How are ambulance personnel prepared and supported to withhold or terminate resuscitation and manage patient death in the field? A scoping review

Natalie Anderson, Julia Slark, Merryn Gott

Abstract


Introduction

Research 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?

Methods

Using 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.

Results

Sixteen 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.

Conclusion

Ambulance 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.


Keywords


death; education; emergency medical services; out-of-hospital cardiac arrest; paramedics; resuscitation decisions

Full Text:

PDF

References


Wissenberg M, Lippert FK, Folke F, et al. Association of national initiatives to improve cardiac arrest management with rates of bystander intervention and patient survival after out-of-hospital cardiac arrest. JAMA 2013;310:1377-84.

Baekgaard JS, Viereck S, Moller TP, et al. The effects of public access defibrillation on survival after out-of-hospital cardiac arrest: a systematic review of observational studies. Circulation 2017;136:954-65.

Hollenberg J, Svensson L, Rosenqvist M. Out-of-hospital cardiac arrest: 10 years of progress in research and treatment. J Intern Med 2013;273:572-83.

Eid SM, Abougergi MS, Albaeni A, Chandra-Strobos N. Survival, expenditure and disposition in patients following out-of-hospital cardiac arrest: 1995–2013. Resuscitation 2017;113:13-20.

Gräsner J-T, Lefering R, Koster RW, et al. EuReCa ONE - 27 Nations, ONE Europe, ONE Registry: a prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe. ibid. 2016;105:188-95.

Pitcher D, Fritz Z, Wang M, Spiller JA. Emergency care and resuscitation plans. BMJ 2017;356.

Cone D. Developing the science of out-of-hospital termination of resuscitation. Resuscitation 2014;85:446-7.

O'Brien E, Hendricks D, Cone DC. Field termination of resuscitation: analysis of a newly implemented protocol. Prehosp Emerg Care 2008;12:57-61.

Brywczynski J, McKinney J, Pepe PE, et al. Emergency medical services transport decisions in posttraumatic circulatory arrest: are national practices congruent? J Trauma 2010;69:1154-9.

Donnelly E, Siebert D. Occupational risk factors in the emergency medical services. Prehosp Disaster Med 2012;24:422-9.

Regehr C, Millar D. Situation critical: high demand, low control, and low support in paramedic organizations. Traumatology 2007;13:49-58.

Gouweloos-Trines J, Tyler MP, Giummarra MJ, et al. Perceived support at work after critical incidents and its relation to psychological distress: a survey among prehospital providers. Emerg Med J 2017;34:816-22.

Bigham BL, Kennedy SM, Drennan I, Morrison LJ. Expanding paramedic scope of practice in the community: a systematic review of the literature. Prehosp Emerg Care 2013;17:361-72.

Cooper SJR, Grant J. New and emerging roles in out of hospital emergency care: a review of the international literature. Int Emerg Nurs 2009;17:90-8.

Druwe P, Monsieurs KG, Piers R, et al. Perception of inappropriate cardiopulmonary resuscitation by clinicians working in emergency departments and ambulance services: the REAPPROPRIATE international, multi-centre, cross sectional survey. Resuscitation 2018;132:112-9.

Anderson NE, Gott M, Slark J. Beyond prognostication: ambulance personnel’s lived experiences of cardiac arrest decision-making. Emerg Med J 2018;35:208-13.

Brandling J, Kirby K, Black S, Voss S, Benger J. Emergency medical service provider decision-making in out of hospital cardiac arrest: an exploratory study. BMC Emerg Med 2017;17:24.

Karlsson M, Karlsson N, Hilli Y. Ethical dilemmas during cardiac arrest incidents in the patient’s home. Nurs Ethics 2019;26:625-37.

Ågård A, Herlitz J, Castren M, Jonsson L, Sandman L. Guidance for ambulance personnel on decisions and situations related to out-of-hospital CPR. Resuscitation 2012;83:27-31.

Anderson NE, Gott M, Slark J. Grey areas: New Zealand ambulance personnel’s experiences of challenging resuscitation decision-making. Int Emerg Nurs 2018;39:62-7.

Munn Z, Peters MDJ, Stern C, et al. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol 2018;18:143.

Tricco AC, Lillie E, Zarin W, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 2018;169:467-73.

Arksey H, O'Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol 2005;8:19-32.

Olaussen A, Semple W, Oteir A, Todd P, Williams B. Paramedic literature search filters: optimised for clinicians and academics. BMC Med Inform Decis Mak 2017;17:146.

QSR International Pty Ltd. NVivo Qualitative Data Analysis Software. 11 edn, 2012.

Khalil H, Peters M, Godfrey CM, et al. An evidence-based approach to scoping reviews. Worldviews Evid Based Nurs 2016;13:118-23.

Tataris KL, Richards CT, Stein-Spencer L, et al. EMS provider perceptions on termination of resuscitation in a large, urban EMS system. Prehosp Emerg Care 2017;21:610-5.

Stone SC, Abbott J, McClung CD, et al. Paramedic knowledge, attitudes and training in end-of-life care. Prehosp Disaster Med 2009;24:529-34.

Smith-Cumberland TL, Feldman RH. Survey of EMTs' attitudes towards death. Prehosp Disaster Med 2005;20:184-8.

Mao DRH, Ong MEH, Bang C, et al. Psychological comfort of paramedics with field death pronouncement: a national asian study to prepare paramedics for field termination of resuscitation. Prehosp Emerg Care 2017:1-5.

Hall WL, Myers JH, Pepe PE, et al. The perspective of paramedics about on-scene termination of resuscitation efforts for pediatric patients. Resuscitation 2004;60:175-87.

Mainds MD, Jones C. Breaking bad news and managing family during an out-of-hospital cardiac arrest. Journal of Paramedic Practice 2018;10:292-9.

Fernández-Aedo I, Pérez-Urdiales I, Unanue-Arza S, García-Azpiazu Z, Ballesteros-Peña S. A qualitative study about experiences and emotions of emergency medical technicians and out-of-hospital emergency nurses after performing cardiopulmonary resuscitation resulting in death. Enferm Intensiva 2017;28:57-63.

Douglas L, Cheskes S, Feldman M, Ratnapalan S. Death notification education for paramedics: past, present and future directions. Journal of Paramedic Practice 2013;5:152-9.

Douglas L, Cheskes S, Feldman M, Ratnapalan S. Paramedics' experiences with death notification: a qualitative study. ibid. 2012;4:533-9.

Bremer A, Dahlberg K, Sandman L. Balancing between closeness and distance: emergency medical services personnel's experiences of caring for families at out-of-hospital cardiac arrest and sudden death. Prehosp Disaster Med 2012;27:42-52.

Smith-Cumberland TL. The evaluation of two death education programs for EMTs using the theory of planned behavior. Death Stud 2006;30:637-47.

Smith-Cumberland TL, Feldman RH. EMTs' attitudes' toward death before and after a death education program. Prehosp Emerg Care 2006;10:89-95.

Ponce A, Swor R, Quest TE, et al. Death notification training for prehospital providers: a pilot study. ibid. 2010;14:537-42.

Hobgood C, Mathew D, Woodyard DJ, Shofer FS, Brice JH. Death in the field: teaching paramedics to deliver effective death notifications using the educational intervention “GRIEV_ING”. ibid. 2013;17:501-10.

Grudzen CR, Timmermans S, Koenig WJ, et al. Paramedic and emergency medical technicians views on opportunities and challenges when forgoing and halting resuscitation in the field. Acad Emerg Med 2009;16:532-8.

Morrison LJ, Cheung MC, Redelmeier DA. Evaluating paramedic comfort with field pronouncement: development and validation of an outcome measure. ibid. 2003;10:633-7.

Greif R, Lockey AS, Conaghan P, et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 10. Education and implementation of resuscitation. Resuscitation 2015;95:288-301.

Dyson K, Bray JE, Smith K, et al. Paramedic resuscitation competency: a survey of Australian and New Zealand emergency medical services. Emerg Med Australas 2017;29:217-22.

Mundell WC, Kennedy CC, Szostek JH, Cook DA. Simulation technology for resuscitation training: a systematic review and meta-analysis. Resuscitation 2013;84:1174-83.

Morrison LJ, Verbeek PR, Zhan C, Kiss A, Allan KS. Validation of a universal prehospital termination of resuscitation clinical prediction rule for advanced and basic life support providers. ibid. 2009;80:324-8.

Becker TK, Gausche-Hill M, Aswegan AL, et al. Ethical challenges in emergency medical services: controversies and recommendations. Prehosp Disaster Med 2013;28:488-97.

Norton RL, Bartkus EA, Schmidt TA, et al. Survey of emergency medical technicians' ability to cope with the deaths of patients during prehospital care. ibid. 1992;7:235-42.

Loscar TA. The policy of truth. Death notifications are part of our jobs, but we're rarely trained in delivering them. EMS Mag 2010;39:38-44.

Walker E. Death notification delivery and training methods. Journal of Paramedic Practice 2018;10:334-41.

Chiang W-C, Ko PC-I, Chang AM, et al. Predictive performance of universal termination of resuscitation rules in an Asian community: are they accurate enough? Emerg Med J 2015;32:318-23.

Verhaert DVM, Bonnes JL, Nas J, et al. Termination of resuscitation in the prehospital setting: a comparison of decisions in clinical practice vs. recommendations of a termination rule. Resuscitation 2016;100:60-5.

Anderson WG, Williams JE, Bost JE, Barnard D. Exposure to death is associated with positive attitudes and higher knowledge about end-of-life care in graduating medical students. J Palliat Med 2008;11:1227-33.

Halpern J, Maunder RG, Schwartz B, Gurevich M. The critical incident inventory: characteristics of incidents which affect emergency medical technicians and paramedics. BMC Emerg Med 2012;12:10.

Bohström D, Carlström E, Sjöström N. Managing stress in prehospital care: Strategies used by ambulance nurses. Int Emerg Nurs 2017;32:28-33.

Halpern J, Maunder RG, Schwartz B, Gurevich M. Downtime after critical incidents in emergency medical technicians/paramedics. Biomed Res Int 2014;2014:483140.

Avraham N, Goldblatt H, Yafe E. Paramedics’ experiences and coping strategies when encountering critical incidents. Qual Health Res 2014;24:194-208.

Williams A. A study of emotion work in student paramedic practice. Nurse Educ Today 2013;33:512-7.

Anderson NE, Kent B, Owens RG. Experiencing patient death in clinical practice: nurses’ recollections of their earliest memorable patient death. Int J Nurs Stud 2015;52:695-704.

Brady M. Death anxiety among emergency care workers. Emerg Nurse 2015;23:32-7.

Brady M. Mortality face to face: death anxiety in paramedics. Journal of Paramedic Practice 2013;5:130-3.

McClatchey IS, King S. The impact of death education on fear of death and death anxiety among human services students. Omega (Westport) 2015;71:343-61.

Ho Chan WC, Tin AF. Beyond knowledge and skills: self-competence in working with death, dying, and bereavement. Death Stud 2012;36:899-913.

Draper EJ, Hillen MA, Moors M, et al. Relationship between physicians’ death anxiety and medical communication and decision-making: a systematic review. Patient Educ Couns 2019;102:266-74.

Zheng R, Lee SF, Bloomer MJ. How new graduate nurses experience patient death: A systematic review and qualitative meta-synthesis. Int J Nurs Stud 2016;53:320-30.

Fraser K, Huffman J, Ma I, et al. The emotional and cognitive impact of unexpected simulated patient death: a randomized controlled trial. Chest 2014;145:958-63.

Consales G, Zamidei L, Michelagnoli G. Education and training for moral and ethical decision-making at the end of life in critical care. Trends in Anaesthesia and Critical Care 2014;4:178-81.

Taylor D, Luterman A, Richards WO, Gonzalez RP, Rodning CB. Application of the core competencies after unexpected patient death: consolation of the grieved. J Surg Educ 2013;70:37-47.




DOI: http://dx.doi.org/10.33151/ajp.16.697

Refbacks

  • There are currently no refbacks.




The Official Journal of Paramedics Australasia © 2019                           ISSN: 2202-7270

 

Crossref Member Badge