Family members should not be at the bedside during resuscitations

By Rashmi Kothari, MD, FACEP

Assistant Professor

Department of Emergency Medicine

University of Cincinnati Medical Center

Cincinnati, OH

When a procedure needs to be done, the last thing I need is somebody jumping up, saying, You’re hurting them.’ Well, putting in an IV hurts sometimes, but it’s something that needs to be done, and that is a mild example. It would be different if I was a family doctor and already had a relationship with the family already, but in the ED I don’t know any of them, or how they’ll react to it.

There’s also the issue of transmission of information. If people are concerned about medical-legal issues, that means there’s less information coming in to the person who’s making the decisions. When you have family members there, I’m going to be careful what I say, and so are my colleagues.

I’m also not sure family members want to be there during the resuscitation. If you were asked the question, "Do you want to be with your loved one as they pass away?" most people would say, "Sure." On the other hand, if [they] were asked if they wanted to watch us putting in an IV, intubating them, doing a rectal exam, or putting in an NG tube—let alone a thoracotomy or cricothyrotomy—the answer might be different. We can have the family step in and out, but that’s wasting personnel. Who’s going to be watching the family?

Here’s a perfect example: A patient came in with an MI, I gave him some thrombolytics and he was doing fine, I had the wife in there talking with him. All of a sudden he went into ventricular fibrillation, and I grabbed the paddles and shocked him. He came out of it, groaned and moaned, then went back into it. I shocked him again. That’s when I looked over and saw the wife sitting there with her jaw on the ground, staring blankly. I said to a nurse, get her into the waiting room. After I resuscitated him, and brought her back and talked to her. But there was definitely anxiety on my part with having her there—what’s going through her mind?

When I don’t know whether the patient is terminal or not, I don’t think that’s a good time to try dealing with family and those issues. I understand the concern for family and that they want to be with their loved one. On the other hand, my first responsibility is with the patient.