as "psychology with a dash of medicine." And yet she was never trained in the former. All of her experience communicating with seriously ill patients and their families comes from real-life situations, from her work in the hospital or riding in ambulances.

"I think it is very important to always be honest with the next of kin and not use any medical jargon," the 42-year-old doctor explains. "Everything I say has to be intelligible."

Lipka says that when a patient dies, she sometimes even hugs the next of kin. "I always stay with them until they can reach another relative or friend, or until the police have arrived," she explains.

New guidelines

But not every member of the emergency services is, like Franziska Lipka, able to intuitively do the right thing in a difficult situation. It was for that reason that psychologist Frank Lasogga, together with colleague Bernd Gasch, founded a discipline in the late 1980s called "emergency psychology." Their goal was to help the helpers, namely emergency services members.

"Both of us had recently been first responders at the site of an accident, and even though we're both psychotherapists, we wished we'd had a kind of manual for these difficult situations," recalls Lasogga, a psychology professor at the Technical University Dortmund. "We even went to the police. But they also said they'd never had any training."

The two psychologists decided, therefore, to develop a set of guidelines for communicating with the severely injured, victims of violence, or the next of kin of people who died unexpectedly. Messengers in these cases should, for example, make sure they've introduced themselves and are speaking with the correct person before clearly and simply stating what happened.

They should also remain with the next of kin long enough for the latter to register and digest the news, and ask questions. "Emergency psychology isn't just about psychological first aid," Lasogga says. "It's also about protecting the affected person from posttraumatic stress."

Still, many emergency service personnel are unfamiliar with such guidelines, and various offices and professions approach the issue differently, in some cases leaving it up to the individual police officers, doctors, paramedics or HR managers to seek out specialized training.

In Germany, many civil servants and emergency services workers have turned to the Red Cross for help. The organization has a special, volunteer-staffed Crisis Intervention Team, which has proven to be a real difference maker for professionals having to rush from one assignment to the next.

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