Should You Stay or Should You Go?

Picture 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.

And 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.

The 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.

Let’s NOT Go Surfing Now

When the Beachboys sang ‘Everybody’s Gone Surfin’ I’m fairly sure they were thinking about waxed boards, shaggy blond hair and ocean waves.

50 years later surfing is a term also associated with browsing the web and more recently with the increasingly popular teen past-time of clinging to the exterior of a speeding car.

The “sport” of car surfing is alarming health experts. National statistics have shown a steady rise in car surfing fatalities. According to the Centers for Disease Control and Prevention (CDC), since 1990, at least 99 people have died or sustained serious injuries as a result of car surfing.

“Broken bones and road rash – severe skin abrasions caused by impact from a fall – are minor injuries from car-surfing,” said Thomas Esposito, MD, chief of the Division of Trauma, Surgical Critical Care and Burns in the Department of Surgery at Loyola University Medical Center. “Head injuries are very prevalent and the effects are devastating.” Young people believe they are invincible but several seconds of thoughtless, risky behavior can lead to a lifetime of permanent disability or even death.”

The national rise in car surfing fatalities corresponds with the introduction of media depictions of the activity in movies, video games and in social media “For those desiring their five minutes of fame, social media such as YouTube and Facebook offer perceived fame and instant gratification,” said Esposito. “Replicating a dangerous stunt and capturing it with a cellphone may seem like a cool idea but can have serious long-term consequences.”

According to the CDC, males are more likely to car surf than females and the average age of persons injured as a result of car surfing is 17.6 years. A larger than average proportion of injuries occur among teen males ages 15 to 19. Injuries have been reported in 31 states, with 39% of these coming from the Midwest and 35% from the South.

Esposito notes that one of the key risks is sudden, unanticipated car maneuvers such as accelerating, swerving or braking, that can force a car surfer off of the vehicle. “People who fall off a moving vehicle may suffer brain contusions, broken bones, fractured skulls, loss of consciousness, internal bleeding, paralysis and death.”

Parents take note! If your teenage son asks to borrow the car to go surfing, just check he’s got his board and is headed off to the beach.  Car surfing is a dangerous game with stakes that are too high if they lose.