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

Abstract

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.

‘Mum, I think we might ring the ambulance, okay?’ A qualitative exploration of bereaved family members’ experiences of emergency ambulance care at the end of life

“…However, little is known about patient and family caregiver experiences of end-of-life emergency ambulance care. 4,5 A need for more research into the role of paramedics as generalist palliative care providers has been identified. 2,[5][6][7] People in developed countries are living longer, with more complex chronic illnesses and a desire to live and die in their own homes.…”

Protocol for the Communication of Bad News in Prehospital Emergencies

“…Several protocols have been developed to support health professionals in the communication of bad news, but none have answered the needs revealed by the families of sudden death victims [1,14], which require orientations on how to give bad news when there are several people present [15] and present the news in a chaotic and violent environment as it happens in the prehospital environment [1,16].…”

Finnish paramedics’ professional quality of life and associations with assignment experiences and defusing use – a cross-sectional study

“…Concurrently, paramedics are increasingly subjected to threats from patients or bystanders, with a majority of EMS personnel, between 57 to 93%, having reportedly encountered physical and verbal abuse in their work during the last decade [ 5 , 6 ]. The continuous imbalance of high-intensity and psychologically demanding assignments with more mundane, low-acuity experiences can affect paramedics’ professional quality of life [ 7 , 8 ] as they often feel emotionally affected by patient encounters, which manifests in symptoms of traumatic stress [ 9 , 10 ].…”

“…Stressors increasing the risk of secondary trauma, both STS and BO, derive from feelings of hopelessness, associated commonly with paramedics’ assignment experiences involving, among others, death and drug overdoses [ 9 , 16 ], as well as a sense of powerlessness in helping others in need, prevalent in cases of social distress [ 10 , 17 ]. In addition, paramedics’ repeated non-acute encounters might cause professional role dissonance, in comparison to the more historical profile of paramedics as critical life-savers [ 7 ], with potential implications on paramedics’ compassion satisfaction (CS).…”