When someone dies, we often think about the impact of the death on friends and family members, but what about the impact on those who were running the CODES, performing the CPR or working on the patient as they were dying?

We all looked at each other in shock - we were numb.
It was a horrible moment that I will never forget.

This is the description nurse Enid Traill, who holds advanced resuscitation and instructor’s qualifications, gave about the moment she learned that the person she’d been trying to resuscitate was Steve Irwin. Even with 25 years of experiences with life and death as a nurse and on rescues, she said it was the most difficult rescue situation she had faced.

Mrs. Traill had been on vacation and was wandering around the beach when she heard the counting…one, two, three…and saw someone being resuscitated. She realized that the rescuers needed help and took over the CPR (cardiopulmonary resuscitation). They worked on him for 10 minutes before paramedics arrived and examined the extent of the injury.

A Fatal Injury
Nurse Enid Traill has commented that Steve Irwin had no hope of surviving the stingray attack that killed him. Paramedics examined the hole in his heart and determined that he wouldn’t have survived even if it had occurred in an operating theatre (operating room). The stingray’s attack had been a death blow.

My Own Reflections: CPR as a Traumatic Event
I well remember those feelings of helplessness that I experienced on many of the codes following a sudden deterioration. You arrive on the scene of someone in distress and start or join in on the CPR efforts. Against the odds of recovery you keep working on the person, hoping against hope, watching the life ebb out of someone. Some of the more memorable cases for me involved:

• A young man recovering from a fungal pneumonia - suddenly ruptured a major vessel in his lungs and bled to death.
• A middle aged man recovering in the Intensive Care Unit following surgery for a ruptured aortic aneurysm bled to death.
• An elderly woman with terminal lung cancer suddenly ruptured a major vessel in her lungs and bleed to death.
• A two-year-old child who suffered traumatic injuries from a car accident died despite major resuscitation efforts.
• A sixteen-year-old hiker was found dead on the scene, crushed by a boulder on her chest.

As with the case of Steve Irwin's fatal blow, all of these case of experiencing a sudden terminal event, there was nothing that could have been done, even if the person was in an operating room when the fatal even occurred. In many of the cases death was almost instantaneous.

The Potential Impact of CPR or CODES on Team Members
Rescue workers, Fire, Law Enforcement and Emergency medical workers on a daily basis place themselves in all sorts of danger--exposure to disease, to personal violence, to gruesome situations and to difficult cases. While these professionals have chosen the setting that they practice, they do not choose what types of cases and situations that they may encounter. Enid Traill did not choose to have her pleasant walk on the beach interrupted by a traumatic resuscitation of someone she knew and someone everyone else knew. For her, this resuscitation has become a horrible moment that she will not forget.

Members of a resuscitation team can be impacted by the resuscitation efforts. Those who worked on Steve Irwin experienced the typical response following a sudden loss--shock and numbness, part of a normal response to a traumatic event.

Normal Responses to a Traumatic Event
There is a significant range of normal responses and symptoms which may occur after experiencing a traumatic event. These symptoms may also occur after repeated exposure to stressful events. The normal responses to a traumatic event include:

• Nightmares (more than once/week)
• Feeling "numb" or detached
• Intrusive memories (more than once/day)
• Depressed mood
• Irritability
• Feeling guilty
• Difficulty concentrating
• Feeling anxious
• Anger/Hostility
• Feeling as though the world no longer "makes sense"
• Fear and/or avoidance of similar situations
• Avoidance of people or things that remind you of the critical incident
• Questioning religious values
• Hypervigilance
• Stress-related physical complaints
• Exaggerated startle response
• Flashbacks
• Difficulty Sleeping
• Withdrawal from usual activities
• Difficulty remembering the critical incident

Stress reactions are common immediately following a traumatic event. Fortunately, most of the reactions will resolve within ten days. From discussion with colleagues, I discovered that many of them had experienced these many of responses at different times during training, often in response to a stressful situation such as a CPR Code.

Dr. Stephen A. Pulley writes in his article on Critical Incident Stress Management (a tool for helping rescue workers and emergency personnel to cope) that:

Stressed providers can develop cognitive and emotional impairments that interfere with the ability to make accurate diagnoses or effective interpersonal communication. Patients, family, and emergency providers all suffer.

He further points out that unaddressed stress not only impairs the ability to care but is also impairs the ability to thrive and enjoy life.

More Information - On Codes, CPR

• CPR - Cardio Pulmonary Resuscitation, Adults - From ADAM's Illustrated Health Encyclopedia
• Cardiopulmonary Resuscitation (CPR) - Patient Education Page from the Journal of the American Medical Association
• (PDF File) Cardiopulmonary Resuscitation (CPR) - Patient Education Page from the Journal of the American Medical Association
• (PDF File) CPR can save someone's life - Patient Education Page from the Journal of the American Medical Association

More Information - On the Impact of Death on Providers

• Critical Incident Stress Management - From eMedicine
• Potential Impact of CODES on Team Members - A published article written by Your Death, Dying and Bereavement Guide
• Fleeing Moments. West J Med. 1990 February; 152(2): 195. - A published article written by Your Death, Dying and Bereavement Guide

Resources for Coping with Traumatic Event

• Coping With a Traumatic Event: Information for the Public - From the Center for Disease Control's Emergency Preparedness & Response Site
• (PDF File) Coping With a Traumatic Event: Information for the Public - From the Center for Disease Control's Emergency Preparedness & Response Site
• Coping With a Traumatic Event: Information for Health Professionals - From the Center for Disease Control's Emergency Preparedness & Response Site

Prior Related Post on Steve Irwin

• Crocodile Hunter, Steve Irwin Dies - Stung by a Sting Ray - From Your Death, Dying and Bereavement Guide