Breaking bad news during the COVID-19 pandemic – a dilemma for paramedics, their patients and their loved ones

By Iain Campbell.

The initial stages of the lockdown that happened in the UK in 2020 was a hectic time to be working on ambulances in London. Like many of our colleagues across the NHS, we were encountering a large number of very unwell patients. There was a lot of fear, a lot of uncertainty, and many of us felt somewhat out of our depths – a common feeling, I think, whilst dealing with a novel virus.

To minimise community transmission of COVID-19, we were not taking anyone to hospital with our patients. When a patient had suspected COVID-19 we were informing anyone they lived with that they must self-isolate. Hospitals were not accepting visitors. Many of our patients were very unwell during this period. For some, whilst they were alone at hospital their partner was alone at home. Families and friendship groups were separated.

For a month or two before the lockdown we were being inundated with news from Italy of patients saying goodbye to their loved-ones via calls. It wasn’t long until we had the same stories here in the UK. This meant that for some patients, the last time they and their loved ones saw each other was as we were carrying them away to our ambulances. This knowledge hit a lot of us ambulance clinicians hard.

This feeling was worsened by the fact that, at the time, funerals were severely limited and many of traditional rituals associated with them banned or changed significantly. Not only were the death rituals we standardly hold in the UK being denied to people, traditional means of informal community support for the grieving were also severely limited.

Ambulance service clinicians, by the nature of our work, get a unique perspective on our patients and their lives. We are invited, unplanned, into people’s homes and will often meet their families or loved ones. This gives us insight into care needs which may be missed by other health care professionals who are not granted this sort of intimate access.

However in this crisis, although our normally advantageous position of being able to highlight missed care needs through social service referral still existed, more often than not the person or people we were leaving at home after transporting their unwell loved one to hospital didn’t meet the criteria for this referral pathway. What these people needed was real pastoral support. Our patients’ loved ones were missing the support they would normally receive at hospital. Due to the time pressured nature of dealing with an unwell patient we could not provide this either. As everything was shut, other places they might have received support from such as, community centres, places of worship, even pubs or visits from friends were not possible. It felt to us as ambulance clinicians that a lot of these people were being forgotten about and so were experiencing avoidable harms.

Therefore, I suggest that some resources must be designed which will help support the loved ones of patients during a pandemic scenario. In my article I propose three recommendations: firstly, that dedicated pastoral outreach teams ought to be set up during pandemics to assist family members of patients transported to hospital; secondly, I offer a framework for how bad news can be delivered by ambulance clinicians during a lockdown; and thirdly, that a new model of bad news delivery more suited for unplanned, time-pressured care should be developed. I have written the following article as I think it is important to bring these conversations and considerations out of ambulance station mess rooms and see if we can come up with a workable solution. The mental health of our patients, their loved ones, and of us as clinicians ought to be considered when we are thinking about our pandemic response.

 

Paper title: Paramedic Delivery Of Bad News: A Novel Dilemma During The Covid-19 Crisis

Author: Iain Campbell

Affiliations: Post Graduate Research Student (MScR) in The Centre for Ethics in Medicine, Bristol University; Paramedic (staff bank) London Ambulance Service.

Competing interests: Nil

Social media accounts of post author: @Iain_A_C

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