Would you let a family member help in a code?

[Riblett]

I am hoping to get lots of different responses to this. When is okay to have a family member help you on a cardiac arrest?

There are so many sides to this issue. I read an article about it in JEMS not so long ago that suggested letting family members be there. In training a few months ago we were taught that it actually helps the grieving process along for some people, because they feel like they did something to help even if they person ends up dying. I never thought I would be faced with the situation until this past Thursday. I guess there is a difference in letting someone who asks help, and giving a 15 second CPR lesson because you are in dire need of an extra set of hands. And if the family member works in the medical field that throws a whole different dynamic into it.

Read my bit and share your stories and opinions, good, bad or indifferent...

A little background first...I work in two different counties and they are night and day different. The metropolitan area one is a huge system and our medical director is known around the country. If you have a code in that county you get a responding ambulance, a QRV supervisor, and engine company and at least one other transport capable ALS ambulance will check in on you most of the time. In the rural county, much of it is still volunteer and if you need help you gotta ask for it.. and you may or may not get it. Most of the time the nearest ambulance or even QRV supervisor is at least 10-15 minutes away. Most of the fire depts do not run first responder. You can request an engine company if you need them, but they are 10-15 out and are unavailable about 75% of the time.

My partner and I are called out for a sick call. Nausea vomitting with some breathing difficulty. We get about a block away and dispatch comes back on and says that the caller advised the patient has had a seizure is now lying on the floor unresponsive and not breathing. We find a 24 y/o female lying on the living room floor with eyes wide in that blank death stare. I opened her airway and she had no respiratory effort but she did have a brady carotid. So I started bagging her and my partner ran to the truck to get a few things. I checked her pulse again right as my partner was putting her on the monitor and sure enough she had coded. I started chest compressions. In addition to the five other adults there was a three year old kid standing there watching that I had not noticed before. I asked them to please get him out of the room. A couple minutes later the family was on the phone with the pastor of their church and I could hear them in the background crying and praying. There was a lady sitting on the floor next to us in a pair of scrubs.

We were struggling to start our IV, give any meds, work the monitor, get end tidal on, bag and eventually intubate the patient and still do chest compressions. And being able to try correctable causes...dream on. We kept calling for help over the radios and none came. I finally got desperate and gave the lady in scrubs a little BVM lesson and had her bag the patient. Turns out she was a nurse aide at a local SNF and the patient's mother. She was talking to her daughter while she was trying to bag her, which I feel bad about in retrospect.

We could not get an IV and had resorted to giving Epi and Atropine down the tube, she was in asystole the whole time. I had to go to the truck and get the EZ-IO but had no one to do chest compressions. So I gave another 15 second chest compression class to her 20-something year old brother and had him do chest compressions. So mom is bagging, brother is compressing, my partner is trying to take blood sugar and start some correctable causes. We were able to get an IO and start pushing drugs and I resumed my chest compressions. Finally after 25 minutes on scene a QRV medic supervisor shows up. He puts a collar on to secure our tube and we finally get the patient out of the house and enroute to the hospital. The family followed us to the truck carrying our bags. The ER worked her too and she had ROSC. Even in the ED my partner and I were still rotating compressions with staff because the community hospital only has 14 beds and limited staff. When it was all over and the adrenaline wore off I thought I was going to fall over and die.

A few hours later I came back on another call and stepped into her room. There she lay on the bed, chest tubes, lido drips, pacer spikes on the monitor and on a ventilator. With the c-collar removed her head lay lifelessly to the side and there was blood oozing from her nose from failed NG tube attempts by the ED staff. She had that same wide eyed blank death stare she had when I found her on her family's living room floor. I looked down at my "save". But what had I really saved? And what impact did what we did have on her family? I am not sure if she made it or not but just as I was about to leave the room her family members walked in. Not a word was spoken as I gave her hand a quick squeeze and left the room. It was a day that her mother and brother will never be able to forget. Will they remember it as the day they did everything they could to help save her? Or will it be remembered as the horrible life-scarring day that she died on their floor and in their hands?

I don't know.

[MeekoBB]

That is seriously rough. You thought quick and used what resources you had available. Sure it can quite possibly help in providing the closer they need but it would be recommended that they seek some addition help for their minds to sort their emotions.

It is something that only time will tell.

[Ridryder 911]

I have written thesis based upon family and cardiac arrest. Personally, I have always utilized anyone help that would participate. Those that usually feel uncomfortable will let you know soon as possible. As you described, much research has been performed and very little ill effects or occurrences have been documented, even on pediatric arrest.

I have in my (30 yrs) experience have found it to be a good closure as well as many feel they were able to "do something".

Ironically, most cultures honor death and family members in the home. North America is one of the few that feel it is "taboo". Until the last fifty years, many deaths occurred in the home and even the body was placed for view at the home.

In regards to your call, many people tend to be "overwhelmed" and unable to give details due to being overwhelmed at the time. Chances are, they would not even be able to identify you (out of uniform) and only give portions of what occurred during the code.

One can only attempt to do the best they can at the time. Hopefully, since it appeared the family was spiritual, interaction with their pastor could help.

R/r 911

[Just Plain Ruff]

unfortunately you know good and well that this person will probably never recover enough to lead any sort of normal life. Heh what's normal I ask.

This is a very sad case and we all have these cases in our career. The one who should have survived but didn't to the one who should have died who didn't.

don't beat yourself up. I've had family members help out on everything from codes to minor calls. No one does a IV pole better than a family member.

Keep kicking and keep doin the job. It's not always like this you know.

[CBEMT]

Do what you have to do. Nobody can prepare you for that kind of situation.

Just be careful. They won, but I'm sure it was no picnic getting there:

http://www.hpso.com/case/cases_prof_index....EMT%2FParamedic

[unknown]

From my seat behind the console The Family members are my hands on scene. They may not know how to CPR but If I get a call like that on a witnessed colapse and no breathing... I am going to start pre-arrivales.

NO- they don't all make it but you do what you must for the patient at that time. Often times when the family helps out they get a bettter undersatnding of the fact you did every thing you could from the very beginning.

[Dustdevil]

I would have done the same thing, Bro. The wellbeing of your patient is numero uno, and you have to give that every possible effort available to you. Sounds like you did that, and made the best of a hard situation. Had you not made that decision, you would have been denying your patient that extra chance.

Because all people are different, with different sensibilities and reactions, there may occasionally be somebody who suffers some psychological effects from being drafted to help their own loved one in an emergency like that. But that would not be the norm. Conventional wisdom is that people want to help. They do not want to be a helpless spectator at their relative's death. They sleep a lot easier, and accept it a lot better if they know they were able to at least try and help.

Another benefit is that, when you involve them in the process, they better understand the difficulty of the efforts you are making, and are less likely to feel like the best possible effort was not made. Of course, when you have an audience, the importance of you operating professionally and competently comes to the immediate forefront. But if you have nothing to hide, then there is no problem with this practice.

Not all of us have truckloads of firemonkeys following us around to be our human Thumpers. It sounds to me like you did your very best, not just for your patient, but for her family too.

[EMDP2081]

i also want to agree with inccognitogirl. I also work 0.3FTE as an EMD and 0.75FTE as an EMT-P and i find that the codes that i go on where the family member has already began CPR, i will often treat them as another First responder and allow them to do things, even if it is a menial task like holding an IV bag or handing me a supply i need. I honestly agree that if you have involved the family member, they feel a sense of ownership in making what are probably the last moments of this persons life, much more dignified. I believe in the EMD process and i think that it is a useful tool when used appropriately and early CPR is what truly saves patients where as all of this ALS stuff we throw at them doesn't have much statistical proven decrease in M&M.

On the other hand, I work in a city of 100,000 people. We are home to the Mayo Clinic. 30,000 of those people work for Mayo. about 8,000 of them are nurses and we have over 1,500 physicians. This can be a blessing and a curse, but is completely reliant on teh mindset of the family members. i would hope that many of them have enough sense to remember that they are probably the world's foremost expert on the metabolic functions of some fungus that grown in a patients right ear lobe and not a broad based emergency care specific provider like we are. i find that 50% of the time that you have other medically trained folks at the scene that if becomes a Charlie Foxtrot and the other portion of that, you have folks who can keep their heads on or are benign.

So in conclusion of this glob of random thoughts, i think it takes a experienced provider to properly utilize a family member during the course of an attempted resuscitation...

Dave NREMT-P EMD

[MSDeltaFlt]

Depends of the situation. I have used family, and I have not.

You did a good job regardless of the outcome.

[andrean678]

I wouldn't beat yourself up, sometimes you just can't tell a family member no.