Objective: To understand effective ways for EMS providers to interact with distressed family members during a field intervention involving a recent or impending out-of-hospital ( OOH) pediatric death. Methods: Eight focus groups with 98 EMS providers were conducted in urban and rural settings between November 2013 and March 2014. Sixty-eight providers also completed a short questionnaire about a specific event including demographics. Seventy-eight percent of providers were males, 13% were either African American or Hispanic, and the average number of years in EMS was 16 years. They were asked how team members managed the family during the response to a dying child, what was most helpful for families whose child suddenly and unexpectedly was dead in the OOH setting, and what follow up efforts with the family were effective. Results: The professional response by the EMS team was critical to family coping and getting necessary support. There were several critical competencies identified to help the family cope including: ( 1) that EMS provide excellent and expeditious care with seamless coordination, ( 2) allowing family to witness the resuscitation including the attempts to save the child's life, and ( 3) providing ongoing communication. Whether the child is removed from the scene or not, keeping the family appraised of what is happening and why is critical. Exclusion of families from the process in cases of suspected child abuse is not warranted. Giving tangible forms of support by calling friends, family, and clergy, along with allowing the family time with the child after death, giving emotional support, and follow-up gestures all help families cope. Conclusion: The study revealed effective ways for EMS providers to interact with distressed family members during an OOH pediatric death