Factors Impacting Treatment of Out-of-Hospital Cardiac Arrest: A Qualitative Study of Emergency Responders

被引:2
作者
Missel, Amanda L. [1 ,9 ]
Dowker, Stephen R. [1 ,2 ,3 ]
Dzierwa, Drake [2 ]
Krein, Sarah L. [4 ,5 ,6 ]
Coulter-Thompson, Emilee I. [1 ,4 ]
Williams, Michelle [1 ]
Trumpower, Brad [2 ]
Swor, Robert [7 ]
Hunt, Nathaniel [3 ,8 ]
Friedman, Charles P. [1 ]
机构
[1] Univ Michigan, Dept Learning Hlth Sci, Ann Arbor, MI USA
[2] Univ Michigan, Dept Internal Med, Div Cardiovasc Med, Ann Arbor, MI USA
[3] Univ Michigan, Dept Emergency Med, Ann Arbor, MI USA
[4] Univ Michigan Med Sch, Univ Michigan, Michigan Inst Healthcare Policy & Innovat, Ann Arbor, MI USA
[5] Ctr Clin Management Res, Vet Affairs Ann Arbor Hlth Syst, Ann Arbor, MI USA
[6] Univ Michigan, Dept Internal Med, Div Gen Med, Med Sch, Ann Arbor, MI USA
[7] Corewell East William Beaumont Univ Hosp, Dept Emergency Med, Royal Oak, MI USA
[8] Univ Michigan, Max Harry Weil Inst Crit Care Res & Innovat, Ann Arbor, MI USA
[9] Univ Michigan, Dept Learning Hlth Sci, Med Sch, 209 Victor Vaughan Bldg, 2054,1111 East Catherine, Ann Arbor, MI 48109 USA
来源
JOURNAL OF THE AMERICAN HEART ASSOCIATION | 2023年 / 12卷 / 10期
关键词
emergency responders; interviews; out-of-hospital cardiac arrest; system of care; HEART-ASSOCIATION GUIDELINES; CARDIOPULMONARY-RESUSCITATION; SURVIVAL; DIAGNOSIS; BURNOUT;
D O I
10.1161/JAHA.122.027756
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BackgroundOf the more than 250 000 emergency medical services-treated out-of-hospital cardiac arrests that occur each year in the United States, only about 8% survive to hospital discharge with good neurologic function. Treatment for out-of-hospital cardiac arrest involves a system of care that includes complex interactions among multiple stakeholders. Understanding the factors inhibiting optimal care is fundamental to improving outcomes. Methods and ResultsWe conducted group interviews with emergency responders including 911 telecommunicators, law enforcement officers, firefighters, and transporting emergency medical services personnel (ie, emergency medical technicians and paramedics) who responded to the same out-of-hospital cardiac arrest incident. We used the American Heart Association System of Care as the framework for our analysis to identify themes and their contributory factors from these interviews. We identified 5 themes under the structure domain, which included workload, equipment, prehospital communication structure, education and competency, and patient attitudes. In the process domain, 5 themes were identified focusing on preparedness, field response and access to patient, on-scene logistics, background information acquisition, and clinical interventions. We identified 3 system themes including emergency responder culture; community support, education, and engagement; and stakeholder relationships. Three continuous quality improvement themes were identified, which included feedback provision, change management, and documentation. ConclusionsWe identified structure, process, system, and continuous quality improvement themes that may be leveraged to improve outcomes for out-of-hospital cardiac arrest. Interventions or programs amenable to rapid implementation include improving prearrival communication between agencies, appointing patient care and logistical leadership on-scene, interstakeholder team training, and providing more standardized feedback to all responder groups.
引用
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页数:52
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