This post is a cooperative joint topic with two widely respected EMS bloggers, Steve Whitehead from Http://www.TheEMTspot.com and Greg Friese, from Http://www.EveryDayEMStips.com Ė Our topic is supposed to be on why it is that EMTs, Paramedics, and other healthcare providers will sometimes ďgo through the motionsĒ and continue on with futile resuscitations with pediatric cardiac arrest victims. Iím sure that they will have very insightful posts on the topic, as they always do. Hereís my take.
Can someone say ďemotionally chargedĒ?
One of the truths about where Iím sitting right now is that Iím chained to a lot of potential responsibility. Today, like a lot of days Iím one of two paramedics on-duty in my service area and the next call is mine. No matter what the next call is, it is my responsibility to get up and answer that callÖ without regard the horror that fate may be sending me to bear witness to and intervene in. All medics have to accept this inherent part of the job. One of the worst of those possibilities is that it may be a call that involves the significant injury or illness to, or even the death of a child.
Mention the possibility of a childís death to even the most cynical and seasoned of healthcare providers and you will send a very cold chill down their spine. Itís just horrible. For me, the blessedly rare times that Iíve lost a child have been sentinel events in my life, things that are often thought of but rarely spoken ofÖ almost always spoken of only to comfort the pain of a colleague experiencing the same thing. The loss or suffering of a child just burns into our souls and leaves an indelible scar that only someone who has experienced it can have true empathy for.
And I for one, wish that I didnít have the empathy that I have for it.
Heaven forbid that I ever have to be one of the parents with pleading eyes at one of those tragic and traumatic scenes. I just canít imagine what they go through when Iíve said ďIím SorryĒ. I canít imagine their pain, and frankly I donít want to. As a parent myself the thought is blocked from my conscious mind and relegated only to the deepest recesses of my subconscious fears. Losing an adult patient is one thing, as we humans come to know that our lives are fragile and that our price of admission is to be removed from this existence. Itís a knowledge that we get as we progress through life and gain the experiences, both good and bad, that make us who we are and will become. However, the terrible thought that one could be ripped from us in their age of innocence is an affront to everything that almost everyone holds dearÖ and itís more than a lot of us can bear to make the last decision of a childís life. Instead, we try. We try hard and we keep trying. We hold out hope against thought and fight on, sometimes against futility.
But in my mind, I think I know why it isÖ because no healthcare person wants to be the person who looks into those pleading eyes and says ďIím sorryĒ. That decision takes an enormous emotional toll upon the parents and family, of courseÖ but also upon the EMT or Paramedic. Itís ultimately easier on us as EMS people, we reason, to fight on. To race headlong into futility and hold out hope that someone else wonít have to say ďIím sorryĒ. At least we wonít have to.
There are probably psychological studies out there that I havenít read that deal with the issue of whether ďCPR TheatreĒ is harmful or helpful to the long-term well being of the surviving family. †These studies are probably well-researched. I took a class once that told me that it was better for family members to be in the resuscitation room inside of a hospital to witness the events as healthcare people try to save their loved onesÖ and I can understand that I guess. Perhaps it is better to witness that ďeverything possible was doneĒ for your departed loved one. I donít know.
As healthcare providers, it is our sworn duty to alleviate suffering as best we can using the tools at our disposal. I, like most of my colleagues, realize that the secondary and tertiary patients that we treat are the family members and their grief reactions to the tragic circumstances that resulted in their calling us. I am reasonably comfortable handling their grief reactions and sadness when an adult passes on scene but I am humbly inadequate to be of much comfort to a parent that has just lost their child no matter how I might try.
My guess that futile CPR theatre can be explained as being more for the parents and families of departed children than it is for the slight chance that we might have missed something. We make the effort in the name of showing to the family members that ďeverything possibleĒ was indeed done, up to and including running their child lights and sirens to a hospital. Iíll even admit that in the back of the ambulance while Iíve done this, Iíve prayed right along with the family that just perhaps this once we would have a miracle. Never once has it happened.
Hereís a mea culpa for you, even though every time Iíve gone through the motions Iíve said it was for the familyÖ †It may really have been for my own benefit as Iíve stated it could be above. I am a paramedic and Iíve seen my share of pain, but I donít think that I can look a parent in the eyes and say ďIím sorryĒ ever again. I just donít want to and as I write this, I canít imagine that I could do that and then come back and look the guy in the mirror in the eyes without wondering if maybe this time wouldíve been the miracle. I am probably selfish for this practiceÖ but is that wrong?
From a completely actuarial perspective, no futile resuscitation should be performed due to safety concerns and the unnecessary costs involved. I agree that with adults, transporting cardiac arrest victims is probably deadly. I also understand that no ambulance should risk a lights-and-sirens trip to transport a body to the emergency room. However, I am not an actuary. In those cases Iím a witness to horrible emotional pain and I want someone else to be the one who says ďIím sorryĒ. Itís human nature, perhaps.
In my career, I have told parents ďIím sorry, thereís nothing I can doĒ in cases where it was blatantly obvious that the child was long beyond hope of any intervention. Iíve done it more than once and I can see the places where Iíve done it in my mind to this day. Sometimes itís completely obvious that there is indeed nothing that anyone can do. However, occasionally I have indeed known this and just done it anyway. Perhaps itís completely subjective. Perhaps it was my level of experience and intuition that guided me at the times Iíve made the decision. Iíll tell you this, it certainly wasnít a decision made from the pages of a textbook.
I donít have the answers to this. But I do want to go home and hug my kid. My only advice to the EMS people out there is to realize that weíre all human, and that all you have to do is your best. Be compassionate, and use your best judgment. For thatís all we can ever do.
For more on this powerful topic for EMS, head over to Greg Frieseís page and also to Steve Whiteheadís page. You also may want to read ďSplashed Sadness Ė A look at Negative Emotions in EMSĒ where I further explore the sad side of EMS and our reactions to it.