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Preparing the EMT for Their First Cardiac Arrest Death

As EMS educators we do a pretty good job of preparing students for the technical aspects of a career in prehospital medicine. One of the things that we could do a little bit better, particularly on the EMT level, would be to prepare them for their first cardiac arrest that does not survive.  We spend time on getting the compression depth, ratio and speed accurate to AHA standards, but how many of us, myself included, fail to prepare a person for the first death that they may have ever had a role in. 

There may be a number of reasons for the absence of this education that includes, quite frankly, not enough time, the instructor’s difficulty in dealing with issues of death, as well as other potential social or cultural issues that surround the topic of death and dying. As a new provider back in the dark ages EMS, I can still remember, to this day over 40 years later, my very first cardiac arrest. I was rather self-assured that since I had learned this new procedure called Cardio-Pulmonary Resuscitation and had perfected it to print out the perfect CPR documentation strip, that death was no longer safe around me!   I thought that all I had to do was to do CPR and this person would miraculously survive and come back to thank me for saving their life.

Death and Dying

You know what happened. The patient died. Even now, I can feel the disappointment that I felt on that day. Frustration in myself because I had to have done something wrong.  Disappointment and what I had been taught, because maybe my instructor had not taught me correctly.  Even disillusionment about moving forward in this brand new industry called emergency medical services.  After all, what would be the use if everything that I had been taught failed to work? 

 I would encourage all of us as EMS educators to sit down and have a frank discussion with your students. I'm really excited about the ROSC rates and the amount of publicity these patients receive when they are able to successfully leave the hospital to resume a normal life with her family and in society. But we have to be honest. Those stories are still in the minority. A large portion, if not the majority, of patients that we treat in cardiac arrest are not going to survive. The only home that they are going to go to is the funeral home. 


One of the most important things that, in my opinion, we have to do is to set the expectations for the new EMS provider.  You know the ones that I am speaking of.  They have the shiny new scissors on their belt and the polished shoes so bright that you can see your own reflection in it.  We don't want to discourage this type of professionalism. But I think at some point in time we need to sit down and talk to our EMTs and say, "sometime in the future you're going to run your first cardiac arrest. Give your patient the very best care that you possibly can. Keep in mind that if patient dies, and you have provided care to the very best of your ability, you will most likely feel that you should have done something more. That, most likely is not an accurate feeling that you are experiencing".   As mentors and leaders of those who are coming up, we should not discourage these feelings but warn the students that are going to come, that they will experience them. In this way students are not blindsided by the emotions that they may experience. This is not “feel good” garbage…this is just good education.


About the author:

Bill Young

Dr. Bill Young is the Program Director of the Eastern Kentucky University Paramedic School.  The EKU Emergency Medical Care Program is the first accredited Paramedic program in Kentucky and the second in the nation. We offer well established Associate of Science & Bachelor of Science degrees in Emergency Medical Care that can be completed online or on campus.  If you are currently a paramedic and interested in expanding your career by completing your degree, 100% online, contact us today at  

Published on February 14, 2018

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