EMS Provider Perceptions on Termination of Resuscitation in a Large, Urban EMS System

Tataris, Katie; Richards, Christopher T; Stein-Spencer, Leslee; Ryan, Stephanie; Lazzara, Pete; Weber, Joseph

doi:10.1080/10903127.2017.1317891

Cited by 20 publications

(19 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While on-scene delays have not been well studied, some factors may include reaching patients in high-rise buildings in urban areas and establishing scene safety. 41 , 42 , 43 For example, prehospital health care professionals responding to patients living in low-income zip codes residing in dense housing complexes could also encounter more logistic difficulties in identifying the proper housing unit or could encounter language barriers, which are present less often in high-income neighborhoods. Although debates on duration of resuscitation and variations with infield termination practices continue, many EMS systems place emphasis on staying at the scene until the return of spontaneous circulation, which may explain longer on-scene times.…”

Section: Discussionmentioning

confidence: 99%

A US National Study of the Association Between Income and Ambulance Response Time in Cardiac Arrest

et al. 2018

View full text Add to dashboard Cite

Key Points Question Are ambulance 9-1-1 times longer in high-income compared with low-income areas, and how do response times compare with national benchmarks across income quartiles? Findings In this US national, cross-sectional study of 63 600 patients with out-of-hospital cardiac arrest, EMS times remained 10% longer in the poorest areas and were more likely to meet 8-minute and 15-minute cutoffs in high-income areas. Meaning Patients with cardiac arrest from the poorest neighborhoods had longer EMS times that were less likely to meet national benchmarks compared with those from the wealthiest neighborhoods, which may lead to increased disparities in the delivery of prehospital care over time.

show abstract

Section: Discussionmentioning

confidence: 99%

A US National Study of the Association Between Income and Ambulance Response Time in Cardiac Arrest

et al. 2018

View full text Add to dashboard Cite

show abstract

“…The included papers contained data from 25 unique studies. Of these papers, 12 were qualitative studies [ 5 , 8 , 22 – 31 ], two mixed-method studies [ 32 , 33 ], and 13 quantitative studies [ 34 – 46 ]. The papers were published between 1993 and 2021.…”

Section: Resultsmentioning

confidence: 99%

“…Others believed family members’ verbal wishes should be honoured [ 45 ]. Family wishes were mentioned as a reason for not complying with the guidelines [ 37 , 46 ]. The family’s despair led them to beg or plead for the continuation of resuscitation—a request that the providers often complied with [ 24 , 29 ], but the emotions of the families also increased the providers’ uncertainty if their decision went against the expressed wishes of the family [ 24 , 30 ].…”

Section: Resultsmentioning

confidence: 99%

Non-medical factors in prehospital resuscitation decision-making: a mixed-methods systematic review

Milling

Kjær

Binderup

et al. 2022

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

Aim This systematic review explored how non-medical factors influence the prehospital resuscitation providers’ decisions whether or not to resuscitate adult patients with cardiac arrest. Methods We conducted a mixed-methods systematic review with a narrative synthesis and searched for original quantitative, qualitative, and mixed-methods studies on non-medical factors influencing resuscitation of out-of-hospital cardiac arrest. Mixed-method reviews combine qualitative, quantitative, and mixed-method studies to answer complex multidisciplinary questions. Our inclusion criteria were peer-reviewed empirical-based studies concerning decision-making in prehospital resuscitation of adults > 18 years combined with non-medical factors. We excluded commentaries, case reports, editorials, and systematic reviews. After screening and full-text review, we undertook a sequential exploratory synthesis of the included studies, where qualitative data were synthesised first followed by a synthesis of the quantitative findings. Results We screened 15,693 studies, reviewed 163 full-text studies, and included 27 papers (12 qualitative, two mixed-method, and 13 quantitative papers). We identified five main themes and 13 subthemes related to decision-making in prehospital resuscitation. Especially the patient’s characteristics and the ethical aspects were included in decisions concerning resuscitation. The wishes and emotions of bystanders further influenced the decision-making. The prehospital resuscitation providers’ characteristics, experiences, emotions, values, and team interactions affected decision-making, as did external factors such as the emergency medical service system and the work environment, the legislation, and the cardiac arrest setting. Lastly, prehospital resuscitation providers’ had to navigate conflicts between jurisdiction and guidelines, and conflicting values and interests. Conclusions Our findings underline the complexity in prehospital resuscitation decision-making and highlight the need for further research on non-medical factors in out-of-hospital cardiac arrest.

show abstract

“…• Termination of resuscitation guideline derivation, prognostic indicators and survival statistics (30,42) • Local medicolegal issues including documented patient wishes (28,31) Improved self-confidence through rehearsal/role-play and discussion of: • Managing death scenes and bystanders (27)(28)(29)(30)(32)(33)(34)36,39,41) • Death notification delivery and communication with bereaved family (27)(28)(29)(30)33,36,38,39) Identified support needs Access to: • Clear policies or guidelines (36,41) • Informal peer support and opportunities to discuss difficult decisions (33,35,36) • Professional support for occupational or personal stressors (30,42)…”

Section: Identified Preparation Needsmentioning

confidence: 99%

How are Ambulance Personnel Prepared and Supported to Withhold or Terminate Resuscitation and Manage Patient Death in the Field? A Scoping Review

Anderson

Slark

Gott

2019

Australasian Journal of Paramedicine

View full text Add to dashboard Cite

IntroductionResearch shows that ambulance personnel can find it challenging to withhold or terminate resuscitation and manage patient death in the field. This scoping review provides a synthesis of published research that has addressed three main questions. Each relates to ambulance personnel enacting decisions to withhold or terminate resuscitation and manage patient death: How are they prepare; what supports and coping strategies are utilised; and what preparation and support needs have been identified?MethodsUsing Arksey and O’Malley’s five-stage scoping review framework this review identifies what is known and what further research is needed in this area.ResultsSixteen methodologically heterogenous papers were located. Half of the studies were conducted in the United States, with the remainder in Canada, Singapore, Spain, Sweden and the United Kingdom. Ambulance personnel receive little formal training and feel unprepared to manage situations where resuscitation is unsuccessful or unwarranted, particularly communicating with family, breaking bad news and managing death scenes. These aspects of termination of resuscitation are so challenging that distancing and avoidance are sometimes used as coping strategies, even when medical futility has been established. In addition to formal counselling for personal loss and stressors, ambulance personnel value downtime and informal peer debriefing, following difficult resuscitation decisions and patient deaths.ConclusionAmbulance personnel feel inadequately prepared to withhold or terminate resuscitation and manage patient death in the field. They want more opportunities to learn about death notification, communication with bereaved families and safe, sensitive management of death scenes. More research is needed to determine how best to prepare and support ambulance personnel for the challenges of resuscitation decision-making and patient death.

show abstract

EMS Provider Perceptions on Termination of Resuscitation in a Large, Urban EMS System

Cited by 20 publications

References 24 publications

A US National Study of the Association Between Income and Ambulance Response Time in Cardiac Arrest

A US National Study of the Association Between Income and Ambulance Response Time in Cardiac Arrest

Non-medical factors in prehospital resuscitation decision-making: a mixed-methods systematic review

How are Ambulance Personnel Prepared and Supported to Withhold or Terminate Resuscitation and Manage Patient Death in the Field? A Scoping Review

Contact Info

Product

Resources

About