Marc Colbeck, CCP, on a paramedic's view of chaplains and codes

A Different Voice on Family and Chaplain Presence at Codes

I am a Critical Care Paramedic with 13 years and (my best guess) about 500-700 cardiac arrests worth of experience. As a paramedic, usually the highest trained medical professional on scene, it has been my responsibility to run the cardiac arrest, perform the most invasive procedures and, most relevantly, to decide who gets to stay in the room (or the ambulance) and who doesn't.

I was very interested to read Dr. Peery's article and appreciate his explanation of the difficulties involved in this situation, as well as his suggestion to err on the side of allowing the family to be present during the code. When I first started running codes, I have to admit that I was pretty overwhelmed, but as I became clinically comfortable, I started to pay focused attention to the family and friends of the patient, as well as to the other providers who participated in running the code.

My experience has been that with the appropriate attention, it is almost always a positive situation to have the family present during codes, as long as this is what they choose.

There is a definite knack to speaking to people witnessing their loved ones being resuscitated and I think that chaplains have a meaningful role to play. Important elements of a code include letting the loved ones know exactly what is going on ("Their heart has stopped and right now they're not breathing, so we have put in a breathing tube and are breathing for them, and we're doing CPR to make their heart pump blood"), what we are doing ("We’re about to give some very powerful drugs that we hope will restart their heart, it will take a few minutes to see whether or not they work" or "We are going to defibrillate, which means we are going to put a small amount of electricity into their heart to see if we can reset their heart's electrical system and make it work normally"), what we hope to accomplish by these actions ("Hopefully their heart will start beating due to the drug stimulation and oxygen we're giving them" or "We should see right away if the defibrillation works; we'll see the results on this screen here. I'll tell you what happens") and finally a realistic prognosis for their loved ones, this includes pronouncing death as well as (quite often) letting the family know that even though we started their loved-one's heart again, it doesn't guarantee that their brain will have survived the arrest. They may never wake up.

I'm glad to see chaplain's actively examining their role in a cardiac arrest – I would LOVE to have chaplains working with us in the ambulances!

If I could offer advice to anyone wishing to provide support to witnesses of cardiac arrests (friends, family and medical professionals, too) it would be to first of all ensure that YOU are comfortable in this setting. It's difficult to watch people die, and many of our own deeper issues can be triggered during a code. Secondly, it would be helpful to clarify ahead of time what the chaplain's role is with the medical team. The chaplain may know this, but this information isn't included in our medical education, so we clinicians need to have an idea beyond "they're here for the family." I would also strongly suggest that a chaplain learn in a general way what is going on medically in a cardiac arrest and practice how to present this simply, factually and helpfully to friends and family. Perhaps a focused, one-day seminar with a willing doctor or nurse could be set up to convey this information. I see this as an invaluable role that chaplains could play. I can't imagine a clinician being upset to hear a chaplain describing why a patient is being intubated or defibrillated (which are both distressing to watch and are important to explain). At the same time, as a clinician there are things that I need to tell the family. I don't want a chaplain to pronounce death before I do! This is the sort of teamwork that needs to be established ahead of time.

Finally, a chaplain needs to be aware of the state of the medical providers involved in the arrest. Many of us are actually quite comfortable with 'routine' cardiac arrests, but I still hate watching children die. It gets me every time. A sensitive chaplain could offer a word of support or a chance to share a coffee with providers if they seem to need it, especially if a trusting relationship has been set up in advance.

Thank you for making for publication available on the Internet, I find it very interesting. I hope my comments are in some way helpful.

 

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