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What we can learn from bystanders about cardiac arrest

Posted by Joel Symonds | 17 Mar 2016

What we can learn from bystanders about cardiac arrest

For over 40 years, cardio-pulmonary resuscitation (CPR) has been recognised as a vital aspect of the treatment of cardiac arrest; originally seen as solely the premise of medical professionals, the concept of bystander or lay-rescuer CPR has increased in popularity and social visibility over recent years. Major national campaigns in the press, media and online have encouraged bystanders to attempt CPR in the event of witnessing an out of hospital cardiac arrest (OHCA), and this process has been steadily and regularly simplified over the years, in an effort to make attempting lay-rescuer CPR less daunting.

It is well known that each minute of delay between onset of OHCA and the defibrillating shock that can restore the heart rhythm translates to an approximate decrease in survival rate of between 7-10%. Bystander CPR, performed as a “stop-gap” or temporising measure until the arrival of professional rescuers, reduces this decreased survival rate to 3-4% per minute.

Bystander CPR saves lives. Its presence or absence is a major determinant in the thought process of emergency medical personnel when deciding whether to persist with a resuscitation attempt, or deem the situation futile. CPR improves the likely success of defibrillating shocks, supports vital organ perfusion during cardiac arrest, and leads to improved neurological outcomes in survivors.

The recognition of a crisis, summoning of help and administration of CPR on scene make up the first link of the chain of survival following OHCA, demonstrating its equal weight and value to the other three “professional” links of the patient journey. This link is most often performed solely by a lay-rescuer.

It is astonishing, therefore, that this essential group of lay-rescuers has only rarely been asked about their experience as part of medical research, and who and what has been asked about has been extremely limited. Almost nothing is known about what occurs when a bystander is suddenly confronted by someone in cardiac arrest, or the thought and decision making processes involved for them in recognising a patient in OHCA and then summoning and delivering help. Further to this, the emotional impact of such an experience and the necessary help and support following it has never been investigated.

Hospital and ambulance staff have spoken anecdotally about the difference between attending a scene in which they expect to find a cardiac arrest versus witnessing a patient arrest in front of them, even with the bolstering support of their experience, training and equipment.
There is no published data on the effects of this event when experienced by an untrained, unprepared and unequipped member of the public.

Through a process of semi-structured interview and Interpretative Phenomenological Analysis, the First First Responders study aims to

◦ Achieve the first in-depth look into ways to improve the early steps of the chain of survival following OHCA
◦ Inform public education efforts, public policy, emergency medical systems
◦ Direct much delayed attention to bystanders’ emotional responses and well being.

Autumn 2017 EMERGE Newsletter now out! Dr Dave Caesar on Purpose & Mindset

Dr Dave Caesar on Purpose & Mindset

10 Aug 2017 | Miranda Odam

Nelson Mandela once said: “What counts in life is not the mere fact that we have lived. It is the difference we have made to the lives of others that will determine the significance of the life we lead.” So what does that mean to us in the Emergency Department? How can we make a difference? There are two factors that I think are really important: purpose and mindset. As clinicians, our purpose is to improve the health and wellbeing of our patients. We all know that this can be harder than it sounds, and that looking after ourselves is also important. Getting the right balance is extremely rewarding, and often requires a degree of support as well as “stretch”. It also requires understanding the effects our decisions, our care, and our treatments have on our patients. How do we really know if something has worked? Could we do this any better? This is where we need the right mindset. The mindset of learners. The GROWTH mindset. Teams with the growth mindset embrace challenges, learn from feedback, persist in the face of setbacks, learn from failure and are inspired by successes, are persistent and want to keep learning. These teams GROW, and individuals develop within them. Teams like this ask the right questions to fulfil their purpose, to improve their understanding and further their knowledge to make a bigger difference to the lives of others and themselves. EMERGE help us in the ED to do this. They help drive our curiosity, stimulate our thinking, stretch our perspectives, and contribute to our growth mindset. There is a Maori saying: “Learning brings greater knowledge, Knowledge brings greater understanding, Understanding brings greater wisdom, Wisdom brings greater wellbeing.” Learning is good for us all.

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TEDxNHS – #InspiredByPeople

TEDxNHS – #InspiredByPeople

8 Aug 2017 | Miranda Odam

When: Tuesday 15th August 2017 Time: 2pm - 8pm (drop in or stay) Where: Lecture Theatre B, Chancellors Building RIE TEDxNHS is a an event for those who work in the NHS live streamed in all four nations of the UK. The ebvent is independently organised and under license from TED. EMERGE (Emergency Medicine Resarch group of Edinburgh) are hosting on behalf of NHS Lothian and we would love you to join us to be inspired by a huge variey of speakers from a blind autistic savant and musical prodigy to a European Space Agency research doctor by way of a clinical entrepreneur and renaissance surgeon. Please contact Emma.Ward@nhslothian.scot.nhs.uk or call 0131 242 3863 to reserve your seat Looking forward to seeing you there!!

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