When resuscitation doesn’t work: A qualitative study examining ambulance personnel preparation and support for termination of resuscitation and patient death

Anderson, Natalie; Slark, Julia; Gott, Merryn

doi:10.1016/j.ienj.2019.100827

Cited by 7 publications

(9 citation statements)

References 46 publications

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“…Study 1 findings 3,13 revealed that the task of resuscitation decision‐making – and in particular, enacting decisions to withhold or terminate resuscitation – required a specific set of skills. Study 2 14 showed that essential preparation for resuscitation decision‐making included clear clinical guidelines, knowledge of prognostic indicators, supported clinical exposure and mentoring, and personal experience with death, grief and bereavement. Across all studies, participants commented that there was a lack of specific education and training in the areas of resuscitation decision‐making, patient death and bereavement.…”

Section: Resultsmentioning

confidence: 99%

“…Key findings from individual studies have previously been compared and contrasted with existing literature. 3,[13][14][15] The focus of this discussion is to outline implications for the preparation and support of emergency ambulance personnel.…”

Section: Discussionmentioning

confidence: 99%

“…Novices may find it particularly difficult to terminate resuscitation, break bad news and provide care after death. Key findings from individual studies have previously been compared and contrasted with existing literature 3,13–15 . The focus of this discussion is to outline implications for the preparation and support of emergency ambulance personnel.…”

Section: Discussionmentioning

confidence: 99%

“…In response to these findings, and after a further review of the literature, 5 we conducted two further studies. Study 2 was a focus group study with 20 experts in ambulance personnel clinical education and peer support, identifying supports before, during and after resuscitation decision‐making events 14 . Study 3 was an online survey of New Zealand paramedicine students, exploring their confidence, concerns, learning experiences and exposure to resuscitation decision‐making and managing patient death 15 …”

Section: Methodsmentioning

confidence: 99%

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Prehospital Resuscitation Decision Making: A model of ambulance personnel experiences, preparation and support

Anderson

Slark

Gott

2021

Emerg Medicine Australasia

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Objective: This paper presents the first Naturalistic Decision Making model of prehospital resuscitation decision-making, which has clear implications for education, practice and support. Methods: A mixed-methods exploratory sequential research design consisting of interviews with ambulance personnel (study 1), focus groups with ambulance educators, managers and peer supporters (study 2), and an online survey of graduating paramedic students (study 3). This paper reports the model developed from integrated findings, across all three studies. All research was undertaken in New Zealand and underpinned by a critical realist worldview. Results: The Prehospital Resuscitation Decision Making model identifies key processes, challenges and facilitators before, during and after ambulance personnel attend a cardiac arrest event. It is the only descriptive model of resuscitation decision making which acknowledges the decision-maker, nonprognostic factors and the importance of adequate preparation and support. Conclusions: This research project is the first to comprehensively explore and model ambulance personnel perspectives on decisions to start, continue or stop resuscitation.The decision-making process is complex and difficult to simply formularise. Education and supports must assist ambulance personnel in navigating this complexity. Where resuscitation is withheld or terminated, ambulance personnel need to feel confident that they can effectively provide after-death care.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Prehospital Resuscitation Decision Making: A model of ambulance personnel experiences, preparation and support

Anderson

Slark

Gott

2021

Emerg Medicine Australasia

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“…35 Firefighters and ambulance staff are well-trained clinically, such as in CPR skills and in solving emergency situations, but they are not trained and prepared for all emotional and ethical conflicts. 31,[33][34][35][36] It is appreciated by those involved when firefighters stay and talk a while after the ambulance departs with the affected or deceased person, as the grief then does not have to be carried alone but is shared in the moment. 37 To be each other's support in WWFA assignments…”

Section: To Take Responsibility For Affected Personsmentioning

confidence: 99%

‘Time is our utmost enemy’: First responders’ experiences of ‘While Waiting For the Ambulance’ assignments in rural environments – A phenomenological study

Nord-Ljungquist

Engström

Fridlund

et al. 2021

Nordic Journal of Nursing Research

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Firefighters around the world have the ability to provide first aid before ambulance staff arrive. In Sweden, this assignment is called ‘While Waiting For the Ambulance’ (WWFA). There is limited knowledge about WWFA in rural environments, therefore the aim of this study was to describe the WWFA assignment in a rural environment from the perspective of the firefighters and the ambulance staff. A descriptive design was used with a reflective lifeworld approach, including 16 telephone interviews with firefighters and ambulance staff. The COREQ checklist was applied. A directed responsibility emerges towards affected persons with a situation-adapted attitude during alarms in a WWFA assignment. The firefighters and ambulance staff are each other’s support with a simultaneous need for support from involved organisations. To strengthen this support, training is required, consisting of interprofessional training, feedback from relevant organisations about first aid efforts and expansion of WWFA assignments. Finally, there is a need for a more coordinated picture in order to provide better conditions for future action by the organisations involved, with increased opportunities to save lives in individual local environments.

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Paramedic care of the dying, deceased and bereaved in Aotearoa, New Zealand

Anderson

Robinson

Moeke-Maxwell

et al. 2020

Progress in Palliative Care

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Paramedics play an essential and distinct role as providers of care to the dying, deceased and bereaved in Aotearoa, New Zealand and around the world. In this paper, we highlight what is known about the features, barriers and facilitators of quality end-of-life care by emergency ambulance personnel. We also identify priorities for future policy and practice, education and research in this area.Paramedics provide urgent and after-hours support to those with known life-limiting illness and their caregivers, but also attend sudden deaths, from unexpected or unknown causes. Paramedic care at the end of life may involve attempted resuscitation; challenging decision-making and communication; symptom relief; recognition of irreversible dying; provision of compassionate, culturally responsive support for co-responders, bystanders and the bereaved. There is an insufficient acknowledgement of the critical and unique role of paramedics, as providers of urgent care to the dying deceased and bereaved. Ambulance personnel around the world want better preparation and support for end-of-life care. Future research should aim to evaluate and improve this vital care, explore the needs and experiences of those who call an ambulance in the context of death, dying or bereavement and address equity and cultural responsiveness.

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When resuscitation doesn’t work: A qualitative study examining ambulance personnel preparation and support for termination of resuscitation and patient death

Cited by 7 publications

References 46 publications

Prehospital Resuscitation Decision Making: A model of ambulance personnel experiences, preparation and support

Prehospital Resuscitation Decision Making: A model of ambulance personnel experiences, preparation and support

‘Time is our utmost enemy’: First responders’ experiences of ‘While Waiting For the Ambulance’ assignments in rural environments – A phenomenological study

Paramedic care of the dying, deceased and bereaved in Aotearoa, New Zealand

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