Cardiopulmonary arrest in primary care clinics: more holes than cheese: a survey of the knowledge and attitudes of primary care physicians regarding resuscitation

Abstract

BackgroundPatients experiencing pre-arrest symptoms may first refer to their primary care physician. The study's aim was to determine the likelihood that a patient undergoing out-of-hospital cardiac arrest will receive appropriate resuscitation efforts in a primary care clinic in a country with a directive that clinics maintain resuscitation equipment and physicians undergo periodic resuscitation training.MethodsAn anonymous, 23-question online cross-sectional survey was created and administered to primary care physicians working in community clinics (10/1/2015-5/3/2015). Recruitment was accomplished by posting a link to the survey to all physicians listed as registered Society of Family Medicine members and in other online forums dedicated to residents and board-certified specialists in family medicine in Israel. The primary outcome measure was the proportion of respondents whose responses indicate that they fulfill all conditions for performing resuscitation.ResultsOf approximately 2400 potential respondents, 185 replied to the survey; the study's findings should be viewed as preliminary. Respondents' characteristics were generally similar to those of the study population, but respondents had a higher rate of family medicine specialists.Respondents were mostly female (n = 108, 58%) Israeli graduates who have practiced medicine for > 10 years (72%, n = 134). 55% (n = 101) had undergone basic life support (BLS) training within < 2 years.Although just 5% (n = 10) estimated call-to-Emergency Medical Service (EMS) arrival time to their clinic to be <5 min, only 64% (n = 119) knew the telephone number for summoning EMS. Most confirmed the existence of a resuscitation cart in their clinic (85%, n = 157); 68% confirmed the presence of a defibrillator (n = 126). Most respondents were aware of the location of the defibrillator in their clinic (67%, n = 123), stated its accessibility during working hours (63%, n = 116), and 56% (n = 103) knew how to use it. Only 28% of the questionnaires indicated that all requirements for mounting an effective BLS response had been fulfilled.ConclusionsThe study suggests that many primary care clinics are under-equipped and their physicians are under-prepared to initiate life-saving services. Steps must be taken to rectify this situation. In addition, to develop more reliable estimates of the phenomena reported in this preliminary study, these issues should be re-examined in the context of a high response rate physician survey.

Evaluation of Usefulness of Cardiopulmonary Resuscitation Education on Public Health Physicians

“…It was also reported that physicians were unwilling to participate such questionnaires. Low rate of participation was likely to be related to belief that the issue is irrelevant as the likelihood of being required to perform CPR in a clinic is very low [5]. In our study, participants were encouraged and motivated to response the questionnaires.…”

“…A swift and appropriate response to these events is crucial for patient survival. This response includes physician knowledge, willingness and preparedness for performing basic CPR and defibrillation as appropriate [5].…”

In-hospital sudden cardiac arrest protocol analysis

“…Occasional cases where resuscitation efforts were not started prior to the arrival of CPR may indicate insufficient medical staff training. Einav et al [19] in their study suggest that many primary care clinics are under-equipped and their physicians are under-prepared to initiate life-saving services. Numerous studies indicate that staff training in advanced life support improves resuscitation outcome [20][21][22].…”

<b>Capacitação em primeiros socorros para equipes de saúde da atenção básica: relato de experiência / Training in first aid to staff of primary health care: an experience report<b>

“…Ainda que a atuação das equipes locais de saúde no atendimento às urgências/emergências seja relevante, estudo sobre a percepção de equipes de saúde, em três Centros de Saúde (CS), no município de Palhoça-SC, identificou dificuldades no processo de implantação da assistência em questão, pela falta de equipamentos, de transporte e espaço físico local e pela pouca capacitação das equipes (6) . Também uma pesquisa realizada em Israel, com o objetivo de determinar a probabilidade de um usuário submetido à parada cardíaca receber suporte de vida adequado em clínica de cuidado primário, destacou o fato de muitas clínicas da AB estarem subequipadas e seus médicos pouco preparados para iniciar os procedimentos de ressuscitação em caso de PCR (7) . Destacando a importância de aprimoramento profissional sobre o tema, um trabalho relata a experiência de capacitação de Agentes Comunitários de Saúde (ACS), de um Centro de Saúde da Família (CSF), no município de Sobral-CE, na abordagem de agravos expressivos em comunidades, como engasgo e queimadura domiciliar (8) .…”