12/01/2025
Your patient is in cardiac arrest, and the odds of survival are not looking promising. The family is crying outside. Do you keep them there, or bring them in?
You know how I feel about this if you've been following me. For me there's no question that family should not be excluded.
Today we report on a recent article proposing a terminology reframe which may help the non-believers.
Instead of calling it โTermination of Resuscitation (TOR),โ consider it Withdrawal of Life Support (WOLS). Perhaps this shift could change how we view (and manage) death in the field.
๐จ Why it matters:
On-scene death happens in ~10 per 1,000 EMS responses, and they are usually sudden, traumatic, and emotionally devastating.
EMS clinicians face high rates of PTSD and moral distress, especially when they feel care is misaligned with patient & family values.
What we can learn from the ICU?
In hospitals, family presence during resuscitation is standard, and associated with:
โถ Decreased PTSD, anxiety, and complicated grief
โถ Increased family understanding and satisfaction
โถ Greater clinician-family trust
Contrast this to EMS, where family presence is less common, often due to legal, emotional, and logistical barriers.
Here's how the authors describe the "Withdrawal of Life Support" approach in the field:
โถ Inviting family to observe resuscitation (when safe and appropriate)
โถ Allowing them to touch/speak to their loved one before compressions stop
โถ Framing TOR as a deliberate withdrawal of life support, not an abrupt ending
โถ Using brief rituals (e.g., moment of silence) to acknowledge death
There are also other tools to help:
โ
GRIEV_ing and SPIKES: structured frameworks for death notification and emotional support
โ
WITNESS mnemonic (page 5 diagram): helps guide EMS crews in offering family presence and managing scenes with dignity
Here's a pragmatic example to consider:
In one case, the EMS crew continued CPR just long enough for a mother to arrive and say goodbye. Once she touched her son and CPR was stopped, the family expressed immense gratitude. The crew found the experience more humane and meaningful than typical TORs.
Are there barriers? Here are the typical ones.
1๏ธโฃ Scene safety
2๏ธโฃ Legal/jurisdictional policies (e.g., medical examiner or law enforcement control)
3๏ธโฃ Emotional stability of the family
What's the overall takeaway?
Reframing "termination of resuscitation" as "withdrawal of life support" isn't just semantics, it's about making death less traumatic, humanizing the final moments, and providing emotional support for both families and EMS clinicians.
I'd highly recommend Emergency Resilience, a death notification course by the true expert on this topic, Alex Jabr. Use it at your agency and consider it for Officer Development. PA
๐ Read the full article here:https://www.handtevy.com/wp-content/uploads/2025/11/Reframing-Prehospital-Termination-of-Resuscitation-as-Withdrawal-of-Life-Support-Applying-Lessons-from-the-ICU-in-the-Prehospital-Setting.pdf
Photo courtesy of Dansun Photos
