EMS World

SEP 2018

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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EMSWORLD.com | SEPTEMBER 2018 17 A recent Trip Report discussed bystander CPR. This month we review another manuscript on the topic. We don't normally review two manuscripts on the same topic so close together, but we all know how important bystander CPR is to improving a patient's chances of survival from out-of-hospital cardiac arrest. In July's Trip Report (www.emsworld.com/ article/220741) we discussed a manuscript that evaluated the quality of bystander CPR. That study used quantitative methods to determine that bystanders perform high- quality CPR. Authors evaluated how often bystanders met AHA guidelines for rate and depth. They calculated percentages and p-values with data obtained from databases. There was no interaction between the study team and the study subjects. This study, conversely, uses qualitative methods to evaluate the experience of bystanders who have performed CPR. There are no calculations and no large databases to query. Rather, the authors spoke face-to- face with bystanders and sought to under- stand how this experience impacted them. Parameters Lead author Justin Mausz and his coauthors performed this study in Ontario, Canada. The EMS system used for this study typically sees about 112,000 emergency calls per year, including approximately 80 cardiac arrests per year where a victim collapses in a public place. About half of these have bystander CPR performed. The authors reported that about 10–20 cases had a bystander deliv- ering a shock from an AED. For purposes of this study, a bystander was defined as "an individual who discovered a victim of cardiac arrest and witnessed their collapse and attempted to intervene by calling 9-1-1, performing CPR, and using an AED." This system had recently implemented a program to track AED use by bystanders, with the goal of providing public education and safety planning, and providing emotional support and referral services to bystanders. Paramedics flagged incidents for follow- up by a community safety specialist. Study authors then contacted those bystanders who agreed to participate to obtain written consent and conduct recorded interviews and focus groups. The study took place from November 1, 2015 to November 1, 2016. The authors had an interview guide that asked questions regarding the emotional, physical and cognitive challenges of the experience, and what bystanders would have changed regarding their CPR training. How- ever, the authors didn't stick exclusively to this guide. Rather, they described their inter- views and focus groups as semistructured. Authors recognized these events may have been distressing and prioritized emotional support over specific questions, allowing the participants to describe the event "in their own words, at their own pace, and in accordance with their own comfort levels." Analysis involved listening to the record- ings and reading the transcripts multiple times to develop codes for categories and themes until a point of theoretical suffi- ciency was reached, or "the point at which progressively fewer new ideas were identified during data collection, the research team was satisfied that all relevant lines of inquiry had been pursued, and we had achieved a rich, deep description of the phenomenon." Results The authors indicated they achieved theo- retical sufficiency after reviewing six out-of- hospital cardiac arrests that included a total of 15 involved bystanders (average age 45.6 years). Every bystander who was asked to participate agreed. They conducted a single one-on-one interview and five focus groups ranging from 2–7 participants. All cardiac arrests occurred in the bystanders' place of work, and all victims except one were coworkers. All bystanders had previous CPR training either through their job or a traditional class, but none had previously performed bystander CPR. Of the six cardiac arrests included in the study, four victims had ROSC on scene, and three survived. The three commonalities that arose from the interview and focus groups were: being called to act, taking action, and mak- ing sense of the experience. With regard to the first, the authors noted the participants indicated that "seeing a person collapse is distressing." Things that were particularly unnerving to participants were "cyanosis, convulsions, incontinence, loss of muscle tone, snoring, and gasping for respirations." They also noted that the victims' face, eyes, and lifelessness were distressing. The authors noted the participants experienced senses of panic and urgency and were prompted by the awareness that someone had to act to try to save the victim's life. While all participants overcame perceived barriers to taking action, a consistent bar- rier was fear of liability or discipline. Partici- pants weren't sure whether they would get in trouble for performing CPR with an expired certification or if their training wasn't recent. Workplace policies and procedures were also a barrier, in one case resulting in an off-duty worker being called to report to work to assist with the response. It helps cardiac arrest victims—but what does it do to nonprofessional rescuers? By Antonio R. Fernandez, PhD, NRP, FAHA THE TRIP REPORT: TURNING RESEARCH INTO PRACTICE Look for PCRF research podcasts based on the topics featured in this column at www.pcrfpodcast.org. REVIEWED THIS MONTH "Please. Don't. Die.": A Grounded Theory Study of Bystander Cardiopulmonary Resuscitation. Authors: Mausz J, Snobelen P, Tavares W. Published in: Circ Cardiovasc Qual Outcomes, 2018 Feb The Effect of CPR on Bystanders

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