Beyond prognostication: ambulance personnel’s lived experiences of cardiac arrest decision-making

Anderson, Natalie; Gott, Merryn; Slark, Julia

doi:10.1136/emermed-2017-206743

Cited by 27 publications

(50 citation statements)

References 22 publications

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“…[73][74][75] Managing the work of death and dying PHPs used a variety of strategies to manage the work of caring for patients who died or were dying, such as collecting as much on-scene information as possible before arrival, especially when attending OHCAs. 67 This was important for understanding the context and dealing with emotional aspects. While on scene, coping strategies such as detachment, surface acting, 42 53 humour 42 and, in the case of suicides, focusing on survivors were used.…”

Section: Resultsmentioning

confidence: 99%

“…A lack of sufficient training around communication and relational aspects of death and dying, palliative and EoLC, 24 25 43 58–60 79 80 OHCA and DNACPR, 67 69 73 75 death notifications 24 25 and breaking bad news 55 69 was evident in the review. PHPs identified deficits in training around DNACPR orders, 73 75 dealing with suicide, 46 52–54 managing bereavement, 71 communicating bad news and emotion work.…”

Section: Resultsmentioning

confidence: 99%

“…73 PHPs described learning on the job through observing their colleagues, 69 and wanted training and mentoring from other HCPs and peers. 67…”

Section: Training and Education Needsmentioning

confidence: 99%

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Death and dying in prehospital care: what are the experiences and issues for prehospital practitioners, families and bystanders? A scoping review

et al. 2020

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ObjectiveTo identify the factors that shape and characterise experiences of prehospital practitioners (PHPs), families and bystanders in the context of death and dying outside of the hospital environment where PHPs respond.DesignA scoping review using Arksey and O’Malley’s five-stage framework. Papers were analysed using thematic analysis.Data sourcesMEDLINE; Embase; CINAHL; Scopus; Social Sciences Citation Index (Web of Science), ProQuest Dissertations & Theses A&I (Proquest), Health Technology Assessment database; PsycINFO; Grey Literature Report and PapersFirst were searched from January 2000 to May 2019.Eligibility criteria for selecting studiesQualitative and mixed methods studies reporting the experiences of PHPs, families and bystanders of death and dying in prehospital settings as a result of natural causes, trauma, suicide and homicide, >18 years of age, in Europe, USA, Canada, Australia and New Zealand.ResultsSearches identified 15 352 papers of which 51 met the inclusion criteria. The review found substantial evidence of PHP experiences, except call handlers, and papers reporting family and bystander experiences were limited. PHP work was varied and complex, while confident in clinical work, they felt less equipped to deal with the emotion work, especially with an increasing role in palliative and end-of-life care. Families and bystanders reported generally positive experiences but their support needs were rarely explored.ConclusionsTo the best of our knowledge this is the first review that explores the experiences of PHPs, families and bystanders. An important outcome is identifying current gaps in knowledge where further empirical research is needed. The paucity of evidence suggested by this review on call handlers, families and bystanders presents opportunities to investigate their experiences in greater depth. Further research to address the current knowledge gaps will be important to inform future policy and practice.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Death and dying in prehospital care: what are the experiences and issues for prehospital practitioners, families and bystanders? A scoping review

et al. 2020

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“…Despite the recommendations from guidelines [1], reported rates of TOR in the field vary from 0% to 67% [28][29][30][31][32]. When applying the new TOR rule at 14 min of EMS-initiated CPR, the reduction in the patient transport rate to the ED is anticipated to be 10% (approximately 11,000 patients per year in Japan) ( Table 2).…”

Section: Discussionmentioning

confidence: 99%

Field termination-of-resuscitation rule for refractory out-of-hospital cardiac arrests in Japan

Goto

Funada

Maeda

et al. 2019

Journal of Cardiology

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Background: Guidelines for cardiopulmonary resuscitation (CPR) recommend using the universal termination-of-resuscitation (TOR) rule to identify out-of-hospital cardiac arrest (OHCA) patients eligible for field termination of resuscitation, thus avoiding medically futile transportation to the hospital. However, in Japan, emergency medical services (EMS) personnel are forbidden from terminating CPR in the field and transport almost all patients with OHCA to hospitals. We aimed to develop and validate a novel TOR rule to identify patients eligible for field termination of CPR. Methods: We analyzed 540,478 patients with OHCA from 2011 to 2015 using a Japanese registry. Main outcome measures were specificity and positive predictive value (PPV) of the newly developed TOR rule in predicting 1-month mortality after OHCA. Results: Recursive partitioning analysis in the development group (n = 434,208) showed that EMS personnel could consider TOR if patients with OHCA met all of the following five criteria: (1) initial asystole, (2) arrest unwitnessed by a bystander, (3) age 81 years, (4) no bystander-administered CPR or automated external defibrillator use before EMS arrival, and (5) no return of spontaneous circulation after EMS-initiated CPR for 14 min. For patients meeting these criteria, specificity and PPV for predicting 1-month mortality were 99.2% [95% confidence interval (CI), 99.0-99.3%] and 99.7% (95% CI, 99.6-99.7%), respectively, for the development group and were 99.5% (95% CI, 99.3-99.7%) and 99.8% (95% CI, 99.7-99.9%), respectively, for the validation group. Implementation of this novel rule would reduce patient transports to hospitals by 10.6% in the development group and 10.4% in the validation group. Conclusions: Having both high specificity and PPV of >99% for predicting 1-month mortality, our developed TOR rule may be applied in the field for Japanese patients with OHCA who meet all five criteria. Prospective validation studies and establishment of prehospital EMS protocol are required before implementing this rule.

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“…We have recently undertaken research that used IPA to explore paramedic decisions to commence, continue, withhold or terminate resuscitation when faced with patients in cardiac arrest (Anderson et al., 2018b) and identify the characteristics of challenging prehospital resuscitation decisions (Anderson et al., 2018a). Here, we will briefly outline our study and discuss our learnings regarding the strengths and limitations of using IPA to explore clinical decision making.…”

Section: Using Ipa To Explore Paramedic Decision Makingmentioning

confidence: 99%

Unlocking intuition and expertise: using interpretative phenomenological analysis to explore clinical decision making

Anderson

Slark

Gott

2019

Journal of Research in Nursing

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Background: Clinical decision making is a complex, but important, research area. Decisionmaking theories have evolved to recognise that, although heuristics and biases can lead to error, expert clinician decision makers can also use intuition to good effect. More research is needed to understand how nurses and other clinicians make sense of complexity and uncertainty. Aim: This paper discusses the utility of interpretative phenomenological analysis to elucidate clinical decision making, expertise and intuition. Methods: A narrative review of published interpretative phenomenological analysis studies exploring clinical decision-making, and discussion of an exemplar study. Results: A limited number of interpretative phenomenological analysis studies have been published in this area. By seeking out descriptions of real-world decision making, interpretative phenomenological analysis research provides ecologically valid insights into what it is like to make time-critical, high-stakes decisions with limited information. Conclusion: Contributing to the study of complex clinical decision making in combination with other research approaches, interpretative phenomenological analysis research has significant

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Beyond prognostication: ambulance personnel’s lived experiences of cardiac arrest decision-making

Cited by 27 publications

References 22 publications

Death and dying in prehospital care: what are the experiences and issues for prehospital practitioners, families and bystanders? A scoping review

Death and dying in prehospital care: what are the experiences and issues for prehospital practitioners, families and bystanders? A scoping review

Field termination-of-resuscitation rule for refractory out-of-hospital cardiac arrests in Japan

Unlocking intuition and expertise: using interpretative phenomenological analysis to explore clinical decision making

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