I recently oriented to the emergency center and although I have some experience in the EC it feels like eons ago because it was during my internship. I love the fast pace and critical thinking that goes on in the emergency center especially during traumas. We (fortunately) did not have any during the short 2 day orientation but I wanted to cover my bases and make sure I understood my role should there be any while I covered the primary CCLS. I’ll give you an idea of what she told me and what I learned during my internship on how to support these patients and their families.
In the event of a trauma with a conscious but injured kiddo:
- Be at the bedside while staying out of the way of providers to explain what’s happening as it happens — once the kiddo is stable/calm you can step out
- Meet the family and explain whose in the room and what they’re doing (if you’re aware of what they're doing.)
- See if any siblings are present to provide support/distraction.
- Explain to the family that once their child is stable a doctor will be available to speak with them but their first priority is to assess and possible injuries and addressing them first.
- Find out if other family is present in the waiting room and see if staff need help finding a private place for them to wait to find out news
- Check back in on the kiddo and address any immediate needs i.e. will they need any clothes because there’s were cut off? Are they worried about family and need reassurance? What questions do they have about what’s happening/what’s going to happen next?
- Find family and see if there’s anything else they need immediately and if siblings have questions at this time
- See when the siblings can come back if the patient is stable
- Follow up later to prep if they’re going inpatient/home and answer any questions prior to next step
In the event that you have an unconscious/possible death:
- All of the above steps are applicable except seeing the patient and explaining what’s happening since they are unconscious INSTEAD explain to the family what you know is happening
- Assess if any siblings are present and provide support/distraction
- Find out if any family is present in the waiting room and if there’s a lot assess if there’s a place they can wait until there is news
- If the patient is coding provide tissues/support to the family and start gathering supplies needed for bereavement in the event that the patient dies
- If the patient dies then find a moment (let’s be honest there’s never a good moment, just a moment) that feels right to offer hand molds, lock of hair, hand prints, etc. dependent on what your hospital offers
- Most families will want to hold their child. This is something we allow at the hospital I work at and when I asked if this was commonly a request of the family the CCLS said she doesn’t remember a time they didn’t want to.
- Find out who is going to tell the other family. Typically a chaplain and doctor present would be appropriate and child life can be available to speak with any children or family members that need support following. This is why a private area would be best since a lot of times you will hear wailing and see family drop to the ground. This was a very unexpected death and people generally don’t handle that well so allowing this coping in a private area is probably best for the family.
- Try to find a window to go do memory work. Usually while parents are holding the child before family wants to come back to say their goodbyes.
- Follow up to see where you can provide the memory work when it’s done. We have to bake our molds and in the last hospital I worked they had to sit overnight. These families won’t be staying the night so you’ll need to find out if they want it sent directly to parents via mail or some other family member. Again this is a sudden death so parents may not want it sent to them. They may even want to pick it up at a later date when they’re ready. Always give these options.
- Find out if siblings want to do a therapeutic activity prior to leaving. I used to go buy a balloon from the gift shop and allow the children to write notes to the family member who died and send it to heaven. Of course find out religious beliefs first but this seemed to have a good closure piece to it. Even providing resources like “The Invisible String” by Patrice Karst would be an option. Look into what resources your hospital already has and see if you can order some to give out or use multiple times in these cases.
Trauma, especially if it ends in death, is never easy, but if we can be there to lend a tissue, do memory work or get them set up with the right people to arrange a funeral, it’s better than not being there at all. Child life has many roles in trauma and I’m sure every hospital sees it differently. Tell me more about what your hospital does and send me an email or DM if you have any questions!