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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.

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