支持家庭和我们自己

Z. Tillett, Andrew Spruce, Shelley Jacobs, Sharon Granville, John Martel, Michelle Crispo
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摘要

院外心脏骤停(OHCA)会给患者家属和急救医生带来严重的后遗症。尽管医学在不断进步,但 90% 的院外心脏骤停仍会导致死亡。这些事件的突然性和意外性增加了幸存家庭成员悲痛的复杂性。特别是 OHCA 已被证明会对紧急医疗服务临床医生的心理健康造成有害影响,他们自我报告在向家属传达死亡通知等坏消息后会出现负面情绪。考虑到与 OHCA 结果相关的严峻预后和相关的情绪影响,我们必须找到更好地支持患者、家属和急救医生的方法。本文旨在为急救医疗临床医生提供建议和工具,以更好地应对 OHCA 复苏过程中家属的情感负担。许多院前临床医生在 OHCA 情景下接受的心理和情绪后果方面的培训非常有限。据作者所知,目前还没有任何全国性的课程或著作涉及如何进行情感支持性 OHCA 的概念。以下是一组经验丰富的急救医疗临床医生、一名儿童生命专家、一名持证临床社会工作者以及具有急诊医学、姑息治疗和急救医疗背景的医生共同提出的专家建议。急救人员最好能利用所概述的策略来帮助预测并随后支持家庭的情感需求。这些策略包括加强沟通的方法、帮助消除家属对心脏骤停的常见误解,以及让急救服务临床医生做好准备在复苏不成功时该怎么做。本文的最终目的是提供工具,帮助急救医疗临床医生更好地与家属保持一致,最大限度地减少对所有相关人员的情绪影响。
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Supporting Families and Our Own
Out-of-hospital cardiac arrest (OHCA) can have significant adverse sequelae for both the patient’s families, as well as the responding EMS clinicians. Despite advances in medicine, 90% of OHCA result in death. The sudden and unexpected nature of these events, adds to the complexity of grief for the surviving family members. OHCA specifically has been shown to have deleterious mental health impacts on EMS clinicians who have self-reported experiencing negative emotions after delivering bad news to families such as a death notification. Given the grim prognosis associated with OHCA outcomes and associated emotional fallout, we must find ways to better support our patients, families, and EMS clinicians. The goal of this paper is to offer recommendations and tools that can be used by EMS clinicians to better address the emotional burden experienced by families during an OHCA resuscitation. Many Pre-hospital clinicians receive limited training around the psychologic and emotional consequences that accompany OHCA scenarios. Currently no national curriculum or writings that the authors are aware of have covered the concept of how to run an emotionally supportive OHCA. The following is an expert consensus of recommendations from a group of experienced EMS clinicians, a child life specialist, a licensed clinical social worker and physicians with backgrounds in emergency medicine, palliative care and EMS. The strategies outlined would ideally be utilized by first responders helping to anticipate and subsequently support the emotional needs of families. The strategies range from ways to enhance communication, help combat common misperceptions from families around cardiac arrest and prepare EMS clinicians for what to do if a resuscitation is unsuccessful. Ultimately the goal of this paper is to provide the tools to help EMS clinicians better align themselves with families to minimize the emotional impact on all involved.
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