A common question from students in classroom training programs, especially when I teach CPR, goes something like this:
“My last instructor told me that sometimes they go through the motions of doing CPR, even when they know it is futile, for the benefit of the family. Do you ever go through the motions?”
Many times the student will offer an example that is some variation of “the instructor said they responded to a SIDS baby. ‘The infant was cold to the touch, had obviously been dead for hours, but since mom or dad were so upset we went through the motions’ of doing CPR.”
In the moments I realize the question is being asked and the student finishes asking the question I usually find myself breathing in deeply and trying to maintain my composure because this question always makes me angry. After an uncomfortable pause at the end of the question this is how I begin to answer:
Another uncomfortable pause.
“No. I never go through the motions. Never.”
Another uncomfortable pause.
I want that last statement to really soak in … I never go through the motions … so they consider what going through the motions means. Not just for CPR but for all the possibilities like patient assessment, equipment checks, washing the ambulance, or writing patient care reports.
As they think through the final uncomfortable pause I begin the full explanation.
“This is why I never go through the motions …
Going through the motions to do CPR when the patient is obviously dead assumes that the family wants you to go through the motions. Are you willing to look over at mom, dad, son, daughter, spouse, life partner, whoever and say “I am just doing chest compressions or sticking this tube in their mouth because I am assuming you want me to go through the motions even though I for sure know and you probably know that this person – your wife, husband, son, daughter, friend, life partner, whoever – is obviously dead.”
The other reason I believe that some EMS providers go through the motions of doing CPR on a corpse is it delays the difficult and uncomfortable conversation that their loved one is dead. That conversation is never easy. Most of us have had little or no training on how to start that conversation. Don’t substitute going through the motions to provide the most appropriate action.
Explaining that the patient is dead is not doing nothing. It is doing the right thing at the right time. By going through the motions you are delaying what you should really be doing – having a plain English no cliché conversation, that the patient is dead.
Sometimes doing all you could, is explaining the patient is dead. If asked, you can also explain how you know the patient is dead.
Going through the motions can also be wildly dangerous for the EMS crew, firefighter or police officer that gets drafted to drive the ambulance, and the citizens driving and intersecting with the route of travel to the receiving facility. If your service is transporting pulseless patients – with very few exceptions – you need to have a very serious conversation with your service director and medical director immediately to discuss why going through the motions to transport pulseless patients is dangerous and potentially lethal.
So there are three reasons to never go through the motions:
1) Don’t assume the family wants you to go through motions when you know better.
2) It delays the difficult conversation to inform the family/witnesses that the patient is dead.
3) Transporting pulseless patients is wildly dangerous.
After that recap I conclude the answer by asking the class to tell me reasons not to start CPR and reasons to stop CPR once it started.
Never go through the motions.
Since I feel so strongly about this question about “going through the motions” I invited my friends Steve Whitehead, theEMTSpot.com, and Chris Kaiser, LifeUndertheLights.com, to write on this same topic. They both graciously accepted. Please visit their posts and leave your comments on the topic here or at their posts. If you decide to write your own blog post on this topic let me know and I will add your post to the list of links.
Tim Noonan, the Rogue Medic, responded to our posts with an explanation of why he wants to be the one to break bad news and how important it is to be there for the family. Read his post a Trilogy on Termination.
David Konig, after reading our three posts, also weighed in on this topic. His post is thought provoking in that he makes a case for almost always (maybe always) transporting pediatric cardiac arrest patients. Read David’s excellent post Because its not all motions and theater.