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Emergency medical service provider decision-making in out of hospital cardiac arrest: an exploratory study
J Brandling1, K Kirby2, S Black3
1University of the West of England, Bristol, UK.
Insights
UK Emergency Medical Service (EMS) providers
Area of Science:
- Emergency medicine
- Resuscitation science
- Clinical decision-making
Background:
- Approximately 60,000 out-of-hospital cardiac arrests (OHCA) occur annually in the UK.
- Existing UK guidelines address resuscitation commencement and cessation in OHCA.
- Decision-making processes for OHCA resuscitation are complex and not fully understood.
Purpose of the Study:
- To explore factors influencing UK Emergency Medical Service (EMS) provider decisions on commencing and ceasing resuscitation for OHCA.
- To address the lack of UK-specific research in this critical area.
Main Methods:
- Four focus groups were conducted with 16 active EMS providers.
- Four case vignettes were used to stimulate discussion on decision-making.
- Thematic analysis was applied to focus group transcripts.
Main Results:
- A three-stage decision-making process was identified: call, scene arrival, and protocol adherence.
- Variability in practice is influenced by factors at each stage.
- Influential factors include available information, protocols, cultural values, interpersonal dynamics, risks, and personal beliefs.
Conclusions:
- Understanding the factors influencing OHCA resuscitation decisions can improve clinical guidelines and education.
- Enhanced understanding may lead to greater consistency and confidence among EMS providers.
- Potential for improved patient outcomes in OHCA situations.
Background:
There are approximately 60,000 out-of-hospital cardiac arrests (OHCA) in the United Kingdom (UK) each year. Within the UK there are well-established clinical practice guidelines that define when resuscitation should be commenced in OHCA, and when resuscitation should cease. Background literature indicates that decision-making in the commencement and cessation of resuscitation efforts in OHCA is complex, and not comprehensively understood. No relevant research from the UK has been published to date and this research study seeks to explore the influences on UK Emergency Medical Service (EMS) provider decision-making when commencing and ceasing resuscitation attempts in OHCA. The aim of this research to explore the influences on UK Emergency Medical Services provider decision-making when commencing and ceasing resuscitation attempts in OHCA.
Methods:
Four focus groups were convened with 16 clinically active EMS providers. Four case vignettes were discussed to explore decision-making within the focus groups. Thematic analysis was used to analyse transcripts.
Results:
This research found that there are three stages in the decision-making process when EMS providers consider whether to commence or cease resuscitation attempts in OHCA. These stages are: the call; arrival on scene; the protocol. Influential factors present at each of the three stages can lead to different decisions and variability in practice. These influences are: factual information available to the EMS provider; structural factors such as protocol, guidance and research; cultural beliefs and values; interpersonal factors; risk factors; personal values and beliefs.
Conclusions:
An improved understanding of the circumstantial, individual and interpersonal factors that mediate the decision-making process in clinical practice could inform the development of more effective clinical guidelines, education and clinical decision support in OHCA. These changes have the potential to lead to greater consistency. and EMS provider confidence, with the potential for improved patient outcome from OHCA.
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