Exploring UK Ambulance Clinicians' Experiences of Attending Out of Hospital Cardiac Arrest (OHCA) Incidents Involving Children: A Mixed Methods Study
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 入组人数
- 2,137
- 试验地点
- 1
- 主要终点
- Delivery of treatment in compliance with European Resuscitation Council Guidelines (work package one)
研究概览
简要总结
This research will explore ambulance clinicians' experiences of attending out of hospital cardiac arrest (OHCA) incidents involving children.
OHCA occurs when the heart stops beating. This is a time critical emergency that requires immediate treatment to maximise the changes of survival. OHCA affecting children is rare, but when it happens it is vital that paramedics and other ambulance clinicians can respond and deliver high quality care.
Because OHCA in children is rare, ambulance clinicians attend these incidents infrequently. Some clinicians may only ever attend this type of incident once in their career. These incidents are technically challenging for ambulance clinicians, and highly stressful. Evidence from other setting suggests that clinicians may be ill-prepared to manage these events.
This research aims to understand how OHCA incidents involving children are currently managed, and to explore the views and experiences of ambulance clinicians with respect to attending OHCA incidents involving children.
By learning from what is currently being done, and from clinicians' experiences, the research team aims to develop recommendations for how the response to these patients, and the support provided to ambulance clinicians, could be improved.
The research team will review the records of patients under the age of 18 who have been treated for OHCA by one ambulance service over a four-year period. Data will be collected from these records to allow the care delivered to be compared to international guidelines, and to explore what factors might influence the delivery of this care.
The research will also involve a survey of ambulance clinicians working across the UK to understand their experiences, and how prepared they feel to attend these incidents. Finally, the research team will undertake interviews with clinicians who have been involved in the management of a child with OHCA and focus group discussions with specialist clinicians to allow us to learn from their experiences.
详细描述
Work Package 1:
This work package comprises of a retrospective cohort study of patients under the age of 18 who have been treated for out of hospital cardiac arrest by one UK ambulance service.
Pseudonymised data will be collated for each patient included in the study, describing all actions taken by the ambulance service from the point the call for emergency help was received by the ambulance service to the time death was confirmed, or the patient was handed over to a receiving hospital team. These data will be collected in case report forms within a secure electronic database system.
Data will be extracted from electronic records (including computer aided dispatch and electronic patient care records) held by the ambulance service. A researcher based in the ambulance service will review each record to ensure complete data capture, supplementing the records with additional information not captured by the electronic data extraction as required (e.g. data entered into free text boxes or captured in handwritten records).
Descriptive statistics will be used to describe the management of patients included in the cohort, and to compare the management to UK and international guidelines. Further analysis will explore if patient management differs in the presence of certain patient, clinician, system, or situational factors.
研究设计
- 研究类型
- Observational
- 观察模型
- Other
- 时间视角
- Retrospective
入排标准
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Patients attended by London Ambulance Service NHS Trust (LAS)
- •Incidents occurring between January 2021 and December 2024
- •Out of Hospital Cardiac Arrest recognised by LAS clinicians
- •Aged under 18 years at the time the incident occurred
排除标准
- •New born patients who had not taken their first spontaneous breath before cardiac arrest was recognised
- •Incidents occurring outside of LAS' operational area (Greater London, UK)
- •Patients who have registered an NHS National Data Opt-Out
- •Survey participants
- •Inclusion Criteria:
- •Ambulance clinician (including registered healthcare professionals and non-registered ambulance clinicians)
- •Currently responds to 999 calls (face to face) as part of their role
- •Would be expected to attend a paediatric OHCA incident as part of their role
- •Consents to participate in study
- •Exclusion Criteria:
- •Non-clinical ambulance service employee
- •Not employed by an NHS Ambulance Service in the UK
- •Interview participants (recent exposure)
- •Inclusion Criteria:
- •Ambulance clinician (including registered healthcare professionals and non-registered ambulance clinicians)
- •Employed by a participating NHS Ambulance Service Site
- •Attended an out of hospital cardiac arrest incident involving a child (>1 day old, < 18 years old) in the 12 months prior to the proposed interview date
- •Consents to participation in the study
- •Exclusion Criteria:
- •Previously participated in an interview or focus group discussion as part of this study
- •Employed in a specialist critical care role (e.g. Critical Care Paramedic)
- •Attended an out of hospital cardiac arrest incident involving a child (>1 day old, <18 years old) within two weeks of the proposed interview date
- •Interview participants (historic exposure)
- •Inclusion Criteria:
- •Ambulance clinician (including registered healthcare professionals and non-registered ambulance clinicians)
- •Employed by a participating NHS Ambulance Service Site
- •Attended an out of hospital cardiac arrest incident involving a child (>1 day old, < 18 years old) more than 12 months prior to the proposed interview date
- •Consents to participation in the study
- •Exclusion Criteria:
- •Previously participated in an interview or focus group discussion as part of this study
- •Attended an out of hospital cardiac arrest incident involving a child (>1 day old, < 18 years old) within 12 months of the proposed interview date
- •Employed in a specialist critical care role (e.g. Critical Care Paramedic)
- •Focus group participants
- •Inclusion Criteria:
- •Ambulance clinician employed in a specialist critical care role (e.g. Critical Care Paramedic)
- •Employed by a participating NHS Ambulance Service Site
- •Consents to participation in the study
- •Exclusion Criteria:
- •Previously participated in an interview or focus group discussion as part of this study
- •Has not attended an out of hospital cardiac arrest incident involving a child (>1 day old, <18 years old) whilst working in a specialist critical care role (e.g. Critical Care Paramedic)
结局指标
主要结局
Delivery of treatment in compliance with European Resuscitation Council Guidelines (work package one)
时间窗: During cardiac arrest event (until handover at hospital or termination of resuscitation)
Proportion of cases that receive treatment that complies with European Paediatric Advanced Life Support guidelines.
Preparedness of clinicians to attend OHCA involving children (work package two)
时间窗: Baseline (defined as the date of survey completion)
Measured using self-reported Likert scale
Clinician experiences of attending OHCA incidents involving children (work package three)
时间窗: Baseline (defined as the date of interview/focus group participation)
Measured through inductive thematic analysis of interviews and focus groups - data from interviews and focus groups will be combined and analysed thematically as one dataset to describe the overall experience of ambulance clinicians.
次要结局
- Proportion of participants with moderate or high levels of symptoms consistent with PTSD following attending an OHCA incident involving a child (work package two)(Baseline (defined as the date of survey completion))
研究者
Keith Couper
Associate Professor
University of Warwick