Emergency medical service providers’ experience with family presence during cardiopulmonary resuscitation

Summary

Objective

To describe emergency medical service providers’ experiences with family member presence during resuscitation, and to determine whether those experiences are similar within urban and suburban settings.

Methods

We conducted a personally distributed survey of a convenience sample of urban and suburban emergency medical service (EMS) providers presenting to two Midwestern Emergency Departments. Providers were questioned as to their experiences with resuscitating patients in the presence of family members.

Results

There were 128 respondents to the survey (59 urban and 69 suburban), of which 70.1% were EMT-Paramedics. No provider who was approached refused participation. Nearly all (122) had performed CPR in the presence of family members, with most (77%) performing greater than 20. Subjects averaged 12.3 years of experience. The majority of urban and suburban providers felt it was inappropriate for family to witness resuscitations (75.9% versus 60.3%, respectively; p = 0.068). Many providers reported feeling uncomfortable with family presence (31.5% urban versus 44.8% suburban; p = 0.136), and few preferred that family witness the resuscitation (13.2% urban versus 15.4 suburban; p = 0.738). A minority of providers believed that family were better prepared to accept the death of the patient (37.0% urban versus 37.6% suburban; p = 0.939). Approximately half felt comfortable providing emotional support (66.0% urban versus 53.7% suburban; p = 0.173). Many felt that family caused a negative impact during resuscitation (53.7% urban and 36.8% suburban; p = 0.061). Urban providers more often reported feeling threatened by family members during resuscitation (66.7% versus 39.7%; p = 0.003), and felt that family often interfered with their ability to perform resuscitations (35.6% versus 16.4%, p = 0.014).

Conclusions

EMS providers have substantial experience with family witnessed resuscitations, are uncomfortable about their presence, and often must provide support for families. While urban providers tended to report more negative experiences and perceptions, there were minimal differences between the two groups.

Introduction

The American Heart Association has recommended in their Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care that whenever possible, health care providers should offer family members the option to remain with their loved ones during resuscitation efforts. The benefits of family presence have been proposed to include removing the family's doubt about what was happening to the patient and knowing that everything possible was done,1, 2, 3, 4, 5 feeling they had supported and helped the patient,2, 3, 4, 6, 7, 8 maintaining patient–family connectedness and bonding, reminding health care providers of the patient's personhood,⁴ reducing their own anxiety and fear, coming to closure on a life shared together,2, 4 and facilitating their grieving.1, 2, 3, 5, 6, 9, 10, 11, 12 Reports suggest that family members are amenable to this practice, and would do it again in a similar situation.3, 4, 7, 9

Despite the growing movement toward including family members as witnesses to resuscitation attempts, there has been an absence of research conducted on bystander and patient outcomes, as well as medical providers’ experiences associated with this practice. To address the latter of these concerns, we sought to describe the experiences of emergency medical service (EMS) providers, who have extensive experience and perceptions with family witnessed resuscitation attempts. In addition, we attempted to determine whether differences in these experiences and perceptions exist between urban and suburban EMS providers.