Allowing Family members to watch loved ones be resuscitated in the ER

EMSnut45, BSN, RN, EMT-P · May 12, 2009

I worked in a pediatric ER where every parent was allowed to witness the recuscitation of their child. There was always a social worker with them to explain what was going on, and answer any of their questions. The majority of the patients did die, and the response from the parents was not negative at all. Every single one of them was very thankful, and knew first-hand how hard everyone worked to save their son/daughter. I also volunteer on the ambulance, and most all of the codes that we run are alongside the family. We do not have the resources to sit with the family member(s) watching, but only on rare occassions have I had to send the family member out with the police officer to calm them down. From my experiences, I am totally for involving the family when the situation is right, and you have the resources to devote to them. If someone in my family codes, I want to be there.

WalkieTalkie, RN · May 12, 2009

We do this in our ER at times. Some family members are able to take it, others are not and they prefer to not witness the code. For those who stay, it does provide closure, and it seems to help them in the grieving process because they know that we did everything we could to bring their loved one back.

GilaRRT · May 12, 2009

I would tend to agree that allowing family members to observe a code can be helpful. However, you need to have good mechanisms in place to provide family member support during the process. Reasons of safety and patient care deliver dictate this necessity.

I am not sure I buy family member presence pulling people through a code. If evidence exists to support this theory, all the better. However, I agree that it can be helpful for family as there is evidence to support this idea.

Mandylou · May 12, 2009

As a parent who experienced this I have mixed feelings. The things we saw were burned into our brains. We were only allowed back when it was clear they would not save him. I honestly can't say that I am thankful or not. I think it really depends on the individual family members. Ultimately I wish I could have held his hand and kissed him when all that stuff was going on but I would have been in the way. I can look back in awe of the code team. They honestly did not want to stop the code even after the doc in charge gave the order. Thank you to all the PICU and ER nurses (and others) who deal with ped deaths, you are amazing.

AnewNur · May 12, 2009

I watched them do CPR on my brother 5/03/09 and it was hard but helpful....

gt4everpn, BSN, RN · May 12, 2009

I think this is a very personal issue and that can make it difficult to accept,I'm just wondering if someone was in a MVA and was badly injured would it benefit a person to see the loved one in that state versus allowing the medical team to stabilize the patient, clean them up a bit, (for lack of better terms)as they still recieve medical attention, and then allow the family to see them. The family can still talk to them and comfort them , I think alot of people especially people who aren't in the medical field would be traumatized by the blood, etc.. going on in the room, I'm also curious to know if there is a special team set up to assist the family member if they faint, or get sick themselves... that would require more staff. I would imagine that the family member would feel helpless and would be hysterical during the resuscitation, I know I wouldn't be able to handle it, I would pass out right away... but maybe this can be a beneficial practice, I hope it could work when put to action though!!, thanks for the responses

WalkieTalkie, RN · May 12, 2009

I think this is a very personal issue and that can make it difficult to accept,I'm just wondering if someone was in a MVA and was badly injured would it benefit a person to see the loved one in that state versus allowing the medical team to stabilize the patient, clean them up a bit (for lack of better terms) and then allow the family to see them, I think alot of people especially people who aren't in the medical field would be traumatized by the blood, etc.. going on in the room, I'm also curious to know if there is a special team set up to assist the family member if they faint, or get sick themselves... that would require more staff. I would imagine that the family member would feel helpless and would be hysterical during the resuscitation, I know I wouldn't be able to handle it, I would pass out right away... but maybe this can be a beneficial practice, I hope it could work when put to action though!!, thanks for the responses

Well most of these come in by squad and 75% of the time, we don't even know who the patient is, let alone who his family may be... and typically if they are that bad off, they are dead before the family is even found and notified. I've never had the chance to have a family witness something like this, but I would imagine it would be much tougher to witness than a medical code. We always cleaned up the patient and covered up any bad wounds before letting the family see them. It gets really ugly sometimes, especially if the chest is cracked, and I have a feeling a lot of family members wouldn't be able to (or want to) see this type of blood bath.

GilaRRT · May 12, 2009

If you look at the evidence, it is beneficial to family members. Remember, this should not be a hap-hazard process. First, somebody would need to be dedicated to the family to answer questions, support the person, and act as a liaison between the person and the medical team. In addition, the dedicated person must be able to talk with the family members and educate the members on what to expect when they go into the room. Clear boundaries must be set, and it goes without saying, that a screening process must be identified to ensure the appropriate person goes into the resuscitation area.

Simply pulling a family member into the resuscitation area without the said process in place is asking for a disaster.

This is not a new concept and facilities have successfully implemented similar programs. Ultimately, this is helpful for the family in many cases. Remember, when the patient at hand dies, you now have the family taking on the role of a pseudo-patient if you will. We must not forget that death is the end for the patient; however, the other's left behind have only started the process of dealing with the death.

Batman24 · May 12, 2009

They allow it in my ER. Not all families do it because it is a very personal thing. They let the families know that whatever they choose to do is the right decision. They also have someone with the family explaining exactly what is going on so they understand.

PICNICRN, BSN, RN · May 12, 2009

We have always let the families stay in my experience- Peds ICU- no matter how bloody or awful. As others have posted, evidence says it is benificial. A chaplin and social worker is always called to bedside and another RN or Doc will stand with the family and tell them exactly what is happening. Studies show that parents feel that they are sure that "everything was done" for their child if they were able to witness the code. Many parents ask that we stop the recus as time goes on and outcome becomes clear to them.

Coming from a Peds world, I was really surprised that this was not common pracitce in the Adult world. I think I would want to be there if my family member was being coded.

Trauma Columnist · May 13, 2009

I actually did my masters thesis on this subject and have a list of resources listed on my blog (see bottom of my siggy line). Personally, my experience (10 years in level one ER) and 10 years pre-hospital has allowed me to say that the code is not about the code team but rather the patient and their family.