ABC of major trauma. Handling distressed relatives and breaking bad news.
Authors: C A McLauchlan
Journal: BMJ (1990)

Problems associated with breaking bad news in cases of trauma * Death or severe injury is sudden and unexpectedCoping with major trauma is stressful for both staff and the relatives.* The victim is often young Handling distressed relatives is an underemphasised part of the work, and * The prognosis is often unsure medical staff may have had no training and little experience of it.It is a time * Staff are often very busy that the relative will always remember and, if handled badly, will leave * Relatives may already have been notified lasting scars.in an unskilled manner * The victim may have committed suicide * Alcohol intoxication may have been acontributing factorVarious outcomes of major trauma Giving bad news is never easy, but it can be especially difficult in cases of * Death major trauma.The nature of the patient's problem and the bad news can be * Serious head injury very varied.The management of the relatives may begin before they arrive * Multiple injuries at hospital and carry on until well after death or discharge of the patient. * Spinal injuryThe principles of management apply to the accident and emergency * Major burns department as well as the intensive treatment unit or admitting ward. * Loss of a limbProviding genuine understanding and support for relatives is the key to * Loss of sight their management. Initial contactWhen a victim of major trauma arrives in the emergency room the priority is immediate resuscitation.Once the victim has been identified the closest relatives or friends should be notified.Communication with the emergency services is very important.The ambulance crew and police, as well as giving information on the incident, Handling the initial contact with may have already seen the relatives or know their whereabouts.It is usually relatives better for a sympathetic police officer to make the initial contact in person rather than for a telephone call to be made from the hospital.The police may * It may be preferable for a police officer to also be able to help with transport.make contact in person * Information on the telephone should be If the telephone is used information should be given by an experienced given by an experienced nurse or doctor nurse or doctor and a lone relative advised strongly against driving to * Relatives should not drive to hospital hospital alone.Mentioning that the victim is unconscious often helps to alone impart a certain severity to the lay person, although the full severity or death * The full severity of injuries or death may is usually best explained in person at the hospital.If relatives are not told of be best explained at the hospital | the victim's death, however, they may blame themselves for not arriving at the hospital in time to be with their loved one at death.It is important to dispel any self recrimination by giving the relatives the exact information, including the time of death.If the relatives have to travel great distances or from overseas the full details, including death, may have to be explained over the telephone.Find out if the relative is alone and, if so, suggest that he or she seeks support locally.Offer to telephone for support.