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Sørensen OB, Milling L, Laerkner E, Mikkelsen S, Bruun H. Professional prehospital clinicians' experiences of ethical challenges associated with the collaboration with organised voluntary first responders: a qualitative study. Scand J Trauma Resusc Emerg Med 2023; 31:79. [PMID: 37964364 PMCID: PMC10644536 DOI: 10.1186/s13049-023-01147-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 11/07/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Volunteer First Responders are used worldwide. In the Region of Southern Denmark, two types of programs have been established. One of these programs consists of voluntary responders without any requirements of education or training who are summoned to prehospital cardiac arrests. The other type of program is established primarily in the rural areas of the region and consists of volunteers with some mandatory education in first aid. These volunteers are summoned to all urgent cases along with the ambulances. Cooperation between professional healthcare workers and nonprofessionals summoned through official channels may be challenging. This study aimed to explore prehospital clinicians' experiences of ethical challenges in cooperation with volunteer first responders. METHODS We conducted 16 semi-structured interviews at four different ambulance stations in the Region of Southern Denmark. Five emergency physicians and 11 emergency medical technicians/paramedics were interviewed. The interviews were transcribed, and the data were analysed using systematic text condensation. RESULTS The study's 16 interviews resulted in the identification of some specific categories that challenged the cooperation between the two parties. We identified three main categories: 1. Beneficence, the act of doing good, 2. The risk of harming patients' autonomy 3. Non-maleficence, which is the obligation not to inflict harm on others. CONCLUSION This study provides an in-depth insight into the ethical challenges between prehospital clinicians and voluntary first responders from the perspective of the prehospital clinicians. Both programs are considered to have value but only when treating patients with cardiac arrest. Our study highlights potential areas of improvement in the two Danish voluntary programs in their current form.
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Affiliation(s)
- Oliver Beierholm Sørensen
- Department of Clinical Research, University of Southern Denmark, 5000, Odense, Denmark
- The Prehospital Research Unit, Region of Southern Denmark, Odense University Hospital, 5000, Odense, Denmark
| | - Louise Milling
- The Prehospital Research Unit, Region of Southern Denmark, Odense University Hospital, 5000, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, 5000, Odense, Denmark
- Department of Cardiology, Nord Zealand Hospital, 3400, Hillerød, Denmark
| | - Eva Laerkner
- Department of Anaesthesiology and Intensive Care Medicine, Odense University Hospital, 5000, Odense, Denmark
- Department of Clinical Research, Research Unit in Anesthesiology, University of Southern Denmark, 5000, Odense, Denmark
| | - Søren Mikkelsen
- The Prehospital Research Unit, Region of Southern Denmark, Odense University Hospital, 5000, Odense, Denmark.
- Department of Regional Health Research, University of Southern Denmark, 5000, Odense, Denmark.
- Department of Anaesthesiology and Intensive Care Medicine, Odense University Hospital, 5000, Odense, Denmark.
| | - Henriette Bruun
- The Prehospital Research Unit, Region of Southern Denmark, Odense University Hospital, 5000, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, 5000, Odense, Denmark
- Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, 5500, Middelfart, Denmark
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Prytz E, Norrblom P, Pilemalm S, Andersson Granberg T, Jonson CO. What motivates and demotivates emergency response volunteers? A survey-based factor analysis study. Scand J Trauma Resusc Emerg Med 2023; 31:38. [PMID: 37568197 PMCID: PMC10422740 DOI: 10.1186/s13049-023-01101-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 07/16/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Organized volunteer initiatives can reduce response times and improve outcomes in emergencies such as cardiac arrests or fires. Retention of volunteers is important to maintain good coverage and capabilities. The current study explores factors underlying volunteers' motivation to continue as volunteers. METHODS Data from 5347 active volunteers were collected through an online survey. An exploratory factor analysis was used to identify underlying factors that were then used in a regression analysis to predict intention to continue as a volunteer. Group differences based on, among others, number of alarms and prior professional experience in emergency response were explored. RESULTS The results showed that the factors community, self-image, and competence were the strongest positive predictors for the motivation to continue, whereas alarm fatigue and negative experience were the strongest negative predictors. Volunteers with professional background had higher competence and lower Alarm fatigue. Volunteers from rural areas and small cities had higher community than those in large cities. CONCLUSIONS Alarm fatigue can make it hard to retain volunteers, which could be addressed using improved dispatch algorithms. Support after dispatch is important to prevent negative experiences. Finally, increased competence, e.g. through education and training, can improve volunteer's motivation to continue.
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Affiliation(s)
- Erik Prytz
- Department of Computer and Information Science, Linköping University, Linköping, Sweden.
| | - Petter Norrblom
- Department of Computer and Information Science, Linköping University, Linköping, Sweden
| | - Sofie Pilemalm
- Department of Science and Technology, Linköping University, Linköping, Sweden
- Department of Information Systems, University of Agder, Kristiansand, Norway
| | | | - Carl-Oscar Jonson
- Center for Disaster Medicine and Traumatology, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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"It's like a swan, all nice and serene on top, and paddling like hell underneath": community first responders' practices in attending patients and contributions to rapid emergency response in rural England, United Kingdom-a qualitative interview study. SCANDINAVIAN JOURNAL OF TRAUMA, RESUSCITATION AND EMERGENCY MEDICINE 2023; 31:7. [PMID: 36782273 PMCID: PMC9924885 DOI: 10.1186/s13049-023-01071-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/29/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Community First Responder (CFR) schemes are a long-established service supplementing ambulance trusts in their local community in the United Kingdom. CFRs are community members who volunteer to respond to people with life-threatening conditions. Previous studies highlighted the motivations for becoming CFRs, their training, community (un)awareness and implications of their work on themselves and others. The practices of CFRs in prehospital care remain underexplored. Therefore, we aimed to explore real-world practice of Community First Responders and their contribution to prehospital emergency care. METHODS We conducted 47 interviews with CFRs (21), CFR leads (15), ambulance clinicians (4), commissioners (2) and patients and relatives (5) from six ambulance services and regions of England, United Kingdom. Thematic analysis enabled identification of themes and subthemes, with subsequent interpretation built on the theory of practice wisdom. RESULTS Our analysis revealed the embeddedness of the concept of doing the right thing at the right time in CFR practice. CFRs' work consisted of a series of sequential and interconnected activities which included: identifying patients' signs, symptoms and problems; information sharing with the ambulance control room on the patient's condition; providing a rapid emergency response including assessment and care; and engaging with ambulance clinicians for patient transfer. The patient care sequence began with recognising patients' signs and symptoms, and validation of patient information provided by the ambulance control room. The CFRs shared patient information with ambulance control who in turn notified the ambulance crew en-route. The practices of CFRs also included delivery of emergency care before ambulance clinicians arrived. Following the delivery of a rapid emergency response, CFRs engaged with the ambulance crew to facilitate patient transfer to the nearest medical facility. CONCLUSION The sequential CFR practices supported ambulance services in delivering prehospital and emergency care in rural areas. CFR practices were founded on the principle of practice wisdom where CFRs constructed their practice decisions based on the patient's condition, their training, availability of equipment and medications and their scope of practice.
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Barry T, Batt A, Agarwal G, Booker M, Casey M, McCombe G. Potential for Paramedic roles in Irish General Practice: A qualitative study of stakeholder’s perspectives. HRB Open Res 2022; 5:40. [PMID: 36072818 PMCID: PMC9418754 DOI: 10.12688/hrbopenres.13545.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Irish health policy emphasises the role of Primary Care and General Practice however, there is a growing shortage of General Practitioners (GPs) in Ireland. Paramedics have traditionally focused on emergency care in the community. More recently Paramedics have taken on roles in General Practice in international jurisdictions, but not yet in Ireland. This study aimed to explore key stakeholder perceptions of ‘the potential for Paramedic roles in Irish General Practice’. Methods: We conducted an exploratory, qualitative stakeholder consultation study incorporating in-depth semi structured telephone interviews followed by thematic analysis. Interviews were conducted with a total of eighteen participants that included six senior Paramedics (Advanced Paramedics), seven General Practitioners (GPs), three Practice Nurses and two Practice Managers. Results: Participants in this study expressed polarised views on the potential for Paramedic roles in Irish General Practice. Paramedics were enthusiastic, highlighting opportunity for professional development and favourable working conditions. GPs, Practice Nurses and Managers were more circumspect and had concerns that Paramedic scope and skillset was not currently aligned to General Practice care. GPs, Practice Nurses and Managers emphasised a greater role for expanded General Practice Nursing. There were varied perceptions on what the potential role of a Paramedic in General Practice might entail, but consensus that Government support would be required to facilitate any potential developments. Conclusions: The findings of this research can inform future development of novel roles in Irish General Practice and suggests that there is appetite from within the Paramedic profession to pursue such roles. A pilot demonstration project, grounded in an action research framework could address data gaps and potential concerns. Any future developments should occur in tandem with and with due consideration for the expansion of General Practice Nursing in Ireland.
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Affiliation(s)
- Tomás Barry
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Alan Batt
- Paramedic Programs, Fanshawe College, London, Ontario, Canada
| | - Gina Agarwal
- Departments of Family Medicine and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Matthew Booker
- Centre for Academic Primary Care (CAPC), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Mary Casey
- UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Geoff McCombe
- School of Medicine, University College Dublin, Dublin, Ireland
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Barry T, Batt A, Agarwal G, Booker M, Casey M, McCombe G. Potential for Paramedic roles in Irish General Practice: A qualitative study of stakeholder’s perspectives. HRB Open Res 2022; 5:40. [DOI: 10.12688/hrbopenres.13545.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Irish health policy emphasises the role of Primary Care and General Practice however, there is a growing shortage of General Practitioners (GPs) in Ireland. Paramedics have traditionally focused on emergency care in the community. More recently Paramedics have taken on roles in General Practice in international jurisdictions, but not yet in Ireland. This study aimed to explore key stakeholder perceptions of ‘the potential for Paramedic roles in Irish General Practice’. Methods: We conducted an exploratory, qualitative stakeholder consultation study incorporating in-depth semi structured telephone interviews followed by thematic analysis. Interviews were conducted with a total of eighteen participants that included six senior Paramedics (Advanced Paramedics), seven General Practitioners (GPs), three Practice Nurses and two Practice Managers. Results: Participants in this study expressed polarised views on the potential for Paramedic roles in Irish General Practice. Paramedics were enthusiastic, highlighting opportunity for professional development and favourable working conditions. GP’s, Practice Nurses and Managers were more circumspect and had concerns that Paramedic scope and skillset was not currently aligned to General Practice care. GP’s, Practice Nurses and Managers emphasised a greater role for expanded General Practice Nursing. There were varied perceptions on what the potential role of a Paramedic in General Practice might entail, but consensus that Government support would be required to facilitate any potential developments. Conclusions: The findings of this research can inform future development of novel roles in Irish General Practice and suggests that there is appetite from within the Paramedic profession to pursue such roles. A pilot demonstration project, grounded in an action research framework could address data gaps and potential concerns. Any future developments should occur in tandem with and with due consideration for the expansion of General Practice Nursing in Ireland.
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Dehghan-Nayeri N, Nouri-Sari H, Bahramnezhad F, Hajibabaee F, Senmar M. Barriers and facilitators to cardiopulmonary resuscitation within pre-hospital emergency medical services: a qualitative study. BMC Emerg Med 2021; 21:120. [PMID: 34645417 PMCID: PMC8515705 DOI: 10.1186/s12873-021-00514-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 10/04/2021] [Indexed: 11/30/2022] Open
Abstract
Background Out-of-hospital cardiopulmonary arrest is a common and fatal problem. Rescuing patients with this problem by pre-hospital emergency medical services is associated with various barriers and facilitators. Identifying these barriers as well as the facilitators in a qualitative and an information-rich way will help to improve the quality of performing the maneuver and to increase the patients’ survival. Therefore, the current study was qualitatively conducted with the aim of identifying the factors affecting the cardiopulmonary resuscitation within the pre-hospital emergency medical services. Methods This qualitative study was conducted using a content analysis approach in Iran in 2021. The participants were 16 Iranian emergency medical technicians who were selected through a purposive sampling method. For data collection, in-depth and semi-structured interviews were conducted. For data analysis, the Elo and Kyngäs method was applied. Results The mean participants’ age was 33.06 ± 7.85 years, and their mean work experience was 10.62 ± 6.63 years. The collected information was categorized into one main category called “complex context of the cardiopulmonary resuscitation” and 5 general categories with 17 subcategories. These categories and subcategories include patient condition (patient’s underlying diseases, age, high weight, number of children, and place of living), dominant atmosphere in companions at home (companions’ feeling of agitation, companions doing harm, and companions helping), policy (educational policy, human resource policy, up-to-date equipment and technology, and do-not-resuscitate policy), performance of the out-of-organizational system (disorganization in the patient handover process, and cooperation of the support organizations), and conditions related to the treatment team (conscience, cultural dominance, and shift burden). Conclusions The results showed that the conditions related to the patient and his/her companions, as well as the organizational factors such as the policies and the out-of-organizational factors act as the barriers and the facilitators to the cardiopulmonary resuscitation within pre-hospital emergency medical services. Therefore, the barriers can be modified and the facilitators can be enhanced by taking various measures such as educating, human resource policy-making, upgrading the equipment, and considering appropriate management policies. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-021-00514-3.
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Affiliation(s)
- Nahid Dehghan-Nayeri
- Department of Critical Care and Nursing Management, School of Nursing and Midwifery, Tehran University of Medical Sciences, Nosrat St, Tehran, 1419733171, Iran
| | - Hassan Nouri-Sari
- Disaster and Emergency Medical Management Center, Ministry of Health and Medical Education, Tehran, Iran
| | - Fatemeh Bahramnezhad
- Department of Critical Care and Nursing Management, School of Nursing and Midwifery, Tehran University of Medical Sciences, Nosrat St, Tehran, 1419733171, Iran
| | - Fatemeh Hajibabaee
- Department of Critical Care and Nursing Management, School of Nursing and Midwifery, Tehran University of Medical Sciences, Nosrat St, Tehran, 1419733171, Iran
| | - Mojtaba Senmar
- Department of Critical Care and Nursing Management, School of Nursing and Midwifery, Tehran University of Medical Sciences, Nosrat St, Tehran, 1419733171, Iran.
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Barry T, Headon M, Quinn M, Egan M, Masterson S, Deasy C, Bury G. General practice and cardiac arrest community first response in Ireland. Resusc Plus 2021; 6:100127. [PMID: 34223384 PMCID: PMC8244493 DOI: 10.1016/j.resplu.2021.100127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 11/21/2022] Open
Abstract
Background In Ireland, the MERIT 3 scheme enables doctors to volunteer as cardiac arrest community first responders and receive text message alerts from emergency medical services (EMS) to facilitate early care. Aim To establish the sustainability, systems and clinical outcomes of a novel, general practice based, cardiac arrest first response initiative over a four-year period. Methods Data on alerts, responses, incidents and outcomes were gathered prospectively using EMS control data, incident data reported by responders and corroborative data from the national Out-of-Hospital Cardiac Arrest Registry. Results Over the period 2016–2019, 196 doctors joined MERIT 3 and 163 (83.2%) were alerted on one or more occasions; 61.3% of those alerted responded to at least one alert. Volunteer doctors attended 300 patients of which 184 (61.3%) had suffered OHCA and had a resuscitation attempt. Responders arrived to OHCA before EMS on 75 occasions (40.8%), initiated chest compressions on seven occasions (3.8%), and brought the first defibrillator on 42 occasions (22.8%). Information on the first monitored rhythm was available for 149/184 (81.0%) patients and was shockable in 30/149 (20.1%); in 9/30 cases, shocks were administered by responders. The overall survival rate was 11.0% (national survival rate 7.3%). Doctors also provided advanced life support and were closely involved in decision making on ceasing resuscitation. Conclusion The MERIT 3 initiative in Ireland has been sustained over a four-year period and has demonstrated the ability of volunteer doctors to provide early care for OHCA patients as well as more complex interventions including end-of-life care. Further development of this strategy is warranted.
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Affiliation(s)
- Tomas Barry
- School of Medicine, University College Dublin, Ireland
- Corresponding author.
| | - Mary Headon
- Centre for Emergency Medical Science, University College Dublin, Ireland
| | | | - Mairead Egan
- Centre for Emergency Medical Science, University College Dublin, Ireland
| | - Siobhan Masterson
- Clinical Strategy and Evaluation, National Ambulance Service, Health Service Executive, Ireland
| | | | - Gerard Bury
- School of Medicine, University College Dublin, Ireland
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Heffernan E, Mc Sharry J, Murphy A, Barry T, Deasy C, Menzies D, Masterson S. Community first response and out-of-hospital cardiac arrest: a qualitative study of the views and experiences of international experts. BMJ Open 2021; 11:e042307. [PMID: 33757945 PMCID: PMC7993284 DOI: 10.1136/bmjopen-2020-042307] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES This research aimed to examine the perspectives, experiences and practices of international experts in community first response: an intervention that entails the mobilisation of volunteers by the emergency medical services to respond to prehospital medical emergencies, particularly cardiac arrests, in their locality. DESIGN This was a qualitative study in which semistructured interviews were conducted via teleconferencing. The data were analysed in accordance with an established thematic analysis procedure. SETTING There were participants from 11 countries: UK, USA, Canada, Australia, New Zealand, Singapore, Ireland, Norway, Sweden, Denmark and the Netherlands. PARTICIPANTS Sixteen individuals who held academic, clinical or managerial roles in the field of community first response were recruited. Maximum variation sampling targeted individuals who varied in terms of gender, occupation and country of employment. There were eight men and eight women. They included ambulance service chief executives, community first response programme managers and cardiac arrest registry managers. RESULTS The findings provided insights on motivating and supporting community first response volunteers, as well as the impact of this intervention. First, volunteers can be motivated by 'bottom-up factors', particularly their characteristics or past experiences, as well as 'top-down factors', including culture and legislation. Second, providing ongoing support, especially feedback and psychological services, is considered important for maintaining volunteer well-being and engagement. Third, community first response can have a beneficial impact that extends not only to patients but also to their family, their community and to the volunteers themselves. CONCLUSIONS The findings can inform the future development of community first response programmes, especially in terms of volunteer recruitment, training and support. The results also have implications for future research by highlighting that this intervention has important outcomes, beyond response times and patient survival, which should be measured, including the benefits for families, communities and volunteers.
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Affiliation(s)
- Eithne Heffernan
- Discipline of General Practice, Clinical Science Institute, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Jenny Mc Sharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Andrew Murphy
- Discipline of General Practice, Clinical Science Institute, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Tomás Barry
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Conor Deasy
- Department of Emergency Medicine, Cork University Hospital, Cork, Ireland
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - David Menzies
- National Ambulance Service, Health Service Executive, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
- CFR Ireland, Dublin, Ireland
| | - Siobhan Masterson
- Discipline of General Practice, Clinical Science Institute, School of Medicine, National University of Ireland Galway, Galway, Ireland
- National Ambulance Service, Health Service Executive, Dublin, Ireland
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