Yes and no. The acceptability of family members under such circumstances is based on the family's wish to remain with their loved one, the opinions of medical personnel, the reactions of family members and patients, the nature of the emergency, and the hospital's policy.

Just as the science of medicine is constantly changing, so too is the relationship between health care personnel and patients and their families. Patients and family members who in the past simply accepted the treatment plans prescribed by their physicians, now are invited to participate in all aspects of their medical care. With this increased involvement in medical decision-making has come a related increase in the presence of families during the actual delivery of medical care.

In most hospitals that allow family presence, family members do not ask to remain; they simply are never asked to leave. In other hospitals, a family member may simply request to stay in order to remain. In some circumstances, medical personnel may sense uneasiness in family members and ask them to step outside to help them leave without feeling guilt for "abandoning" their loved one. Family members should never be forced to remain in the treatment area.

The views of medical personnel about the presence of family can affect the appropriateness of this practice. Optimal care of the patient is the first goal of emergency physicians, nurses, and technicians, as well as the patient's family.

If emergency personnel are sufficiently uncomfortable with the presence of family members to the point that it might undermine their performance then family members should not be present. Just as it should not be forced on a patient's family, it should not be forced on an emergency medical team.

Family members can be a help or a hindrance in the emergency department, depending on their behavior. Those who remain in a room quietly, or stand at a bedside and soothe or encourage a loved one, will not be a distraction to an emergency team. However, outbursts of hysterical behavior, physical interference with medical actions, or other types of disruptive behavior may require a family member to leave the room. Similarly, if a patient is agitated by the presence of a family member, then that person should leave.

The nature of a patient's problem also can dictate the appropriateness of family presence. For example, procedures which unduly expose the patient may prove embarrassing to both family members and patients. Some hospitals regulate family presence based on the criticality of the patient or intervention, limiting the presence of family members to only minor procedures on stable patients. Other emergency departments adopt the opposite philosophy, based on the belief that the more unstable the patient, the greater the need for family members to be present.

A survey of 400 parents, published in the July 1999 issue of Annals of Emergency Medicine, found that most would want to be present when invasive procedures are performed on their children, with parental desire decreasing as procedural invasiveness increased.

There can be drawbacks to the presence of family members during resuscitations and emergency procedures. For example, family members remaining with patients have collapsed during relatively minor procedures; some have been seriously injured, requiring medical assistance and care themselves. Even such medically mundane activities as insertion of intravenous catheters or simple laceration repairs have produced episodes of fainting in parents or spouses. Unfortunately, in some high-profile cases, people have successfully sued hospitals and health care providers over these instances.

In other cases, family members have witnessed actions they felt were below the standard of care and used this as a basis for legal actions. Health care providers, and emergency department personnel in particular, are at higher risk for such claims as a result of the nature of emergency medicine. Such instances are rare, although even a single event can discourage a hospital from permitting the practice.

The presence of family members can also present a problem in teaching centers. Instruction of inexperienced students or physicians in training programs must be done tactfully when relatives are present at the bedside.

The presence of family members in emergency departments is a relatively new practice. Although the presence of families has always been the standard at some hospitals, it has only been in the past decade that it has been openly discussed in the medical literature.

Except in hospitals that have policies against it, the decision whether to allow relatives to remain often is made on a case-by-case basis. All the factors presented above must be considered, as well as the personalities and preferences of family members and medical personnel.

Research in this area has demonstrated that physicians and nurses with the most experience with this practice tend to favor its use in emergency departments, while those with limited or no experience would rather avoid it. As expected, residents in training are also more opposed to having family members present during a procedure than are attending emergency physicians.

Like all new concepts, family presence has its supporters and critics. Some physicians believe it should be mandated in every department, while others believe it should be prohibited. With strong feelings and good supporting arguments on both sides of this issue, it's not surprising there is no universal approach to family presence in all hospitals.

Occasionally, family members and medical personnel may disagree over the appropriateness of their presence. If time permits, or it involves an upcoming procedure, then discussions can be held with hospital personnel. However, in emergency situations, this generally is not an option, and decisions must be made in a timely fashion.

The first priority in any such disagreement is the patient's care. Delays in care should not occur because of arguments about relatives remaining in the room. If a family member must be removed from a treatment area, often the need for such a drastic measure can be addressed after the patient is stabilized. However, these disagreements are rare, and generally there is time for a brief discussion to resolve both family member and medical personnel concerns.

In most instances, an open dialogue between the attending physician and the family will lead to a rapid resolution of the disagreement or an agreeable compromise. Even when medical personnel feel strongly that it is inappropriate for family members to be present, assurance the family will be permitted to return to the bedside as soon as the procedure is completed often alleviates concerns.

The only behavioral rule governing family presence is that the family must not interfere with the care of the patient. Disruptive behavior, whether verbal or physical, will not be permitted under any circumstances in any emergency resuscitation. If a family member does not feel he or she can maintain control, he or she can ask to be escorted from the resuscitation area.

Lack of interference does not imply lack of interaction. Provided it does not impede access to the patient, family members generally are encouraged to speak with, touch, comfort, and soothe emergency patients as appropriate. Emergency personnel will provide guidance as to the degree of physical interaction that will be helpful. Family members are encouraged to ask questions of emergency staff if it will help them understand what is happening. The timing of such questions or the length of answers will vary depending on the status of the medical procedure.