Key Takeaways

    • Witnessing a patient in sudden cardiac arrest can be an emotionally traumatic experience for everyone involved, but especially for family and lay rescuers. 
    • The scene may look chaotic and be hard for a witness to understand all of the procedures and processes that are happening.  
    • It is important for you to be equipped to help as much as possible given the time constraints of the situations.
What are the common questions from family memebers on the scene?

As the emergency medical professional on the scene of a cardiac arrest, you will likely have many questions and concerns coming your way from family members and other witnesses.  This resource attempts to give some helpful language to address common questions about cardiac arrest

Q: Is the patient in pain? Are they suffering? Are you breaking their ribs? Does CPR hurt them?

A: Some people have chest pain during the initial seconds of sudden cardiac arrest. However, once you lose consciousness, you don’t feel pain. In fact [breaking ribs] is common. But without CPR, the person will not survive, and the rib fractures do not cause serious harm. People who do survive consider rib fractures to be a minor inconvenience  – especially compared to the alternative.

Q: Can the patient hear what’s going on around them? 

A:  People have different degrees of awareness after cardiac arrest. Some have spontaneous breathing or responsiveness to pain, while others have full awareness with open eyes and verbal responses. The last sense to stop working is hearing, so there is a chance the patient will be able to hear what is going on, but every patient is different.

Q: Should I stay here and watch?  What about my own mental health?

A: Family-centered care includes greater opportunities for families to be at the bedside, including during cardiac arrest resuscitation. While this initiative is not universally supported at this time, it has been promoted by many scientific guidelines, professional societies, and a few hospital systems. Offering family presence is a useful first step in family-centered cardiac arrest care.

Q: Are they technically dead?

A: Yes, the patient’s heart has stopped beating on its own and they are no longer breathing. That is why the first responders are providing CPR so that blood and oxygen can continue to circulate and go to the vital organs (heart, brain, liver, kidneys, etc.). This will give the patient the best chance to survive and for their body to resume its normal functions.

Q: How long will you keep doing CPR?

A: It depends on particular aspects of the patient’s status.  When the patient has not experienced a traumatic injury, it is typical that there will be at least 20 minutes of CPR where first responders will compress the chest to keep the blood pumping to the body, delivering respirations to the airway to inflate the lungs, and monitoring the electrical activity of the heart.  Depending on many other factors, such as potential causes, existing disease states, the safety of the scene for the patient and the responders, and patient wishes, resuscitation could continue for an hour or more.

Q: What are those medications you are giving to my loved one?

A: The medications help to restore or replace things that the body is unable to produce while in cardiac arrest.  For example, epinephrine or adrenaline is a medication that can help the heart beat more efficiently.  The patient may also receive medications like calcium chloride, magnesium, or sodium bicarbonate to replace essential electrolytes.  In addition, medications like amiodarone or lidocaine can help block abnormal rhythms in the heart.  Finally, patients will likely receive fluids like normal saline to keep them well-hydrated.

Q: Why aren’t you taking them to the hospital? Shouldn’t a doctor be taking care of them?

A: Fortunately, the care that is given in the hospital can be replicated in the field by the EMS clinicians who are on the scene.  They will be doing almost all of the same procedures and treatments that a hospital can provide.  Patients have a better chance of survival if the treatments are provided on the scene, rather than trying to take care of them in a moving ambulance, which can be dangerous for all parties involved.

Q: Why are the police here?

A: When a patient goes into cardiac arrest, law enforcement must be present because the death was unexpected.  Even in cases of expected death, law enforcement is there to ensure there are no potential criminal issues with the patient’s loss of life.

Q: How do I tell my friends and family about this?

A: A sudden cardiac arrest is extremely traumatic and difficult, emotionally and mentally. Telling others about this event can likely trigger strong emotions in you.  It may be difficult to discuss this topic, but you can use the questions and answers on this page to help you with any questions that others may have.  Feel free to direct them to this page for answers to their questions. 

Q: How do I cope with this terrible event? How will I ever get over this?

A: You are right to worry about your mental health after witnessing or experiencing a patient in sudden cardiac arrest.  You will likely feel a range of emotions from sadness to denial to questioning to anger, among many others.  There are resources like community groups, online groups, and online guidance to help you with coping. 

Q: What happens if all the treatments work and the patient is saved?

A: The patient will need further extensive care at the hospital.  To prepare for transport, first responders will stabilize the patient with medications or treatments so that they remain alive in the ambulance There will be a coordinated and extensive procedure to move the patient to the stretcher and then to the ambulance, where the clinicians will notify the hospital of their impending arrival.  Law enforcement may remain on the scene to conclude their paperwork and any investigations.  The fire department and EMS clinicians will guide lay rescuers, friends, and family in their next steps to stay by the patient’s side, and with ways to follow-up with the first responders at a later date.

Q: What happens if the resuscitation is not successful and the patient dies? 

A:  The procedures vary from one place to another, but typically, the first responders will summon the police (if they are not already on the scene) and the medical examiner or coroner.  If the resuscitation is deemed to be over, the EMS clinicians will declare the patient dead and the body will be turned over to the custody of the police.  The officials will then complete the necessary documentation. The body will be placed in a bag and taken to the morgue or funeral home.

Q: Can I go with you to the hospital?

A: Yes.  Most ambulances allow family and friends to ride with them to the hospital.  If this is not possible, you can meet the patient at the hospital.

Q: Will they be normal if they survive?

A: While most people who survive sudden cardiac arrest can return to their previous level of functioning, survivors will need follow-up care with physicians who specialize in heart conditions (cardiologists and electrophysiologists). Some survivors of cardiac arrest experience medical problems, including impaired consciousness and cognitive deficits. Functional recovery continues over the first 6 to 12 months after out-of-hospital cardiac arrest in adults. It is common for survivors to have memory loss and to experience depression and anxiety for some time after their event.

Thank you to our contributors

Hilary Gates & Beth Froelich

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