Of the 90+ million emergency department (ED) visits in 1995, 339,000 (0.4 percent) deaths occurred in the department.1 The timing and nature of death is often unexpected and traumatic to the survivors. In one study, 65 percent of ED deaths were considered unexpected versus 7 percent of inpatient deaths. 2 Compounding this difficult, acute situation the ED staff generally have no prior relationship with the patient or the family. 3

Death notification training is deficient throughout medical education. Medical students question how well they are prepared to tell a family about death. 4 One-half of emergency physicians report training in death notification during medical school, and only one-third during residency. Seventy percent of ED physicians find death notification to be emotionally draining. Without proper training, this role is even more difficult. 5 Educational programs involving videotaping of death notifications and role playing can assist physicians in developing the necessary skills. 67 and 8 The ED staff can become desensitized, or preoccupied with moving on to the living patients who are waiting. One-quarter of families describe the ED staff as cold, unsympathetic, and not reassuring. 9

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