Death and dying

Introduction: Death in the emergency department (ED) occurs frequently. Approximately 249,000 patients die in EDs annually (0.2% of ED visits). Emergency care of dying patients and survivors presents numerous unique challenges to emergency physicians and other front line providers. Management of end-of-life (EOL) symptoms, communication, cultural sensitivity, attention to spiritual needs, and psychosocial support for grieving survivors are essential skills for emergency physicians. Caring for dying patients is challenging. The American College of Emergency Physicians (ACEP) acknowledged this and provided some guidance when they issued a Policy on Ethical Issues at the End-of-life, in 2008. Within that policy, the college succinctly summarized the importance of compassionate end-of-life care by stating, “Emergency physicians should respect the dying patient’s needs for care, comfort, and compassion.” In this chapter, we review the basic issues of death and dying in the ED and provide some strategies for management.