In the Midst of Life

the serious illness or death of a loved one, especially when they can see that everything medically appropriate has been done. The disadvantage is that the reality of resuscitation may prove distressing, particularly if it is traumatic or if they are uninformed. Furthermore, they may physically or emotionally hinder the staff involved in the resuscitation attempt. However, it seems likely that for many relatives it is more distressing to be separated from their family member during these critical moments than to witness them. From the patient’s point of view, most would probably want to have their family present but it would be unusual for the patient to have expressed an advanced directive stipulating the inclusion of specific relatives, partners, carers or friends. For the clinical staff undertaking resuscitation, the presence of relatives could increase stress, affect decision-making, and affect the performance of the staff involved. On the other hand, verbal or physical interference by a relative could be prevented by close supervision and restriction of numbers.
    Progressives believe that relatives or partners should be given the opportunity to be with their loved ones at this time, and proper provision must be made for those who indicate that they wish to stay. If resuscitation is to be witnessed by relatives, partners or carers, it is essential that they be supported throughout by appropriately trained clinical staff, and that the resuscitation team leader is prepared for and aware of their presence. Every hospital should have a written policy about the procedure to be followed when relatives, partners or carers request to be present during cardiopulmonary resuscitation and this would normally be the responsibility of the local Resuscitation Committee.
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    Summaryand conclusions
    Modern resuscitation methods and techniques date from the many major advances in research and development of medical practice in the 1950s and 1960s. Changes since then have mainly resulted in improvements in existing procedures, rather than in the development of new medical treatments; consequently, improvements in the outcome of cardio-pulmonary resuscitation have been relatively small. The introduction of cardio-pulmonary resuscitation in the 1960s, as with many new drugs or medical procedures, resulted in initial scepticism, followed by enthusiasm, leading to over-enthusiasm and over-use, until a more precisely defined usage becomes established. With the development of procedures, medical practice has run ahead of many of the moral and ethical issues involved in resuscitation decisions. Most of these issues, such as the applicability of Do Not Attempt Resuscitation orders and Advanced Decisions, are now being reassessed so that they come into line with current medical practice.
    In general, the success rates of cardio-pulmonary resuscitation remain disappointingly low, especially in out-of-hospital resuscitation, and it does not seem likely that developments in the near future will substantially help to improve the situation. In my view, the most helpful development would be for clinicians to be able to define in advance which people and which conditions are most likely to have a successful outcome, and which will not; there is an obvious need to be more selective about for whom, when and where we undertake cardio-pulmonary resuscitation although this is clearly much easier to do for patients in hospital.
    Sudden collapse and death are in fact very rare in healthy people, and are probably becoming even rarer in countries that have falling mortality rates from heart disease. The greatest challenge is to understand when there is likely to be little or no benefit from cardiopulmonary resuscitation, and to identify more systematically those people in advance. By doing this, death could be managed in a better and more humane way – which is the whole point of this book.
    In the end, doctors cannot cheat death; we can only delay it.

THE PARAMEDIC’S TALE
     
    ByLouise Massen, Clinical Team Leader, Thameside Ambulance Station, South East Coast Ambulance Service (SECAMB)
     
    I joined Kent Ambulance Service on the i April 1993.I am second-generation ambulance service and absolutely love my job with a passion! There is nothing else I ever want to do.
    We received a three-month residential training course, which was run by a specialist ambulance training college. The course encompassed emergency driving, manual handling, and the