Pre-hospital resuscitation: what shall we tell the family?

Pre-hospital cardiac arrest makes up a relatively small percentage of overall ambulance workload, although its technical management is given an understandably high level of importance on paramedic education programmes. Student paramedics can spend many hours being taught relevant theory, and then put into practice cardiac arrest management in various scenarios. However, despite the emphasis on assessment, treatment and the honing of associated psychomotor skills, they may never meaningfully discuss or practice dealing with family members present. This aspect of care is largely left to individual practice and experientially driven. Paramedic exposure to cardiac arrest is rare and even declining in some systems (Dyson et al, 2015). It would be unsurprising that when paramedics do attend a cardiac arrest call their overall capacity to deal with it is largely taken up with focused patient treatment, leaving family or friends present sidelined.

Of the 10 211 out of hospital cardiac arrests in London in a 1-year period (2014–2015), 4 665 involved attempted resuscitation with 414 discharged alive (Virdi et al, 2015). Despite survival rates improving, pre-hospital cardiac arrest has a very poor prognosis. While it is right that paramedics do not compromise direct patient care, this reality should challenge healthcare professionals to think more widely about who they need to care for, and consider more broadly who constitutes their patient.