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Emerg Med J. 2018 Apr;35(4):208-213. doi: 10.1136/emermed-2017-206743. Epub 2018 Jan 5.

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

Author information

1
Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
2
Adult Emergency Department, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand.

Abstract

INTRODUCTION:

The purpose of this study was to explore ambulance personnel's decisions to commence, continue, withhold or terminate resuscitation efforts for patients with out-of-hospital cardiac arrest.

METHOD:

Semistructured interviews with a purposive sample of 16 demographically diverse ambulance personnel, currently employed in a variety of emergency ambulance response roles, around New Zealand.

RESULTS:

Participants sought and integrated numerous factors, beyond established prognostic indicators, when making resuscitation decisions. Factors appeared to be integrated in four distinct phases, described under four main identified themes: prearrival impressions, immediate on-scene impressions, piecing together the big picture and transition to termination of resuscitation. Commencing or continuing resuscitation was sometimes a default action, particularly where ambulance personnel felt the context was uncertain, unfamiliar or overwhelming. Managing the impact of termination of resuscitation and resulting scene of a death required significant confidence, psychosocial skills and experience.

CONCLUSION:

This unique, exploratory study provides new insights into ambulance personnel's experiences of prehospital resuscitation decision-making. Prognostication in out-of-hospital cardiac arrest is known to be challenging, but results from this study suggest that confidence in a poor prognosis for the cardiac arrested patient is only part of the resuscitation decision-making picture. Results suggest ambulance personnel may benefit from greater educational preparation and mentoring in managing the scene of a death to avoid inappropriate or prolonged resuscitation efforts.

KEYWORDS:

cardiac arrest; paramedics; prehospital care; qualitative research; resuscitation

PMID:
29305380
DOI:
10.1136/emermed-2017-206743
[Indexed for MEDLINE]

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