How to talk about death in the backcountry

Erin Genereux, FNP-BC
Garrett Genereux, WEMT

While death in the backcountry is pretty rare, accidents happen. If the unthinkable occurs and you’re left with the seemingly impossible task of telling the rest of the group or those at home that their friend or loved one has died, the way you deliver the information will affect how it is received. While there is no perfect way to say someone has been severely injured or died, there is language you should avoid. Consider using these talking points:

• Give regular updates, especially if the patient’s condition appears to worsen. This may start to allow time for “anticipatory grief” to begin to build in preparation for the final outcome.
• It is okay to say that “We are doing everything possible,” while at the same time, being realistic.
• Give a brief narrative for context and then deliver the news. Don’t be too short but don’t be too complex.
• Be honest and direct. DO NOT LIE. If you are talking in person, make eye contact, and don’t be afraid to show emotion. Survivors want someone else to care that their loved one just died.
• Refer to the person by name and use the words “death,” “died,” or “dead.” Avoid euphemisms that may be confusing to those receiving the news.
• Avoid excessive technical information. No medical jargon, boil it down to its simplest terms.
• Avoid unnecessary gruesome details. Knowing that their loved one is dead is painful enough. 

It might help to think of the delivery as an equation using the utmost empathy:

	Preparation/Warning	+ Mechanism	+ Outcome
USE	2-way communication: "I am sorry, I need to have a difficult conversation with you..."	Keep the story as simple as possible: “While climbing ____ fell…” “While running a difficult rapid ____ swam and…”	“…and was seriously injured.” “…and died.”
DON'T USE	1-way communication: "There was nothing we could do, but..."	Because of their severe volume shock/increased ICP/lung damage/etc. their critical systems crashed which then caused their heart to stop beating and…	“…is no longer with us.” “… has passed on.” “… isn’t doing well.”

When notifying or treating expedition members in the field following the delivery of another member's injury or death:

• If applicable, continue treatment their injuries
  
• Protect them from further chaos and stress as much as possible
• Be calm
• Assist them in meeting their basic needs: warmth, hydration, food, etc.
• Share what happens next in a clear step-by-step clear fashion, for example, how the evacuation is going to be carried out
• Help them make a plan to connect with family, friends, loved ones, pets once they are able to leave the field
  

Care for others and yourself doesn’t end at the scene, Responder Alliance has developed tools for what comes next. While designed for those serving in backcountry first responder roles, these tools can be applicable to anyone who experiences a Potentially Traumatizing Event (PTE). The 3-3-3 protocol is a way to check in with others or yourself over the first 3 days, 3 weeks, and 3 months following the incident.

As Kenneth Iserson2 writes, “No one likes to deliver the news of a sudden, unexpected death to others; it is an emotional blow, precipitating life crises and forever altering their world.” The surviving victim(s) just wants the person telling them the news to show that they care. To show empathy that someone that they loved and cared for has died. If you do your best, you will accomplish what is necessary.