Barriers to action: behavioral determinants of bystander intervention in medical emergencies - a scoping review

Bystander intervention at the scene of illness or injury can significantly impact the outcomes of emergencies. This scoping review aims to identify the determinants of bystander behavior in such scenarios.

A comprehensive search was conducted across PubMed, Cochrane, Google Scholar, CINAHL, and grey literature, resulting in 3957 studies. After removing duplicates, 2499 studies were screened for titles and abstracts by two independent reviewers, with conflicts resolved by a third reviewer. A total of 257 articles were then subjected to full-text screening, leading to the inclusion of 42 studies for data extraction. Data were collected on various factors, including the type of emergency, region, area of study, setting, age group, gender, prior training, presence of bystander intervention, and determinants of behavior.

In studies presenting age‑stratified analyses, bystander intervention was reported in 75% of studies involving individuals aged ≤ 18 years and in 69% of studies focused on adults. Where training status was reported, 18% of adult‑oriented studies indicated prior training, with no such reporting among studies involving individuals ≤ 18 years. Cardiac arrest was the most common type of emergency (95%). Most studies were conducted in community settings (76%), with the remainder in institutional settings (24%). Negative determinants included lack of knowledge, skills, and self-efficacy, with variations between community and institutional settings. Motivators for intervention, though less frequently reported, included young age, education/training, and a supportive environment.

The review highlights key barriers and motivators for bystander intervention, emphasizing the need for targeted education and training programs, as well as supportive environments to enhance bystander response in emergencies. These findings provide a foundation for developing multifaceted strategies to improve bystander behavior and emergency outcomes.