Communication And Counseling For Survivors

In many cases, the communication, care, and counseling provided for survivors (family, friends, and the like) of victims of cardiac arrest will have more impact than the actual resuscitative efforts. A majority of emergency physicians find the notification of death to survivors emotionally difficult. 24 Optimum care should be provided for families and friends of victims of cardiac arrest, regardless of the level of treatment rendered and outcome. Some general guidelines for such support might include the following:25,26

1. Give advance warning, if possible. During the resuscitative efforts, a member of the health care team should communicate the gravity of the patient's condition.

2. Provide a private, quiet location for communications.

3. Spend adequate time in counseling and in answering questions.

4. Use clear and succinct language. Often medical jargon is not accurately understood. It is generally appropriate to use straightforward language, such as "died" and "death," rather than "didn't make it," "passed on," and the like.

5. Use proper names of the deceased and family members.

6. Accept any reaction as normal. Even unexpected reactions, such as apathy, anger, and hysteria may not be inappropriate.

7. Don't hesitate to show emotion. Families may benefit from sharing emotions.

8. Reassure loved ones that the patient likely did not suffer.

9. Attempt to absolve any guilt feelings. It is generally inappropriate to suggest that a different course of action (calling 911 sooner, different actions by prehospital personnel, and so on) may have changed the outcome.

10. When appropriate, discuss organ donation. Many families find organ donation a positive experience.

11. Allow the family to view the body. This may provide some closure and aid in their acceptance of the death.

12. Utilize additional resources when appropriate. These may include social work, nursing, psychiatry, clergy, or other ancillary and support staff.

13. Invite further questioning. The emergency physician may serve as an important resource for future concerns or questions that may arise.

Recently, some facilities have allowed family members to be present during the resuscitative phase of a dying child or adult. The practice is growing but remains controversial.

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