Casualty and Death Notifications: Delivery and Follow-Up

Typically, legal authorities make the official death notifications to family members following a traumatic event or disaster. However, in some cases, it may become necessary for the workplace to notify family members of the casualty or death of a loved one. In today's diverse environment, there is no one-size-fits-all procedure regarding casualty and death notification. It will always be necessary to apply the cultural customs and courtesies unique to each location.¹

Death notification can be one of the most difficult tasks faced by anyone, because hearing the news of the death of a loved one can be the moment family members remember vividly for the rest of their lives. There are several steps to consider prior to notification:

• Selection of the notifier
• Information gathered about the event
• The notification staging and delivery²

It is important to select someone who is sympathetic, empathetic, and a good communicator. If possible, bring someone who knew the person. A sophisticated explanation of events is not always required, nor what the family needs at that moment, especially if the notifier is not a medical provider.

Positive Identification

Provide notification as soon as possible, but not prior to positive identification of the deceased by the coroner or medical examiner. Identify the deceased person's appropriate family contact or next of kin, and gather as much critical information as possible about the circumstances of the death. Make sure the information is from a primary source, rather than a secondary source, to ensure that the information conveyed is accurate.

Familiarize yourself with the details beforehand so that you can provide precise information for the family. Family members will likely look to you to provide important information, including details about how the death occurred. You may have to repeat the details several times, as family members may have difficulty processing the information. Provide basic information, and then add detail as requested.

It is important to be aware of health considerations concerning the family members to be notified, and whether other people are likely to be present at the notification. Document all of your efforts to reach the family, and never notify a child or use a child as a translator. Also, do not take any possessions of the deceased to the notification.¹

In Person

Always make the death notification in person and not by telephone. It is very important to provide the family member with a human presence during an extremely stressful time.³ Notifiers who are present can assist if the family member has a dangerous shock reaction, which is not uncommon. If someone goes into shock, have the person lie down, elevate his or her feet, keep the person warm, monitor breathing and pulse, and immediately call for medical assistance.⁴ If there is absolutely no alternative to a phone call, arrange for a professional, neighbor, or friend to be with the next of kin when the call comes.⁵

Notification in Pairs

Always try to have two people present at the notification. The team never knows what it will encounter, as there may be multiple family members present who may experience severe emotional or physical reactions. Make sure you have time to discuss your reaction to the death with a manager or at least one other team member before participating in the notification. This will enable you to better focus on the family when you arrive.

Ask to come into the home or private office, if the notification is at a work site. Do not make the notification at the doorstep or in any public setting. Ask the family members to be seated, and then sit next to them. Notifiers may need to clarify the identity and age appropriateness of the family members.¹

Plain Language with Compassion

Once the family members are seated, notify them quickly using the following sequential notification technique. Make eye contact, and speak slowly and in plain language with warmth and compassion:

1. Ask them how much is already known about the situation.
2. Provide information about the event.
3. Describe any life-saving measures.
4. Give the conclusion.
5. Make the statement of death or serious injury.²

Sample Script

I want to talk to you about your husband, Mark. Mark was involved in a plane crash. What do you know about this incident so far?

I know nothing about it. What happened?

The airplane Mark was flying experienced engine problems.

Was he hurt badly? Is he OK?

He was flown by helicopter to the hospital, CPR was done, and the doctors worked on him for about 40 minutes, but his heart wouldn't start again.

Is he dead?

Yes, Mark died. They did everything possible. I know this must be very difficult for you. I am very sorry for your loss.

General Guidelines

Do not use terms like expired, passed away, or we've lost him or her.⁴ Patiently answer any questions about the cause of death, the location of the deceased body, if there will be a delay before the body is released (such as remote location of the incident, investigation, and so on). If you do not know the answer, say so and let the family know you will get back when more information is available, and be sure to follow through.

Accept the family members' emotions and your own. Do not try to talk them out of their grief. Statements such as "He died doing what he loved," or "It was his time," are generally not helpful. Be sensitive to religious burial rituals and procedures that may arise during your notification.

Take time to provide information, support, and direction. Do not simply notify and leave. Family members often need time, even days, before accepting the deceased's belongings. Under no circumstances should they ever be delivered in a trash bag. They can be transported in a closed box at a later time. If possible, tell family members how to recover items if they are in the custody of the law enforcement or government body. Offer to

• Call a friend, family member, or religious leader who will come to provide support, and stay until the support person arrives
• Help contact others who must be notified, if appropriate
• Drive the family to the location where the loved one is

Never leave a newly notified person alone. Before you leave the notification scene, always have a friend, neighbor, religious leader, or relative present who can manage the situation.¹

How Individuals Respond to Death Notification

Even if there is no physical shock response, death notification can create an emotional crisis response for the family members. They may have a need to express feelings, a need for help in determining what happens next, and a need to begin restoring a sense of control.

Some of the factors that affect stress reactions are the intensity of the event, such as a violent death versus a heart attack, and the individual's ability to understand what's happening. An individual with psychological shock symptoms may exhibit the following:

• Intrusion—He or she may mentally play the event over and over.
• Avoidance—He or she may withdraw from activities or support systems.
• Increased arousal—He or she may experience increased feelings of irritability or hypervigilance.

Many individuals, regardless of background, find themselves numb and unable to take the next step. This is where the support person helps the most. Before you leave, ensure ongoing support is available. This may be a friend, neighbor, religious leader, or relative.¹

Follow-Up

Always leave a name and phone number with family members, and plan to make a follow-up contact the next day. If the death occurred in another country or state, leave the name and phone number of a contact person at that location.

Most family members are confused, and some might feel abandoned after the initial notification. Many will want clarification or may need more direction on arrangements that are necessary. Following up is an important step that can be truly helpful.

Know how to access immediate medical or mental health care such as through the employee assistance program (EAP), should family members experience a crisis reaction that is beyond your response capability.

Death notification is very stressful, and it is important not to carry the emotional experience by yourself. Some basic self-care strategies include

• Engaging in activities that are meaningful to you
• Balancing your lifestyle with physical exercise, a well-balanced diet, and adequate sleep and rest periods
• Creating an internal team support system where you can talk and share your feelings and experiences
• Reminding yourself that your reactions are normal
• Managing your own workload
• Debriefing your own personal reactions with caring and qualified mental health personnel¹

References

1. Leash, R.M. (2010). Death notification: A practical guide to the process. Hinesburg, VT: Upper Access.
2. McIntosh, E. Death notification training [PowerPoint slides].
3. Bennett, T. (2008). In person, in time. Retrieved June 27, 2024, from the Iowa State Attorney General's Office website: https://www.iowaattorneygeneral.gov
4. Sitterle, K.A. (1995). Mental health services at the compassion center: The Oklahoma City bombing. National Center for PTSD Clinical Quarterly, 5(4), 20–23.
5. Lord, J.H. (1996). America's number one killer: Vehicular crashes. In K. J. Doka (Ed.), Living with grief after sudden loss (pp. 25–39). Bristol, PA: Taylor and Francis.