PARAMEDIC RESUSCITATION DECISION-MAKING IN OUT OF HOSPITAL CARDIAC ARREST: AN EXPLORATORY STUDY

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Abstract

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. This study explored the influences on paramedic decision-making when commencing and ceasing resuscitation attempts in OHCA.

Methods

Four focus groups were convened with 16 clinically active paramedics from emergency response vehicles and specialist teams as well as teaching and management staff. Four case vignettes were discussed in these focus groups to explore paramedic decision-making. The initial three focus groups were formulated to test and refine the research methodology and consisted of non-standard paramedics (i.e. those in management, teaching or specialist paramedic roles). The final focus group consisted of ‘standard’ paramedics. The focus group discussions were audio recorded and transcribed in full. Thematic analysis was used after the focus groups had taken place and for final reporting.

Results

There are three stages in the paramedic decision-making process when deciding 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 are: factual information available to the paramedic; structural factors such as protocol, guidance and research; cultural beliefs and values; interpersonal factors; risk factors; personal values and beliefs. Variations in context and circumstance are vast, and therefore simple guidance cannot suit every case.

Conclusions

An improved understanding of the circumstantial, individual and interpersonal factors that mediate the decision-making process in practice could inform the development of more effective guidelines, leading to greater consistency and paramedic confidence, with the potential for improved patient outcome.

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