Should You Stay or Should You Go?

family presence during resuscitation2Picture this familiar scene. A critically injured person is wheeled into the emergency room by paramedics. Concerned, shocked and occasionally hysterical family members rush to the patient’s side. An army of doctors, nurses and techs begin emergency resuscitation efforts, inserting breathing tubes, CPR, starting IV’s, drawing blood, administering drugs and other fluids.  One of these health care professionals, nodding toward the family and screaming “Get them out of here!”

We’ve all see it… either in real life or on TV.

Cutting to the next scene, the family is escorted into a stark family crisis room. While healthcare staff work desperately to resuscitate the patient, a social worker updates the family on their progress. If the patient dies, staff  make him as presentable as possible, and then invite the family in to say good-byes. The social worker supports the family during this difficult time, and the code team return to their care of other patients.

For decades, this approach seemed to work well. The common wisdom was that if we did let the family in during the code, they’d either get in the way or become so distraught that we’d have more patients on our hands. Furthermore, we felt we were doing the family a greater service by letting them see their loved one only after we’d removed tubes and lines, even though the calm scene we produced was in total contradiction to actual events.

But recently, this traditional approach has been questioned. It turns out that many family members want to be present during resuscitation efforts, rather than hidden away in a side room.

family presence during resuscitationAnd even though health care professionals are still divided on whether families should be present, most agree the issue must be addressed.

Now, research is starting to question whether family members be allowed to remain in the room as these potentially lifesaving efforts begin?

A two-year study led by a researcher Jane Leske PhD, has shown that family members – parents, spouses, fiancées and adult children – of trauma patients, can benefit by being present during critical moments of care.

Those who do choose to do it really want to be there,” says Leske, professor of nursing at the University of Wisconsin-Milwaukee. “They want to watch everything and get information. It lowers their anxiety and stress to see that everything possible is being done. Seeing is believing.”

However, family presence during resuscitation is controversial and underutilized. Indeed, many health care professionals and hospitals argue against it, concerned that the procedures may be too traumatic for family witnesses, or that family members may become emotionally out of control and interfere with care.

Leske conducted this study in collaboration with medical staff at a facility where families have the option of staying and observing resuscitation efforts. It compared outcomes for family members of patients, ages 18-93, with critical injuries from gunshot wounds or motor vehicle accidents at a Southeast Wisconsin Level 1 trauma center.  The center had offered family presence during resuscitation for more than two years by the time Leske’s study began.

cpr_pr.299225225_stdThe study focused on 140 family members over age 18, divided in two roughly equal groups – those who opted to remain with the victim during resuscitation; and those who chose not to, or were not able to reach the emergency department in time. Researchers interviewed family members within 72 hours after admission to the surgical intensive care unit, to discuss the family’s coping resources, communication and anxiety levels.

She and her research team found a number of benefits to having family members present, and no drawbacks.

They concluded that while families can benefit from being present during resuscitation, it’s also important that the hospital have policies and procedures in place on when and how to allow the option. For example, family presence during resuscitation should not be permitted when family members are intoxicated, extremely agitated or emotionally unstable.

Other researchers agree. A large French study published last month in the New England Journal of Medicine concluded that relatives who did not witness CPR had post-traumatic stress disorder (PTSD)–related symptoms of anxiety and depression more frequently than those who did witness CPR. Family-witnessed CPR did not affect resuscitation characteristics, patient survival, or the level of emotional stress in the medical team and did not result in medico-legal claims.

What are your thoughts on this?  Would you want to stay…or walk away.  Let us know.

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SATS & CPR

Go Gov. Beverly Perdue!  SRxA’s Word on Health applauds the North Carolina Governor who has just passed a law requiring all high school students in the state to have basic emergency-response training before they can graduate.

Although high schools have been required to teach CPR since 1997, until now this has been unenforced.

But starting with the class of 2015, the bipartisan plan requires that schools teach American Red Cross or American Heart Association curriculum for cardiopulmonary resuscitation and obstructed airway treatment.

The new law comes as great news to Tracey Stell, assistant director of education services at Durham Regional Hospital.  “It melds wonderfully into Durham County’s strategic plan to increase the rate of bystander CPR and it’s really going to help people get more immediate care, which will make a difference in survival,” Stell said. “You shouldn’t have to wait for an ambulance to arrive for CPR to start. Man, that’s a huge win.”

The new law signed on Thursday joins another aimed at saving lives: a law requiring at least one defibrillator kit in every state building in North Carolina and training for state employees to use them.

North Carolina joins four other states that have signed CPR graduation requirements into law this year: Iowa, Alabama, Tennessee and Minnesota.

By making CPR as important as ABC’s, we hope the next generation of students will be better equipped to start college life and save the lives of others.

I Spy an AED

SRxA’s Word on Health loves a good challenge – and they don’t come much better than this.  A group of researchers from the University of Pennsylvania are set to save lives with cell phone cameras… and they need help.

The MyHeartMap Challenge, will be a month-long contest starting in mid January. It will invite Philadelphians to the streets and social media sites to locate as many automated external defibrillators (AEDs) as they can. AEDs are lifesaving devices used to deliver a controlled electric shock and restore normal cardiac rhythm following a heart attack.  AED’s are widely used in hospitals and by pre-hospital providers such as EMT’s; but they can also be used by people with no medical training since they provide audio instructions that talk users through the process of performing CPR and defibrillation.

There’s an estimated one million AEDs across the nation. Some are hung clearly on the walls in airports and casinos, but others are tucked away in restaurant closets and under cash registers in coffee shops. Since  AEDs are not subject to regulations that would allow their makers to know where or when their devices are being used there’s currently no uniform system to track their location.

The contest hopes to change that.  Furthermore, it’s just a first step in what the Penn team hopes will grow to become a nationwide AED registry project that will put the lifesaving devices in the hands of anyone, anywhere, anytime.

Armed with a free app on their mobile phones, contest participants will snap pictures of the lifesaving devices wherever they find them in public places around the city. Contestants will then use the app to geotag the photos with their location and details about the device and send them to the research team via the app itself or the project’s web site.

The data collected will be used to create an updated app linking locations of all public AEDs in the city with a person’s GPS coordinates to help them locate the nearest AED during an emergency.

Better still – the person or team who finds the most AEDs during the contest will win $10,000. Additionally, people who find various pre-located “golden AEDs” around the city will win $50.

More and more, scientists are learning that we can benefit from the wisdom of the crowd,” says MyHeartMap Challenge leader Raina Merchant, MD, Assistant Professor of Emergency Medicine. “Participation from ordinary citizens will allow us to answer questions and make the city safer than our team could ever do on its own.”

MyHeartMap Challenge participants can register as individuals or teams, and the Penn researchers suggest participants develop creative ways to maximize their chances of winning. If, for instance, a team can figure out how to use their social networks via Twitter and Facebook to engage people who work in public locations in Philadelphia to take photos of AEDs, the team could win $10,000 dollars without even leaving their desks. These “virtual teams” could prove to be faster and more efficient than any individual working alone. Participants can also organize AED scavenger hunts or mini-contests to locate all the AEDs in a workplace building, or compete against friends to see who can find the most devices. The researchers encourage participants to start strategizing and forming teams now so they can be first out of the gate to win.

What are you waiting for?