How much do you tell the family?

[tcripp]

This is a rhetorical question in that I'm not posing it to the forum for an answer but rather am just curious on your take or on the policies of your inividual services.

We ALL know that movies are over dramatic - else they wouldn't sell. So, taking this movie and putting it in to a real life scenario...

The little boy is playing in a baseball game - stealing bases. As he rounds first, he clutches his chest and collapses. He appears t be having a seizure and someone yells to call an ambulance. Dad scoops him up and, by POV, drives him to the hospital himself. Upon entering the ED, he proclaims that the boy is not breathing. Song and dance aside, they put him on a NRB and hook him up to the monitor.

Next scene, the little boy is in a room and mom/dad are talking to him. As the nurse is checking on the boy, the mother asks about all the tubes, wires and monitors. The nurse then explains about the tools to the point of explaining,"...diastolic and systolic. We like this to number to stay above 90. If his blood pressure drops, we'll have to do something. ...can't have it go below 70 again. ...70 and below is heart failure." Needless to say, while they are watching his systolic number drops 1.

When you have family in the vicinity of the monitors, how much or how little do you share with the family members? You have someone standing there while running a code; how much do you tell them as you work?

Edited March 13, 2010 by tcripp

[JPINFV]

When you have family in the vicinity of the monitors, how much or how little do you share with the family members? You have someone standing there while running a code; how much do you tell them as you work?

It's completely situational dependent. If I have time, I'll share everything to the best of my knowledge. Remember, the loved ones may very well be making end of life decisions. Additionally, it's a good way to judge just how much the family, especially if kids are present, know about what's going on.

Example: When I was in 3rd grade, my mother had 2 strokes and ended up on a ventilator in the ICU for a month and it was really touch and go for a while (my father was seriously considering withdrawing life support for a time). Now generally, 8-9 year olds aren't allowed in the ICU for generally understandable reasons, however my father was able to talk the nursing staff into letting me in (that man can talk his way into Fort Knox). When we were getting ready to leave I was waiting just outside the door the the room for my dad to finish up and the nurse started to ask me what each of the machines did to judge how much I could understand. Being a faithful watcher of Rescue 911 (yea, go ahead... laugh ), I could describe what basically each thing was doing. Because of that, that RN went to bat the next day when that charge nurse wasn't going to let me in with my Dad.

[spenac]

Depends on the call and the patients family. Sometimes getting them involved calms them down. Plus educating them as time allows can instill more trust and confidence you as the Paramedic.

[VentMedic]

We share alot with the families especially in pediatrics/neonates. If a parent accompanying their child on transport, we will brief them on the basic numbers and alarms they might hear. We will also go over the rules for the parent for safety and to remain calm or at least freak out in place and not move during tranport. How much they see and hear will be dependent on the transport mode we are using such as helicopter with 1 or 2 pilots, fixed wing or ground and where the parent will be sitting. We do not want them to be alarmed by what they hear and see especially if it is a true critical alarm. Above all we don't let them see us sweat and will continue to communicate with the family as much as possible. (Sidenote: The pilot or driver of the ambulance will know very little about the condition of the child or neonate.)

In the ICUs, the family members will eventually become as good with the monitors including identifying a dicrotic notch on a waveform as some of the staff. Everything will be explained in detail by members of different specialties such as RT, RN, MD, RRT and EEG technicians. And yes the parents will be told of the alarm parameters as to why they are set and when they become a concern for action. This is especially true in the Neuro ICU where BP, ICP and CPP are being monitored. It doesn't take long for the family to start monitoring the foley catheter and the EVD as well.

If the patient codes with the family present we will ask if they want to remain and assign a staff member with them to explain what is happening. In the past we would shove them out and slam the door in their bewildered and frightened faces. Now, the thought behind allowing the family to stay is that seeing everything done for their loved one gives them closure. A good staff member at their side may also be able to distract or prepare the parent (or other family) before the code team opens the chest or does some other shocking procedure. Of course if the family becomes uncontrollable or too distraught, the staff member will shove them out the door and remain with them.

Allowing loved ones be with the elderly patient also gives them permission to say stop when the code is starting to look brutal but the "kids" were insistent on saving their 99 y/o mother or grandmother. They too will have a better chance for closure in that they still attempted to save their loved one's life and could also agree to stopping when they realize it may not be the wisest to continue or the staff member monitoring the code with them explains "no hope of being just like the loved one they once knew".

When we do an end of life procedure or "terminal wean" as some refer to it, the procedure will be discussed with the family and it will be their choice to be present for the actual discontinuation of life support. If I know there is no spontaneous respirations without the ventilator, I may encourage them to stay with the family member because that patient will probably not last in the time it takes to get from the waiting room. If we suspect the patient will last may even for days, it might be best the family is not present until the medication can be titrated to ease the appearance of respiratory distress. But again, the family will be informed of as many steps as possible including what to expect on the monitors which may be muted but still visible.

Edited March 14, 2010 by VentMedic

[Medic One]

I tell my wife just about everything..she is an ER doc so it makes our lives much easier knowing what each one of us do.

My son is 17 and daughter is 14. They both get 90% of evrything that happens. They have been in the ER watching "mom" work cardiac arrests and she is also a medical examiner so they have had many opportunies to see the well... the ending part of life.

We express how valuable life is and are not afraid to tell them how it is when suddenly you get seriously hurt or killed because of stupidity or drinking and driving.

As far as the rest of our family we tell them some of the goods and bad but it is on a more censored fasion.

[Siffaliss]

Excellent topic.

I would certainly agree that it depends on the situation. I've only run into a couple of situations where family was simply too upset to hear anything and just wanted to watch. They wouldn't have had it any other way, and as it is *usually* their last glance at a dying relative, who am I to say they have to go sit down somewhere?

I find that most families are usually happy with hearing SOMETHING. Depending on how it's said it usually involves telling them something involving why there's a tube in their throat, why CPR is being done and that meds are being given to try and restart the heart. When asked "so their heart isn't beating right now?" or "they aren't breathing right now?", I am always honest. There is usually no need to be brutally honest (except with medical relatives who ask the questions and want the answers).

Again, always depends on situation.