The Emotional Side Of CPR: Reflecting On The Challenges Of Resuscitation InThe Wake Of Damar Hamlin

First, I want to extend my thoughts, wishes, and prayers to Damar Hamlin, his family, and his teammates. Seeing his collapse on television stirred many emotions in me; I can’t imagine what those who were on the field or in the stadium experienced.

As a pediatric emergency physician, I can tell you that anything related to cardiopulmonary resuscitation (CPR) is difficult. America got a real glimpse of the horrors of CPR on national TV. If you think burnout is caused by the electronic medical record, I will tell you that for me, CPR is the cause of my clinical wanderings and my deep passion to push for more prevention, training, and primary care. Performing CPR on one less patient is worth every effort.

For us “providers” of CPR, it’s a tough world. I have too often been part of resuscitating a child, and I can tell you it’s unforgettable and gut-wrenching for all involved. Here are some things from my clinical perspective that most in the public may not perceive about performing CPR on adults or children:

1. EMTs and paramedics are thrown into these situations around the country every day. They respond at a moment’s notice, and their actions, along with those of lay bystanders, are the main impacts on the outcome. Recognizing, treating, and rescuing patients within minutes determines life, death, and neurologic outcomes.

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2. Nurses, respiratory therapists, and ER physicians become anxious when they receive a radio call from these first responders. They want to know what happened, how long the person has been down, what the estimated time of arrival is, and whether the patient has a pulse.

3. From our experience in the emergency department, we know that the answers to these questions will likely determine the patient’s outcome. The condition of the patient when they arrive at our emergency room is critical. Rarely does a patient have a chance of recovery if they are pulseless or have no blood pressure on arrival. The work of bystanders and first responders is critical.

4. More and more, we are thankful to have a full team and the resources needed to act swiftly. With a full staff, we know we are prepared to act on our years of experience, training, and team building. We rely on our ongoing training, practicing mock scenarios, and pre-established roles and responsibilities to achieve the best outcome.

5. We use algorithms to help our thinking and guide our interventions, but we must quickly recognize the cause and the necessary interventions. All the while, we must ensure that the stress of the moment does not overwhelm us and that we can separate our emotions from our interventions.

6. Team-based care is paramount as we gain more information from our paramedics and expand the core emergency department team with pharmacists, social workers, chaplains, and intensive care staff.

7. Our shared mission is to get the patient to the intensive care unit. If we can do this, we know that the patient has vital signs and some hope of recovery.

8. Our final task is to update the family on the status of their loved one. I find nothing more challenging than relaying this information to the family. It is incredibly difficult to put into words what, why, where, and how their loved one is doing.

What we saw on Monday night, which few of us discuss or appreciate, is the emotional side of CPR. The impact on the players, announcers, teams, officials, and fans was on display. I was struck by the tears and distress of those witnessing the care being delivered. What we don’t discuss is the emotional side of CPR, including all of us who provide CPR. For me, no greater stress comes in the emergency department than the EMS call that states we have a “full arrest coming in.” Watching CPR in progress is awful and stirs emotional thoughts that I wish we discussed more. The emotional aftermath for us “providers” is a key area that is too often lost.

1. The paramedics don’t get the rest of the night off. They hop back in their trucks and wait for the next challenge. I try to console them or debrief, but this is a few seconds before they head back out the door.

2. The hospital staff doesn’t get to go to the locker room, contemplate what happened, lock the doors, or suspend their care. No, we walk back out into the emergency department. We spend some time completing paperwork and our electronic chart. We clean up the resuscitation bay. We move on to the next patient, while also checking the clock to see when we are going home.

3. We wait for the next EMS call, hoping it’s not tonight.

The horrible event on Monday Night Football is one I wish could never happen again. I wish we never had to do CPR anywhere or anytime on anyone, especially children. However, I am thankful this young man received immediate attention from well-trained staff and was close to great emergency care. The first responders should be applauded and comforted.

Perhaps this tragedy can spur on more discussion at another time about bystander training, access to EMS, team-based care, and why we need equitable access to primary and emergency care in underserved and rural areas. For today, I am thankful that Damar is in intensive care and hope for his full recovery. I am praying for him, his family, and all those who provided his care.

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