One of the most horrifying things anyone can go through is to watch a loved one suddenly die. The memory of this event may remain painfully vivid to family members, who will also remember everything you did or said on scene.
Medic 1 (two paramedics) responds to a call for an unresponsive male. Thornton First Aid Squad also responds with three volunteer EMTs and is first on scene. They initiate CPR and notify dispatch of their patient’s status. Eight minutes later, the medics arrive and enter the house.
They find a 62-year-old male on the floor with CPR in progress. Three distraught family members tell the medics that they were downstairs watching TV when the patient went upstairs for a few minutes. At the next commercial break, he was found unresponsive. The family did not initiate CPR.
The patient is in asystole and treatment continues per ACLS. Medical control is reached by phone and the doctor wants the patient transported.
As the crews carry the patient from the house, his wife tearfully asks if he will be alright. The need for reassurance in her voice is palpable and heart wrenching. Mike, one of the EMTs, says, “Don’t worry, ma’am, he’s going to be fine.”
The medics exchange glances, but they are too busy to say anything. As the patient is loaded onto the stretcher, one of the medics, Dean, is able to speak to the family. He explains that the EMT misspoke and the patient is not going to be okay. In fact, there is a good chance he will not survive. He tries as clearly as he can to counteract Mike’s statement and believes that the family has a clear picture of the outcome. He says nothing to Mike, but gives him a look that requires no explanation.
Later, at the hospital, when the patient is pronounced dead, the doctor goes out to tell the family. He is shocked when the wife shrieks, “They said he was going to be OK!”
It’s clear that the wife heard only what she wanted to hear. Once the statement was made, nothing that Dean said could change her belief that the patient was “going to be OK.” Lying to or misleading the family was a grievous error. The medics failed to take control of the flow of information and an inexperienced person filled that void. The EMT was also hurt once he realized what he had done and suffering the scorn of the medics was only salt in the wound. Educating him would have at least helped on the next call. It is not always possible to know what the people you are working with will do or say. Communication is the key. If one person is clearly in charge and verbalizes a plan, the other team members will probably not feel a compulsion to alter treatment or information. A silent scene is a recipe for misunderstanding, miscommunication and frustration and stands in the way of coordinated and focused patient treatment.
Speaking to the family as soon as possible is critical. Once the treatment has commenced and there are enough personnel to continue, someone should break off to update the family. Preface bad news with a warning, such as, “I’m sorry to have to tell you this” or “I’m afraid I have some bad news.” This softens the blow and allows them to transition their feelings. You can continue with: “Right now, your husband has no pulse and is not breathing. We are doing CPR and breathing for him. His condition is very serious and you should prepare yourself for the fact that he may not survive. We are doing everything we can to save him. It is possible he may improve, but at this point, I can’t say what will happen. I’m sorry to have to tell you this, but I want to be honest with you.”
I have found this prepared speech, with variations, to be an effective way of trying to comfort the family while still being honest. If you notice, the negative statements are balanced with the positive ones. He’s pulseless, but we are doing CPR. He is critical, but we are doing everything we can. He may not survive, but he may improve. I’m sorry, but I want to be honest. If your statements are primarily positive, they will ignore the negative ones, but if your statements are primarily negative, they might be angry with you if the patient survives.
Many people seem to think that CPR is the cure for being dead. Everyone on Baywatch who drowns pops up from the sand five minutes later in time for hugs and kisses all around. We know better, and it is our job to make sure the family understands the seriousness of the patient’s condition.
Empathy is the most important part of providing emotional support to the family. Let them know you understand their grief. Many areas have patient advocates or counselors who can come to the scene to help the grieving. Facilitate their arrival if necessary.
Discuss your concerns with other responders and agree on a plan. Don’t leave the scene until you know that the patient is being cared for in some way, and that the family has sufficient emotional support. Don’t discount the physical effects of grief, and keep an eye on any family member who seems to be manifesting any physical complaint.
Offer to notify other loved ones by phone. This is often one of the first things people want to do, but they may not be in any condition to speak clearly. If they are sobbing and unclear on the phone, this can create panic and worsen the situation. If you volunteer for this, be sure to introduce yourself, explain where you are and who you are with, and tell them what has happened. Ask if there is anything you can do or any message to relate, and if they are coming to the scene or the hospital, always remind them to drive safely.
Good customer service means that patients receive all treatments appropriate to their condition in a timely and competent manner. It also means that everyone on the scene understands what happened. A volunteer on their first code might be devastated that the patient died, but if everyone else looks fine, they keep it inside. Once outside the scene, take a minute to talk with others and see how they are doing. Don’t forget to ask yourself as well!
Taking a few minutes to attend to these details will be much appreciated by the family. If they can have the peace of mind that everything possible was done, it will greatly help their emotional healing.
Paramedic and nurse Chris Hendricks has been in EMS since 1994 when he joined the Ortley Beach First Aid Squad. When he authored this article, he was a field instructor with Pridemark Paramedics Services in Boulder, CO. He now works as a paramedic and ER nurse, and serves with the Wyoming Air National Guard as a flight nurse. He will be receiving his Masters of Science in Nursing Education in summer 2011 and is a certified emergency nurse and a certified forensic nurse.