Wednesday, September 16, 2009

Family Presence During CPR

The majority of EMS providers have experience, in one role or another, in providing real-life CPR. Anyone who has knows the following five things:

1) CPR is chaotic and often confusing, even for trained professionals.
2) It is a violent and ugly spectacle replete with torn clothing, cracked ribs and vomit. The patient's body is battered by tubes, needles and electrical shocks.
3) It has nowhere near the success rate that TV leads our patient population to expect.
4) Successful resuscitation in the field doesn't mean they'll survive their time in the hospital, let alone be discharged with the same level of neurological and physical function.
5) EMS providers often begin CPR without the faintest glimmer of hope.

Aside from following protocol, it seems we are often motivated to perform CPR in order to be able to look the patient's family in the eyes and honestly tell them, "We did everything we could." This has led to a real question, both within EMS and in hospital environments- should family members be allowed to witness the chaotic, technical and often nauseating moments that constitute the end of their loved one's lives?

There has a been a lot of qualitative research (or subjective, if you want to be judgmental) done on this subject. There's no real agreement; some medical professionals think it aids in the healing process, others think it complicates the grieving process unnecessarily. The same thing goes for patient's families, although few ever think about it until they're faced with the decision.

I'd like to post a couple different points of view on this, both from EMS providers and the general public. So...what do you think? Leave a comment or drop me a line on Twitter @squirrel325. I'm interested to hear your thoughts.

9 comments:

  1. If the family wants to watch I say let them watch. As a first responder I say yes to family requests to help when I am there alone waiting for more personnel to arrive. Just make sure your directions are really clear.

    I think the more significant issue is going through the motions when the patient is obviously dead to just be able to tell the family that you did everything you could (when that is in fact not true because there is nothing that could be done).

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  2. I got to go to a CPR call once during a medic ride-along. The resuscitation took place out in the street where a good size group of family members and bystanders had gathered. Personally I think one of the police officers should have been assigned to taking care of the family. A firefighter did help get a chair for one of them. Bottom line with me someone should be assigned to being a temporary social worker for the family and asking the family if they want to watch the resuscitation.

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  3. I share Greg's view that it's up to the family. One might suggest that they wait in the next room, but if they want to stay let them. It's their family member, their loved one.

    And not to stay on the band wagon with Greg, but I'm also curious as to people's opinions on "going through the motions." To me it seems that it is a necessary evil in some situations. It could reduce some of the doubt and questions in their mind, and potentially reduce any backlash after the incident. Some might question the actions of an EMS crew who "didn't do anything" to help their loved one, which could have unwanted ramifications down the line - justified or not.

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  4. You should read the beginning of “The Year of Magical Thinking” by Joan Didion where her husband goes into cardiac arrest in their apartment and she watches the EMTs work on him. Later she becomes obsessed with figuring out the exact moment at which he died, and she wonders whether the EMTs would have done all they died if he weren’t still alive in the apartment. It only brings more questions and complicates her grief. And her memory of what she saw the EMTs do is unreliable, making her question the events even more. It doesn’t bring her any comfort. I think a lot of patients would react the same way, but people should have the choice to be around for it if they want.

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  5. In 17 years of being a medic, I have had good and bad experiences. Had a scene that I had no 1st Responders and actually had the son in law bagging while EMT did compressions and I pushed drugs and defibbed. When we finally called it the family was at peace that we had done all we could. It gave them great closure.
    I had another scene that the son began throwing furniture and screaming at us. Our 3rd rider attempted to deal with him and keep him off our backs while we ran the code and waited for PD. (In hindsight, we should have carried our equipment back to the truck and locked ourselves inside until he was contained.) It all just depends on the vibe I get on the scene... Oh, there is nothing more fun than running a code in an expensive resturant! People tend to get grossed out when you suction the patient prior to intubation on the dining room floor. They should have gotten the point and left when we started pushing tables out of the way...

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  6. I think the answer is: it depends.

    What I know of CPR is what I've seen on TV. I've never seen it performed in real life except on CPR dummies, and never in earnest. (If I'd ever bothered to really think about it, I think I would have intuited that it could be a frantic, rib-cracking mess... but I didn't really know that until just now.)

    Some people are going to freak out from seeing something chaotic in ANY CONTEXT, EVER. Others are going to heal more quickly, knowing - because they saw it with their own eyes - that literally everything had been done.

    I don't think there's a blanket answer. Keeping everyone away while CPR is performed is as wrong as letting everyone watch. It's not private and secret, its part of the human condition. If you were working my dad, I'd damn well watch. On the other hand, some people know only what they've learned through media and are so nutso they'll try to sue for unnecessary violence during {insert loved one here}'s last moments.

    I have no idea how someone in your shoes would choose, though; I think you just gotta let the cards fall where they will.

    Conclusion: TV - ONCE AGAIN - has done us all a disservice. I bet seeing CPR in real life breaks a lot of brains.

    Stupid TV.

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  7. I fully agree to allow them to watch if they so choose. If they choose to watch, then it gives them closure. Something they don't get after we transport them. On scene they witness the effort. Then we laod them up, transport to an ER, where they sit in a room waiting. Then someone they don't know in a lab coat comes out and says, sorry. I think we are more real life to people, in emergencies, than doctors and nurses in hospitals are. That is good and bad for us. People see our effort, but they see our mistakes as well. And they should. Life is about effort and success and failure. In EMS we know this better than most. We get to walk the line between those who live and those who die. Some we can save and some we cannot. People should be there when their loved one dies. I believe the effects in the long run prove benificial.

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  8. General consensus where I work is to allow them to watch. Really, if they don't want to watch they most often leave the room. If you want a good opinion regarding this, try talking to the parent of a SIDS child. Somewhere deep inside most of them know there is nothing that can be done by the time EMS arrives. Yet they still want "every effort" made. We often teach our students that they're no longer treating "the patient" at that point, they're treating the family by going through the motions and transporting. Good or bad, family will hang on every word and action of ours... so be professional, compassionate, and don't forget them.

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  9. I've done CPR in both the field setting and the hospital setting. We leave it up to the family as to their wishes. Some want to see and make sure that everything that we could do is being done. I think having a good liason with the family so they can explain what's going on and why we're doing what we're doing is a definate must.

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