Family Presence During Resuscitation by First Responders

Should we think differently about having the family members present at the scene?

Cardiac arrest is a common situation all first responders encounter in their careers. These types of calls always cause a great deal of stress for first responders and require an immediate sequence of actions designed to reverse and prevent death. Pre-hospital resuscitations are usually well-rehearsed ballets, with each successive step following a pre-set protocol, and demanding time-sensitive decisions to depart from the routine when unusual circumstances arise. A distraught family member  on scene during a cardiopulmonary resuscitation could impose  a distraction……or would it?

Given the fact that 80% of out-of-hospital cardiac arrests happen at home, the likelihood that there is a family member present at your next cardiac arrest call is very high.  You may find this circumstance very stressful but having some information and tools to handle it may help make the situation better.

What does the research say?

Two large, international reviews looking at the effect of family presence during resuscitation when cardiac arrest occur in the hospital setting found the following:

• • There is a lack of high-certainty evidence regarding the impact of family presence during resuscitation on their loved one’s survival, in both kids and adults.
  • In case of both adults and kids experiencing cardiac arrest, the majority of family members would choose to be present if faced with this situation again; however, not all family members wish to be present during resuscitation.
  •  ‘Being there’ was meaningful to family members and seeing that ‘everything was done’.
  • Family members and lay public who perform CPR have reported being very impacted by EMS providers simply saying “Thank you” and “You did a great job.” They remembered this moment even 20 years later.

Thinking differently about having the family present at the scene

During any resuscitation event, as first responder, our primary concern is the patient experiencing cardiac arrest. And that’s how it should be. However, it is very important to think about the family/witness/lay rescuer perspective during the life-changing situation happening in front of them. This is the worst possible day of their lives, and we have to do everything we can to mitigate the impact on their health and mental well-being as well. Unexpected severe illness and death can predispose loved ones to what is known as complicated or prolonged grief, regardless of the outcome of the resuscitation.  Understanding what is happening and hearing a few words of support from you, as a first responder, could make all the difference.

 What can I do to help?

• • When you arrive at the scene and have assessed the situation, find the family member you can talk to as you assess the situation. Tell them what is going to happen and ask if they would like to stay or go to another room.
  • If there are multiple people present, find a key person to avoid repeating information.
  • Explain what is happening and what you are doing step-by-step as much as you can.  
  • If the family member provided CPR, thank them and tell them they did the right thing. These simple words have been shown to be very empowering and supportive.
  • If you transport the patient to the hospital, be clear about what will happen next and what the family should do now.
  • In the event that you have to terminate the resuscitation at the scene, take time to stay and talk to the family. Answer as many of their questions as you can and provide some brief comfort that you did all you could.
  • With either outcome, provide the family information about Heartsight so they can seek out more information on their own, when the time is right.

Sources

Family presence during adult resuscitation from cardiac arrest: A systematic review

Family presence during resuscitation in paediatric and neonatal cardiac arrest: A systematic review

Thank you to our contributors

Katie Dainty & Curt Mahoney