As a public safety chaplain, I have gone on a lot of cardiac arrest calls over the years. If I can respond fast enough, I am right there while the fire and EMS crews are still doing CPR. There is a strong focus and intensity of the crew as they fight to stave off death through pharmaceuticals and mechanical methods. If anyone has watched it, the event can be both violent and highly emotionally charged. But those who called 911, and maybe started the CPR effort, are often moved aside, away from the action.

Cardiopulmonary resuscitation (CPR) is often associated with saving lives, providing hope, and offering a sense of security in emergency situations. However, amidst the chaos and urgency of these events, a group of individuals often overlooked - the hidden victims. These hidden victims are the family members, friends, and witnesses who witness CPR attempts and are left to grapple with a range of emotions and psychological distress. It is important for us as chaplains to recognize these people and get to them as fast as we can. Studies have shown that those who have no advocate have higher incidences of PTSD in response to the resuscitation effort. (Compton, Scott N et al. 2009, p. 229)

While we as chaplains have always ministered to these people, I think we can do better, and use science to make our case. In a study that was reported in the New England Journal of Medicine, it was found that those who watch CPR and have an advocate with them, have significantly lower symptoms of PTSD than those who are left alone during the events.

“Being present during cardiopulmonary resuscitation (CPR) may help the family members understand that everything possible to bring the patient back to life has been implemented. In addition to quelling suspicion about behind-closed-doors resuscitation efforts and unrealistic expectations of such efforts, the family member’s presence may offer the opportunity for a last goodbye and help that person grasp the reality of death, with the hope that the bereavement process will not be prolonged or complicated by pathologic mourning or post-traumatic stress disorder (PTSD).”(Jabre et al. 2013, p. 1009)

With this insight, I suggest four things for fire departments and public safety chaplains.

1. Chaplains must enter into the cardiac arrest scene as soon as possible. I’m not advocating that chaplains run Code-3 to the calls, but once the code is recognized, the chaplain should either be requested by the on-scene crew, or if protocols allow, the chaplain should respond automatically. The objective is that the chaplain should be there to be that educated and compassionate advocate for the hidden victims, and if desired, encourage viewing of the resuscitation efforts. If possible, the chaplain should get notice of the cardiac arrest call at the same time as the crew to be prepared to respond or even start to unofficially respond in order to close the distance and response time to the scene. The desire is to get the chaplain on scene as soon as possible.

2. Next, upon arrival and after checking in with command, the chaplains should work by acknowledging and validating the emotional impact experienced by the hidden victims during a CPR call. I have found that witnessing a loved one undergoing CPR can be an extremely distressing and traumatic experience, causing a range of emotions such as fear, helplessness, and guilt. By actively listening and empathizing with the hidden victims, chaplains can create a safe space for them to express their feelings and process their experiences effectively. Since many in society look at the death event as a spiritual event the chaplains are uniquely equipped to either minister to this aspect of human need or help advocate for those who can. If the hidden victim doesn’t have a spiritual outlook, the chaplain can serve as a compassionate advocate.

3. Chaplains should be trained in providing emotional support to the hidden victims of a CPR call. This support should encompass a variety of therapeutic techniques such as the ministry of presence, active listening, trauma-informed care, validation of emotions, and spiritual religious support of different faiths. As an example, chaplains can encourage the expression of grief, anger, or confusion while reassuring the hidden victims that their reactions are normal and understandable. Providing a non-judgmental and compassionate presence can significantly aid the healing process.

4. Often, the emotional impact of witnessing a CPR call can linger long after the event itself. If local protocols allow, the chaplains can play a vital role in offering follow-up support to the hidden victims, ensuring they do not undergo emotional distress in isolation. By providing contact information and offering ongoing check-ins, chaplains can facilitate a sense of connection and continuity of care. Additionally, creating support groups or connecting individuals with resources and counseling services can further promote long-term healing and resilience.

The hidden victims during a CPR call are often overlooked but endure significant emotional trauma. Chaplains have a crucial role to play in ministering to these individuals by recognizing the impact, providing emotional support, and offering follow-up and connection. By doing so, chaplains can help alleviate the psychological distress experienced by the hidden victims, aiding their healing process, and promoting their overall well-being. It is vital that we not only focus on the physical aspects of medical emergencies but also extend our support to those affected emotionally, validating their experiences, and equipping them with the tools they need to cope and heal effectively.

Chaplain Chris M. Wade, M.Div

Compton, Scott N., Heather Grace, Alexander Madgy, and Robert A. Swor. “Post-Traumatic Stress Disorder Symptomology Associated with Witnessing Unsuccessful Out-of-Hospital Cardiopulmonary Resuscitation.” Academic Emergency Medicine 16, no. 3 (March 1, 2009): 226–29. https://doi.org/https://doi.org/10.1111/j.1553-2712.2008.00336.x.

Jabre, Patricia, Vanessa Belpomme, Elie Azoulay, Line Jacob, Lionel Bertrand, Frederic Lapostolle, Karim Tazarourte, Guillem Bouilleau, Virginie Pinaud, and Claire Broche. 2013. "Family Presence During Cardiopulmonary Resuscitation." New England Journal of Medicine 368, no. 11: 1008-1018.