Why did this EP do this?

[iliacus]

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About 7 months ago I was working as a tech in an ED when a 3 y/o boy was brought in in full arrest. The EP allowed the mother into the trauma bay to watch the resuscitation. The child died and we all watched as the mother realized that her little boy was dead. Is this a common practice and if not, why do you think the EP did this?

 

[Sessamoid]

About 7 months ago I was working as a tech in an ED when a 3 y/o boy was brought in in full arrest. The EP allowed the mother into the trauma bay to watch the resuscitation. The child died and we all watched as the mother realized that her little boy was dead. Is this a common practice and if not, why do you think the EP did this?

Is it common? Probably not yet, but there is definitely a trend towards allowing family members to be present during resuscitations (appropriately escorted). I had heard Parkland had instituted this policy a couple years (?) ago, and the response has been quite favorable. So not common, but certainly acceptable, and somewhat cutting edge.

 

[roja]

There are many reasons to allow the family to be present during a resussitation. Particularly of a neonate or small child. Imagine sitting outside a room, knowing your 2 year old was having god knows what was going on. and then all of a sudden a stranger comes out and tells you your child is dead. You have no idea what was done or if everything was done.

Have been on a resussitation of a 4 week old, I can state that it is VERY important to have the family there. They need to see you doing everything possible for thier loved one. They need to see that you have put forth a huge effort to save them. Does it alleiviate thier grief? Not even close. However, it does allow them to know that everything was done for thier child.

Having said that, the family is usually brought in AFTER lines have been placed, ET placed, etc. That way they see that the code is going but they aren't watching everyone stick things into thier loved one.

 

[mikecwru]

There are many reasons to allow the family to be present during a resussitation. Particularly of a neonate or small child. Imagine sitting outside a room, knowing your 2 year old was having god knows what was going on. and then all of a sudden a stranger comes out and tells you your child is dead. You have no idea what was done or if everything was done.

Have been on a resussitation of a 4 week old, I can state that it is VERY important to have the family there. They need to see you doing everything possible for thier loved one. They need to see that you have put forth a huge effort to save them. Does it alleiviate thier grief? Not even close. However, it does allow them to know that everything was done for thier child.

Having said that, the family is usually brought in AFTER lines have been placed, ET placed, etc. That way they see that the code is going but they aren't watching everyone stick things into thier loved one.

I've had codes in front of family members, and the reaction is usually positive (as far as the situation allows) and I have placed lines in front of family members, too. We do this more at our academic referral site than at our county hospital.

mike

 

[Seaglass]

On a more EBM note, I believe the American Heart Association has conducted studies (ar at least references them in the ACLS book) that showed family members present during a resuscitation dealt better with grief and had a better psychological outcome than those not present.

C

 

[docB]

I have tried to get the family into the resus bay a number of times. Once or twice I've had the charge nurse freak out but generally it goes well. The way I usually do it is that after I the outcome is pretty much a given (you know they're dead) I go out to the family and tell them that things aren't going well if I think they can handle it I take tham back. If thay're already in severe status tachylordia I let tham sit then go back and tell them when I've pronounced.

 

[Sessamoid]

severe status tachylordia

Never heard that one before. I love it! Gonna have to remember that one.

 

[Apollyon]

Do you guys get the family spokesperson, like they do upstairs? I realize I'd done it incidentally, but one of our attendings told me yesterday that, where he trained (Highland), more than once, the gaggle of family members became SO emotional, two EP's and several social workers were assaulted, and, as such, they started a deal where one or two family members would be appointed, and that person would tell the rest the (inevitable) bad news.

We did that for our 20 y/o code (ETCO2 5 and no cardiac movement on U/S --> I called it 1 min after arrival - FD had coded him for ONE HOUR AND TWENTY MINUTES in the house...with a tenuous/no IV), and it worked well.

 

[paramed2premed]

I have done plenty of codes in front of the entire family. In their house, even.

It seems that everyone is so worried about families freaking out and disrupting the flow of the resus, but that has never been my experience. People are invariably respectful, helpful even.

Of course, when we get to the ED, these same family members, some of whom may have been performing CPR, are sent to the waiting room!

 

[Apollyon]

I have done plenty of codes in front of the entire family. In their house, even.

I'd forgotten all about that, from my EMS days. I used to have the captain/lieutenant corrall the family as we and the engine company were working the code. It was always a place for some gallows humor, and it occasionally got to the point where we had to (thanks Archie B.) stifle ourselves so we didn't burst out laughing.

Last field code I worked was during an earthquake. I wrote an article about it, which I can email to you, if you are so inclined.

 

[paramed2premed]

I'd forgotten all about that, from my EMS days. I used to have the captain/lieutenant corrall the family as we and the engine company were working the code. It was always a place for some gallows humor, and it occasionally got to the point where we had to (thanks Archie B.) stifle ourselves so we didn't burst out laughing...

You probably didn't mean it this way, but...

If I understand you correctly, you had someone take the family away from the resuscitation, in their own home, so that you guys could have the space to joke around.

My whole point about field codes was that, despite the discomfort that ED staff feel when family is present, EMS has run respectful and professional codes in front of families for years, without interference or trouble (mostly).

 

[beanbean]

In my town (Suffield, CT) we have a Patient Advocate Team as part of our volunteer ambulance. There are about 7-8 of us that are part of the team and we respond to help the family, friends, or bystanders when there is a particularly traumatic call. Usually the police or EMS crew asks for one of us to be paged; sometimes we just respond after hearing the description of the call. We explain to the family what is happening during a code and if the patient is pronounced on scene we stay and help explain the ME release/funeral home procedures, contact relatives, etc. We drive family members to the hospital if they are unable to do so, give out printed directions tothe hospital, assist the police in giving death and accident notification, etc. It is a big help to have a patient advocate there when youa re working a code in front of the family. It enables you to totally focus on the patient while someone else is focused on the family.

 

[Apollyon]

You probably didn't mean it this way, but...

If I understand you correctly, you had someone take the family away from the resuscitation, in their own home, so that you guys could have the space to joke around.

My whole point about field codes was that, despite the discomfort that ED staff feel when family is present, EMS has run respectful and professional codes in front of families for years, without interference or trouble (mostly).

No, it was giving us room to work, so that people weren't getting in the way. It wasn't

you had someone take the family away from the resuscitation, in their own home, so that you guys could have the space to joke around.

but, on occasion, something would happen, or somebody would say something, that was amusing, and, in otherwise grave circumstances, we would have to not laugh out loud. Having been in MANY field codes, often, there wasn't much to laugh about (but, then again, there was the save I got, and I said, "How much does this guy weigh?", out loud but sort of rhetorically, and he says, "I weigh 220", and I laughed and said, "there's my lidocaine dose!")