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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Honoring Our Military

Today, Veterans Day, our nation honors the men and women who have served our country. Cities host parades, department stores have sales, schools and the Federal Government close. Most of us are thankful for a day off. But how many of us will stop and think about the tremendous sacrifices made by those in the military community – the risks they take and the burdens they carry? And how many of us will take the time to reflect on how families and lives are forever changed as a result of war?

Since September 11, 2001, over 2 million men and women have deployed to fight the wars in Iraq and Afghanistan – many of these have deployed multiple times.  During this time, countless family members have suffered through multiple separations. And let’s not forget the 5,798 American men and women who have died during these wars or the 40,000 who have come home with significant physical injuries. In addition, many of our troops come home with invisible injuries of war including post traumatic stress, traumatic brain injury, depression and anxiety.

Sadly, a large number of those who suffer these invisible injuries fail to seek the care that they so need and deserve. The stigma associated with seeking mental health care and our cultural reluctance to admit mental health concerns prevents many of the brave men and women in our armed forces from obtaining proper treatment.

Families are suffering. A recent study in the journal, Pediatrics, found that young children in military families are about 10% more likely to see a doctor for a mental health difficulty when a parent is deployed than when the parent is home. Social scientists have long known that the cycle of deployment and reintegration puts a significant strain on the families of those who serve, particularly spouses. Given that the conflict in Iraq has been underway for over seven long years, tens of thousands of military children have only known the experience of war.

While most civilians are familiar with the terms “post traumatic stress” and “traumatic brain injury” it is striking how little the average person knows about these very understandable, yet potentially devastating, consequences of war.  Movies and television programs often portray veterans suffering with post traumatic stress as out-of-control and hyper-aggressive. While difficulties with impulse control and rage are indeed possible manifestations there is a range of other symptoms and reactions that are less well known. Some withdraw and become disengaged from those around.  Others have difficulty finding meaning in life, while others may experience anxiety, flashbacks and severe sleep disturbance. Sometimes the painful mental health symptoms that result from the experience of war lead to self-medication and substance abuse and suicide. Then there is the dramatic increase in the number of suicides reported by active duty personnel as well as those who have separated from the military.

Some members of our military community come home to families that cannot possibly understand what they have seen or done. Unable to bridge the gap between who they were when they deployed and who they are upon return, our service members find themselves in relationships that falter and marriages that fail.

But there is reason to hope. Many within government and Veterans Affairs, the academic community, the nonprofit sector, the entertainment industry, and caring individuals in communities across the country are stepping up to assist those who serve our country and their families.

The rest of us can help by recognizing and accepting psychological injuries of war and encouraging our veterans to receive proper care and treatment in a timely manner.  Together, we can stem the tide of suicides and save hundreds of thousands of service members who have come home from war with injuries that they alone cannot heal. In order to be successful in this mission, however, we must harness the goodwill, the knowledge, the resources and the commitment of a thankful nation that recognizes the sacrifices made by so few for so many.

SRxA’s Word on Health would like to honor and thank all of our Veterans.

Mood Monitoring

Word on Health was interested to hear about a simple, free online diagnostic tool that helps patients and primary care doctors screen for four common psychiatric illnesses: depression, bipolar disorder, anxiety disorders and post-traumatic stress disorder.

Developed by M-3 Information and validated by researchers at the University of North Carolina at Chapel Hill, the 27-item questionnaire can detect a mood disorder with approximately 80% accuracy.

This is good news for the 1 in 10 Americans who suffer from depression and other mental-health disorders but never receive treatment because they don’t understand what’s wrong.

Bradley Gaynes, M.D., M.P.H, lead author of the study and an associate professor of psychiatry in the University of North Carolina at Chapel Hill School of Medicine said “For millions of people, a single tool that can screen for multiple disorders would be very helpful.”

M-3 has also developed a mobile phone version of the checklist that will be released shortly.  In the meantime, Word on Health readers can take their mental health pulse at http://www.mymoodmonitor.com/