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Werner K, Stassen W, Theron E, Wallis LA, Lin TK. Patient Preferences for Out-of-Hospital Cardiac Arrest Care in South Africa: A Discrete Choice Experiment. Value Health Reg Issues 2024; 43:101006. [PMID: 38857557 PMCID: PMC11349466 DOI: 10.1016/j.vhri.2024.101006] [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: 09/17/2023] [Revised: 03/27/2024] [Accepted: 05/01/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVE This study examined the trade-offs low-resource setting community members were willing to make in regard to out-of-hospital cardiac arrest care using a discrete choice experiment survey. METHODS We administered a discrete choice experiment survey to a sample of community members 18 years or older across South Africa between April and May 2022. Participants were presented with 18 paired choice tasks comprised of 5 attributes (distance to closest adequate facility, provider of care, response time, chances of survival, and transport cost) and a range of 3 to 5 levels. We used mixed logit models to evaluate respondents' preferences for selected attributes. RESULTS Analyses were based on 2228 responses and 40 104 choice tasks. Patients valued care with the shortest response time, delivered by the highest qualified individuals, which placed them within the shortest distance of an adequate facility, gave them the highest chance of survival, and costed the least. In addition, patients preferred care delivered by their family members over care delivered by the lay public. The highest mean willingness-to-pay for increased survival is 11 699 South African rand (ZAR), followed by distance to health facility (8108 ZAR), and response time (5678 ZAR), and the lowest for increasing specialization of provider (1287 ZAR). CONCLUSIONS In low-resource settings, it may align with patients' preference to include targeted resuscitation training for family members of individuals with high-risk for cardiac arrest as a part of out-of-hospital cardiac arrest intervention strategies.
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Affiliation(s)
- Kalin Werner
- Institute for Health and Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA; Division of Emergency Medicine, University of Cape Town, Western Cape, Cape Town, South Africa.
| | - Willem Stassen
- Division of Emergency Medicine, University of Cape Town, Western Cape, Cape Town, South Africa
| | - Elzarie Theron
- Division of Emergency Medicine, University of Cape Town, Western Cape, Cape Town, South Africa
| | - Lee A Wallis
- Division of Emergency Medicine, University of Cape Town, Western Cape, Cape Town, South Africa
| | - Tracy K Lin
- Institute for Health and Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
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Marzaleh MA, Peyravi M, Ahmadi E, Shakibkhah I, Armin H, Mahmoodi H, Avazaghaei H. Exploring paramedics' lived experiences in confrontation with patients' death during missions: a phenomenological study. BMC Emerg Med 2024; 24:115. [PMID: 38992587 PMCID: PMC11241868 DOI: 10.1186/s12873-024-01042-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 07/08/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Emergency personnel are the first line of emergency response systems to respond to emergencies; in essence, they are usually exposed to a wide range of physical and psychological problems. Accordingly, the current study aimed to clarify the lived experiences of paramedics when exposed to Patients' Deaths during their missions in 2023. METHODS This study was carried out using a qualitative approach and interpretative phenomenology from January 9, 2022, to September 21, 2023. The research was performed in Fars, Alborz, and Isfahan provinces in Iran. Data were gathered using semi-structured interviews with 17 male emergency personnel (both from the emergency medical service and Red Crescent). The obtained data were analyzed utilizing Smith's approach to clarify the lived experiences of emergency responders when facing deaths in various incidents in Iran. RESULTS Seventeen emergency personnel with the age range of 24-60 (average = 39) years and with a history of confronting patients' deaths during their services were interviewed. Their lived experiences of being exposed to patients' deaths during the emergency response in Iran were classified into three main themes: psychological and emotional status, personality, disposition, and behavior status, and mental and physical status. Sub-themes such as psychological and emotional problems, mental and physical problems, and sub-subthemes such as anxiety, stress, decreased appetite, irritability, insomnia, forgetfulness, and fatigue were also noted within the main themes. CONCLUSION While emergency personnel work diligently to save the lives of patients, the current study demonstrated that they were susceptible to multiple psychological, emotional, and physical problems, which potentially affect their lives outside of the workplace and make them more vulnerable to related physiological and psychological diseases. It is recommended that policymakers and clinical educators make ways to prevent these problems and provide emergency personnel with physical, psychological, and emotional support.
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Affiliation(s)
- Milad Ahmadi Marzaleh
- Department of Health in Disasters and Emergencies, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahmoudreza Peyravi
- Department of Health in Disasters and Emergencies, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Esmaeil Ahmadi
- Department of Health in Disasters and Emergencies, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Iman Shakibkhah
- Department of Health in Disasters and Emergencies, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Armin
- Department of Health in Disasters and Emergencies, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hadi Mahmoodi
- Department of Health in Disasters and Emergencies, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Hossein Avazaghaei
- Department of Health in Disasters and Emergencies, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Glad M, Grønlund IR, Møller AM. A survey of emergency medical service providers' perspectives regarding relatives influence on acute prehospital treatment of adult patients. Acta Anaesthesiol Scand 2024. [PMID: 38937943 DOI: 10.1111/aas.14480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 05/23/2024] [Accepted: 06/07/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND In the field of prehospital emergency medicine, specialized emergency medical service (EMS) providers interact with acutely ill patients and their relatives. The influence of family presence during in-hospital resuscitation is well described. However, no studies have previously assessed the influence of relatives' presence in the acute prehospital setting. The aim of this study was to investigate EMS providers' perspectives on relatives' impact on the acute prehospital treatment of adult patients. METHODS An online anonymous survey was distributed to all prehospital EMS providers in the Capital Region of Denmark. The survey included 25 research questions on a 5-point Likert scale, investigating relatives' influence on treatment in three different domains: positive, negative, and resuscitation. A higher domain score indicates a high level of agreement or frequency. RESULTS Two hundred forty-six EMS providers completed the survey (84 ambulance technicians, 87 paramedics, and 75 physicians). There were no significant differences in the positive domain across professions (p = .175). Physicians had a statistically significant lower median score in the negative domain, compared with ambulance technicians and paramedics (2.50 vs. 2.63 and 2.63, p = .024). In the resuscitation domain, paramedics and physicians had a significant lower median score compared with ambulance technicians (3.00 and 3.00 vs. 3.14, p = .003). CONCLUSION All professions were equally positive towards the relatives' presence and involvement in the acute prehospital setting. Physicians were less likely to be negatively influenced by the presence of relatives compared with ambulance technicians and paramedics. In all professions, increased experience led to improved comfort with handling relatives.
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Affiliation(s)
- Marie Glad
- Research Unit, Department of Anaesthesia, Surgery and Intensive Care, Herlev Hospital, Copenhagen, Denmark
| | - Ingeborg R Grønlund
- Research Unit, Department of Anaesthesia, Surgery and Intensive Care, Herlev Hospital, Copenhagen, Denmark
| | - Ann Merete Møller
- Research Unit, Department of Anaesthesia, Surgery and Intensive Care, Herlev Hospital, Copenhagen, Denmark
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Brown N, Pike C. Saving ambulance resources: a service evaluation of the identification of non-viable out-of-hospital cardiac arrest in London by advanced paramedic practitioners in critical care. Br Paramed J 2024; 8:38-43. [PMID: 38445109 PMCID: PMC10910289 DOI: 10.29045/14784726.2024.3.8.4.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
Background Advanced paramedic practitioners in critical care (APPCCs) are advanced clinical practitioners focused on the delivery of pre-hospital critical care. While working in an ambulance control room setting, APPCCs seek to identify emergency calls appropriate for operational APPCCs to attend. These would include out-of-hospital cardiac arrest (OHCA). Through interrogation of incoming emergency calls they are also able to identify OHCA calls where resuscitation may be futile. In these cases, and within a governance framework, they stand down multiple ambulance responders, leaving only the closest responding resource to attend, thereby 'saving resources' that can be re-directed to other waiting emergency calls. It is believed that this is the first initiative of this nature in the United Kingdom. Methods A three-year retrospective service evaluation of data was undertaken. The aim was to quantify the number of 'saved resources', including both double crewed ambulances (DCAs) and solo (single-person) responders, and furthermore to equate those savings into potential hours saved, using average known job cycle times (JCTs). Additionally, safety was assessed by searching all mandated incident reports for occasions where, despite cancellation of resources by an APPCC, resuscitation was commenced by the first response to scene. Results A total of 13,356 ambulance resources were saved. Of these, 6593 (49.4%) were DCAs and 6763 (50.6%) were solo responders. Using the average JCT for deceased patients of 104.8 minutes, the total time saving equated to 23,328.48 hours of work or 1944.04 12-hour shifts. When considering DCAs alone, the average JCT for obviously deceased patients was 110.9 minutes. This equates to 12,186.1 hours of work or 1015.5 12-hour shifts. A total of 15 incident reports were identified. All had been investigated, revealing appropriate decision making in cancelling ambulance resources. No patient harm was identified. Conclusion APPCCs working within a governance framework safely saved a significant number of ambulance resources over a three-year period. Perceived benefits include 'freeing up' DCA and solo responders, allowing them to be redirected to other emergency calls, leading to potential improvement in response times for patients waiting for an ambulance resource.
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Affiliation(s)
- Nick Brown
- London Ambulance Service NHS Trust ORCID iD: https://orcid.org/0000-0002-7257-536X
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Satchell E, Carey M, Dicker B, Drake H, Gott M, Moeke-Maxwell T, Anderson N. Family & bystander experiences of emergency ambulance services care: a scoping review. BMC Emerg Med 2023; 23:68. [PMID: 37316865 DOI: 10.1186/s12873-023-00829-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/23/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Emergency ambulance personnel respond to a variety of incidents in the community, including medical, trauma and obstetric emergencies. Family and bystanders present on scene may provide first aid, reassurance, background information or even act as proxy decision-makers. For most people, involvement in any event requiring an emergency ambulance response is a stressful and salient experience. The aim of this scoping review is to identify and synthesise all published, peer-reviewed research describing family and bystanders' experiences of emergency ambulance care. METHODS This scoping review included peer-reviewed studies that reported on family or bystander experiences where emergency ambulance services responded. Five databases were searched in May 2022: Medline, CINAHL, Scopus, ProQuest Dissertation & Theses and PsycINFO. After de-duplication and title and abstract screening, 72 articles were reviewed in full by two authors for inclusion. Data analysis was completed using thematic synthesis. RESULTS Thirty-five articles reporting heterogeneous research designs were included in this review (Qualitative = 21, Quantitative = 2, Mixed methods = 10, Evidence synthesis = 2). Thematic synthesis developed five key themes characterising family member and bystander experiences. In an emergency event, family members and bystanders described chaotic and unreal scenes and emotional extremes of hope and hopelessness. Communication with emergency ambulance personnel played a key role in family member and bystander experience both during and after an emergency event. It is particularly important to family members that they are present during emergencies not just as witnesses but as partners in decision-making. In the event of a death, family and bystanders want access to psychological post-event support. CONCLUSION By incorporating patient and family-centred care into practice emergency ambulance personnel can influence the experience of family members and bystanders during emergency ambulance responses. More research is needed to explore the needs of diverse populations, particularly regarding differences in cultural and family paradigms as current research reports the experiences of westernised nuclear family experiences.
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Affiliation(s)
- Eillish Satchell
- Te Ārai Palliative & End of Life Research Group, School of Nursing University of Auckland , Private Bag 92019, Auckland, 1142, New Zealand
| | - Melissa Carey
- Te Ārai Palliative & End of Life Research Group, School of Nursing University of Auckland , Private Bag 92019, Auckland, 1142, New Zealand
| | - Bridget Dicker
- Paramedicine Research Unit, Auckland University of Technology, Auckland, New Zealand
- St John, New Zealand (Hato Hone Aotearoa), Auckland, New Zealand
| | - Haydn Drake
- St John, New Zealand (Hato Hone Aotearoa), Auckland, New Zealand
| | - Merryn Gott
- Te Ārai Palliative & End of Life Research Group, School of Nursing University of Auckland , Private Bag 92019, Auckland, 1142, New Zealand
| | - Tess Moeke-Maxwell
- Te Ārai Palliative & End of Life Research Group, School of Nursing University of Auckland , Private Bag 92019, Auckland, 1142, New Zealand
| | - Natalie Anderson
- Te Ārai Palliative & End of Life Research Group, School of Nursing University of Auckland , Private Bag 92019, Auckland, 1142, New Zealand.
- Adult Emergency Department, Auckland City Hospital, Auckland Mail Centre, Private Bag 92024, Auckland, 1142, New Zealand.
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Øvstebø AMM, Bjørshol CA, Grønlien S, Lund H, Lindner TW. Symptoms of post-traumatic stress disorder among first aid providers. Resusc Plus 2023; 14:100373. [PMID: 36935818 PMCID: PMC10020090 DOI: 10.1016/j.resplu.2023.100373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Background Every year, large numbers of individuals are present or provide first aid in situations involving out-of-hospital cardiac arrest, injuries, or suicides. Little is known about the impact of providing first aid or witnessing a first aid situation, but research indicates that many first aid providers (FAP) experience persistent psychological difficulties. Here we aimed to assess the level of psychological impact of being a FAP. Methods In this retrospective study, FAP attending follow-up were asked to complete the International Trauma Questionnaire (ITQ), which is a self-report diagnostic measure of post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (CPTSD). We recorded endorsement of a symptom or functional impairment (score ≥ 2/4 on at least one of 18 items). Results Of the 102 FAP in this study, 86 (84%) showed endorsement of a symptom or functional impairment. Common symptoms/functional impairments included being super-alert, watchful, or on guard; having powerful mental images; avoiding internal reminders or memories; and being affected in important parts of one's life. One-third had affected ability to work. Of the FAPs who attended follow-up more than one month after the incident (n = 32), 19% met the criteria for PTSD or CPTSD. Conclusions The majority of FAPs have endorsement of a symptom or functional impairment. Some FAPs fulfil the criteria of PTSD. We suggest that follow-up should be offered by the EMS to all FAPs involved in incidents with an unconscious patient.
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Affiliation(s)
- Anna Marie Moe Øvstebø
- The Regional Centre for Emergency Medical Research and Development (RAKOS), Stavanger University Hospital, Stavanger, Norway
| | - Conrad Arnfinn Bjørshol
- The Regional Centre for Emergency Medical Research and Development (RAKOS), Stavanger University Hospital, Stavanger, Norway
- Dept. of Anesthesiology and Intensive Care Medicine, Stavanger University Hospital, Stavanger, Norway
- Clinical Institute 1, Faculty of Medicine, University of Bergen, Bergen, Norway
- Corresponding author at: Stavanger University Hospital, P.O. Box 8100, NO-4068 Stavanger, Norway.
| | - Sissel Grønlien
- Emergency Medical Communication Center, Innlandet Hospital, Gjøvik, Norway
| | - Helene Lund
- Emergency Medical Communication Center, Stavanger University Hospital, Stavanger, Norway
| | - Thomas Werner Lindner
- The Regional Centre for Emergency Medical Research and Development (RAKOS), Stavanger University Hospital, Stavanger, Norway
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Anderson NE, Robinson J, Goodwin H, Gott M. 'Mum, I think we might ring the ambulance, okay?' A qualitative exploration of bereaved family members' experiences of emergency ambulance care at the end of life. Palliat Med 2022; 36:1389-1395. [PMID: 36154525 DOI: 10.1177/02692163221118204] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In the context of a sudden or unexpected event, people with a life-limiting illness and their family caregivers may be dependent on emergency ambulance services. AIM To explore bereaved family members' experiences of emergency ambulance care at the end of life. DESIGN A qualitative study using reflexive thematic analysis of data collected from semi-structured phone interviews. SETTING/PARTICIPANTS A purposive sample of 38 family caregivers identified from a database of deaths in Aotearoa, New Zealand. RESULTS Emergency ambulance personnel assist, inform and reassure patients and family caregivers managing distressing symptoms, falls, infections, unexpected events and death itself. Family members and patients are aware of the pressure on emergency services and sometimes hesitate to call an ambulance. Associating ambulances with unwanted transport to hospital is also a source of reluctance. CONCLUSIONS The generalist palliative care provided by emergency ambulance personnel is a vital service for patients in the last year of life, and their caregivers. This must be acknowledged in palliative care policy and supported with training, specialist consultation and adequate resources.
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Affiliation(s)
- Natalie Elizabeth Anderson
- Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand.,Te Whatu Ora Te Toka Tumai Auckland, Auckland, New Zealand
| | - Jackie Robinson
- Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
| | - Hetty Goodwin
- Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand.,Te Whatu Ora Te Toka Tumai Auckland, Auckland, New Zealand
| | - Merryn Gott
- Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
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Ericsson CR, Nordquist H, Lindström V, Rudman A. Finnish paramedics' professional quality of life and associations with assignment experiences and defusing use - a cross-sectional study. BMC Public Health 2021; 21:1789. [PMID: 34610798 PMCID: PMC8490964 DOI: 10.1186/s12889-021-11851-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/22/2021] [Indexed: 12/04/2022] Open
Abstract
Background Paramedics experience traumatic events and social emergencies during assignments while also being subjected to verbal and physical threats. Consequently, they are at risk for burnout and secondary traumatic stress, factors inherent to professional quality of life. Defusing and peer-support potentially decrease such symptoms; however, perceived defusing needs and use are not always balanced. Our aim was to explore Finnish paramedics’ professional quality of life, using the Professional Quality of Life Scale, with associations to EMS assignment experiences as well as formal and informal defusing need and use over a 12-month period. Methods A quantitative study of 257 Finnish paramedics using a cross-sectional design. Study outcomes were secondary traumatic stress (STS), compassion satisfaction (CS), and burnout (BO) scores using the modified 9-item Short Professional Quality of Life scale (ProQOL). Likert-type scales were used to collect participants’ recollections of assignment experiences and defusing from a 12-month period. Associations were explored using Spearman’s correlation coefficients. Results Short ProQOL score medians were STS 4.00 (IQR 3), BO 6.00 (IQR 3) and CS 13.00 (IQR 3). STS and BO correlated to experiences of social emergencies and traumatic events while BO correlated to experiences of threat situations (r = 0.206, p = .001). Paramedics perceived a need for defusing in general associated with STS (r = 0.178, p < .001) and participated in informal defusing. Participation in defusing of any form did not associate with ProQOL scores. Conclusions Finnish paramedics’ more frequent experiences of social emergencies, traumatic events, and paramedic-directed threat situations were associated with higher levels of STS and BO. STS was also associated with paramedics’ increased need for defusing and use of informal peer defusing, although neither STS, BO or CS scores associated to any defusing form. Managing paramedics STS and BO, while fostering CS, could therefore be a future research focus. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11851-0.
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Affiliation(s)
- Christoffer R Ericsson
- Faculty of Medicine, University of Helsinki, Helsinki, Finland. .,Department of Healthcare, Arcada University of Applied Sciences, Jan Magnus Janssons plats 1, 00560, Helsinki, Finland.
| | - Hilla Nordquist
- South-Eastern Finland University of Applied Sciences, Kotka, Finland
| | - Veronica Lindström
- Department of Neurobiology, Care Sciences and Society, Section of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Ann Rudman
- Department of Health and Welfare, Dalarna University, Falun, Sweden
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