The day started out normally enough: come into work, get my assignment, and start preparing my OR. I didn't need to move in right away; while we normally move patients into the OR around 0700, my patient wouldn't be moving in until 0800. And so, when the trauma code was called overhead at 0654, I was called upon to scope out the trauma bay.
I headed down to the ER, expecting the usual car accident, stabbing, or shooting. Well, it was a car accident all right, but certainly not the usual. A young woman, on her way to work, struck head on by a drunk driver. Yes, before 7a.m. But the heartbreaking part was that this woman arrived with the CPR device compressing away, her obviously pregnant belly bouncing in sync with the compressions. The baby was in obvious distress, and there was no time for transfer to the OR or to wait for an OB to arrive from maternity, four floors away. The trauma surgeon did an emergency C-section, right there in the trauma bay. Suddenly, we had not one but two trauma patients. And both were coding.
Baby boy was intubated and gradually his color improved, although respiratory function, heart rate, and pulse ox remained well below norm. He was sent to a nearby children's hospital NICU, with many crossing their fingers and saying a prayer that he would make it.
We never did get mom back. We tried drugs, we tried external pacing, we tried every trick in the book. All without success. We did what we could to get her incision closed and cleaned up for family to see.
We all heard the husband/father arrive. The wails as he was told his wife didn't make it, the sobs as he was walked into the trauma bay and sank to his knees. Every single person in that trauma bay was crying right along with him, even those known as the crusty old battle-axes who have never openly shed a tear.
I've cried over patient situations and deaths before, but always privately and usually in my shower at home after a hard day at work. But this was a situation where I couldn't hold it together, and I was certainly not alone. This was one of those traumas that will likely haunt many involved for the years to come.
Many healthcare employees are involved in events in the workplace that can lead to traumatic stress brought about by strong emotional responses (Vaithiligam, Jain, & Davies, 2008). In light of these events, hospitals should provide support to involved employees. Many offer an Employee Assistance Program (EAP), but is an EAP always enough? Employees may be reluctant to contact the EAP if they fear their employer will find out they have sought mental health help.
My facility goes beyond the EAP and provides critical incident debriefings when deemed warranted or if staff request a debriefing. The most recent was after a sudden onslaught of more than a dozen heroin overdoses that led to poor survival rates and several becoming organ donors. I am sure there will be one to follow today's events.
Debriefing allows those involved in a traumatic event to process it, vent emotions, and address potential physical or emotion harm that may result from the experience (Davis, 2013; Vaithiligam, Jain, & Davies, 2008). A timely debriefing that occurs within 72 hours of the precipitating event can reduce short- and long-term crisis reactions and psychological trauma (Davis, 2013). Healthcare employees can greatly benefit from the option to attend a critical incident debriefing. Does your facility provide this crucial support?
References
Davis, J. A. (2013). Critical Incident Stress Debriefing From a Traumatic Event. Psychology Today. Retrieved from Critical Incident Stress Debriefing From a Traumatic Event | Psychology Today
Vaithiligam, N., Jain, S., & Davies, D. (2008). Helping the helpers: Debriefing following and adverse incident. The Obstetrician & Gynaecologist, 10, 251-256. doi: 10.1576/toag.10.4.251.27442
