For the emergency department manager: who talks to the family during resuscitation?

What the study shows

A French randomized study included 570 family members during prehospital resuscitation. Its findings addressed, among other things, psychological symptoms in relatives. But the study was not simply about letting families into any setting where lifesaving care is under way. In the setting studied, someone was assigned to support the family, making communication with relatives part of how the response was organized. That distinction matters for an emergency department manager: a finding from outside the hospital does not tell us what effect a similar offer would have in an emergency department. Differences in space, staffing, and how care unfolds call for a separate assessment of what the department can accommodate. The study gives reason to examine the issue, not to promise that every family will benefit in the same way.

Offering a choice

Offering the option to be present begins with a choice, not an assumption that family members should either enter or stay outside the room. It helps to explain briefly what they may see during resuscitation, who will accompany them, and that they can leave at any time. Declining does not mean they care less about the patient; agreeing does not mean they must stay until the end. The person making the offer should identify a place where the family can watch without obstructing the team. If no such place is available, that needs to be explained clearly. This lets relatives decide on the basis of understandable information, while the safety of the patient and everyone present remains the limit on what can be offered.

A designated person for the family

While the team is treating the patient, one designated person can stay in contact with the family rather than leaving that task to clinicians performing the resuscitation. That person should be able to explain actions briefly and answer questions, with cover arranged in case they need to step away. They should tell relatives what is known at the time, without promising a particular outcome. They can provide updates on significant changes and ask whether family members need a break or want to leave. After resuscitation, they should establish when and with whom the family can speak next. This division of roles does not remove the family's uncertainty, but it allows them to receive information without drawing the team away from the patient.

Communication during resuscitation

During resuscitation, relatives need brief updates, not a detailed account of every action. The person with the family can explain in plain language what is happening and what the team is trying to do, distinguishing what is known from what remains uncertain. If a question cannot be answered immediately, it is better to acknowledge it and say they will come back to it than to guess. Nor should anyone promise an outcome that cannot be predicted. The conversation must respect the patient's privacy and not interfere with care. Clear sentences and a willingness to answer questions later help maintain contact, even when the staff's attention is focused on saving a life.

When the plan needs to change

The plan for family presence may need to change during resuscitation. If the space becomes overcrowded, a hazard arises, or the team cannot work safely with relatives present, lifesaving care remains the priority. Asking family members to leave the room need not be framed as a punishment or a withdrawal of support. It is better to point them to a safe place nearby and say who will return with an update and where they can meet. Contact should not end when they move. The person supporting the family can briefly explain the reason for the decision without going into details that would hinder the team's work. This makes the limits of their presence clear and lets relatives know what to expect next.

After resuscitation

After resuscitation, the family needs a summary of what happened, time for questions, and information about next steps, whether or not they were present. It is worth asking about relatives' immediate needs, arranging the next contact, and considering access to further support. A review of 26 studies of patient and family experiences after disclosure of a difficult event supports the importance of continued communication: it highlights timeliness, support, and the involvement of those affected. It concerns a different situation from family presence during resuscitation, however. Because qualitative studies predominated, it does not establish a single best script for the conversation. Rather, it is a reminder not to leave the family alone with unclear information.

Adapting the approach to the department

Before a department begins offering families the option of being present during resuscitation, it should assess its space, staffing, and the preparation of the person who will support relatives. It needs criteria for when the offer is possible and cover if staffing changes. It is also worth deciding how to pass on what the family has already heard and which questions remain unanswered, so the next person does not have to start the conversation from scratch. Once the approach is in place, the department can monitor families' experiences and whether contact can be maintained without disrupting the team's work. It should not promise the outcome of the French randomized study: that study involved prehospital resuscitation, not a hospital emergency department. A local plan must reflect local capacity.

Family presence during resuscitation requires a choice, a safe place, and someone to explain what is happening. Findings from a French prehospital study should not automatically be applied to the emergency department.

Using Empatyzer to prepare for conversations with families during resuscitation

A resuscitation team can use Empatyzer before an emergency, while there is time to prepare how they will communicate with the family. In a conversation with Em about themselves, the person who will support relatives can put together a simple message: whether being present will be possible, who will accompany the family, and how they can choose to leave during resuscitation. A conversation with Em in team mode helps assign roles in advance, including who takes over family contact if the designated person is unavailable. Em can also help phrase brief, clear explanations of what the team is doing without promising an outcome. Micro-lessons support preparation for explaining the situation calmly to relatives. This is communication preparation, not a substitute for the team's decisions about safety, where the family can be, or how resuscitation proceeds. The prepared wording should therefore be a starting point, adapted to what staff actually know at the time.