Traumatic choices

Cut-to-Cure's back from a Trauma conference in Vegas, and has some observations:

On the last day, half of the morning was spent on discussions of "ethical issues" the most interesting one was related to the presence of family members in the trauma bay during resuscitation. Objections included the lack of space in the ED, having family members "fall out" during a resuscitation, family member interference and criticism (that's not how Dr. Carter did it on ER last night!) and of course, fear of litigation if things don't go well. Those that support the presence of family members during resuscitation cite reports (mainly related to ICU codes) that state the emotional benefits and "closure" that having family members present provides. The speaker polled the audience asking who would want their family member to see them with all of the accessories that go along with a complicated trauma resuscitation, very few said yes. I think that the presence of families in the trauma bay can only be a hindrance.

Meanwhile, over at gruntdoc, there's polite disagreement (also see codeblog's commentary):

I do resescitations for a living, and can say that only in VERY limited circumstances would I NOT allow a family into the room. (One or two, not the extended family).

There is, when present, no doubt in their mind that everyone is doing everything to "save" their loved one. I would say that the family of the chronically ill "do the best", as they've been around medicine and hospitals for a long time, and the environment isn't overwhelming. Those who aren't hospital aware are frequently comforted by the fact that all those people are working so, hard, which is the absolute truth.

I support letting the family in. If they're disruptive, let them go (with the Chaplain, or your equivalent), but most will understand. It's what I'd want. I wouldn't insist reluctant observers be forced to attend, but were it me, and my family is on the table, I want to be there.

I'm all for giving people choices, but am curious what the literature says is best for closure and bereavement in these cases. I suspect that with sudden or unexpected deaths (ie, trauma), family members might need to see more of the process to accept what's happened. This could be less necessary in patients with chronic illness.

I also wonder about the layout of the trauma bay -- where I work, there's not a lot of room for family to be shuffled in and out. They'd also be either way too close to the action, or off in the corner. Maybe the expansion plans call for a small viewing area.