Debriefing Following an Incident
The Stress of Saving a Life
I smile when I think of the way that high school CPR is spreading across the country. Seeing the reports of rescues reminded me of the first time I saved someone. Saving a life can shake you up.
As a travelling university student, I was in a London laundromat waiting for my clothes to dry, when a little kid choked on something. He turned blue and was in trouble. His mother screamed. I whacked him on the back and out flew a coin. While the boy was better right away, mom took a minute. Then she swooped up her child, said, “thanks” and left.
I knew I had just saved a life. It felt neat, ordinary, giant and I was proud. I knew what to do and it worked. Later, I thought about it lots. I replayed that episode over and over. I wish I had been able to talk about it, to tell someone what happened and how I felt about it. Saving a life wasn’t without some anxiety, normal stuff perhaps, but bouncing it off someone would have helped me understand that.
My “patient” lived. As CPR instructors, we know that doesn’t always happen. We are traumatized by crisis incidents. When someone chokes and is dying, who is affected more? The bystander who can do nothing? Or, the young person who steps in? I suspect both are, but in different ways. Anyone teaching CPR trains people to intervene. That instructor, anticipating those stressful moments, can provide some guidance, both up front and later, about putting the anxiety in a healthy place.
There should be a section of any CPR course in which instructors speak about the emotions that follow using a CPR skill. A scenario used to practice skills, could go beyond the “what do you do” to include a little “how do you think you will feel?” Focussing briefly on the serious side of CPR training, not only motivates students but also prepares them for the emotions that sometimes follow helping someone.
Talking about the tough calls afterwards makes a difference for paramedics. It will also help students who use their CPR skills. A student in Montreal performed the Heimlich maneuver successfully on his father. Later, the boy was uncomfortable with all the attention and he wanted to get back to his TV program. Unaffected? Don’t believe it. Does he need trauma counseling or Critical Incident Stress Debriefing? Probably not. In most cases, talk is enough. Some guidelines help.
After seeing the easy, respectful relationship many students and their teacher/instructors, I realize those teachers are in a unique position. If students perform CPR, consider setting a quiet 15 minutes aside with them. Ask what happened. Let each one tell the facts of the story. Ask how they felt about it. If it isn’t clear from their own conversation, let the students know that what they are feeling is pretty normal stuff. If they did well, tell them. If they could have done better, avoid judgements. This is a listening time. Do not take notes. This works with 1 student as well a group. While occasionally a student needs further help, most of the time the “trauma” is minimal and this is enough.
Our students will be proud if they save a life. In another scenario, they should be proud they tried. We can help shape the memory of that experience. I still see that coin flying out of that child’s mouth and doing a slow motion roll out onto the street. I saved a life that day. But I didn’t put it behind me until I wrote a letter telling someone what happened and how I felt. Even though I have saved other lives in my medical career, even though I never knew that boy’s name, that save is the one I remember most. It was one of the best things I ever did.
Justin Maloney, MD
Base Hospital Program for Ottawa-Carleton