Research

Oversight (Medico) is a national 24-hour emergency telemedical support unit. Consultation, advice and permissions can be sought by practitioners on dynamic situations where treatment falls outside the PHECC guidelines.

This study aims to explore the CPRIC experience of paramedic practitioners in Ireland as well as their awareness and views on educational and other support needed to deal with the phenomenon.

Methodology This cross-sectional study included quantitative and qualitative elements with an online anonymous survey of practitioners and a follow-up, confidential, one-to-one semi-structured interview with practitioners who volunteered to take part. There was no patient or public involvement.

An invitation to participate with an introductory letter was distributed to 358 EMTs, paramedics and APs (from the National Ambulance Service, Dublin Fire Brigade and Defence Forces in two regions). Recruitment occurred via work emails distributed by employers. Interested practitioners responded to a dedicated email address.

The anonymous online survey, created using Google Forms, included: l Practitioner profile l CPRIC experience l Three case vignettes.

The interviews were transcribed and analysed using thematic analysis, without reaching saturation.

Data were analysed using Microsoft Excel. Research ethics approval was granted by the University College Dublic (UCD) Human Research Ethics Committee (LS-E-20-152-Carty-Bury).

lthcare Ltd

Hea

MA

2022

©

Results Survey results Out of the 358 practitioners invited, 232 replied (response rate 64.8%) including 136 APs, 78 paramedics and 18 EMTs from all three organisations. Most participants (81%) were male.

Out of the 232 respondents, 224 (96.6%) reported management of an OHCA (eight EMTs had not been involved); 174/232 (75%) were aware of CPRIC (APs: 91.7%; paramedics: 53.8%; EMTs: 44.4%).

Of the 224 with experience of OHCA care, 73% reported involvement in six or more incidents within the previous 12 months, indicating the cohort had significant recent experience. Of those with OHCA experience, 127/224 (56.7%) said they had witnessed some form of CPRIC, 79/224 (35.3%) said they had not and 18/224 (8%) were unsure.

Of the 145 respondents who had or may have witnessed CPRIC, 76/145 (52.4%) had experienced CPRIC once and 47.6% reported more than one episode.

Respondents were asked to comment on the most recent case they had experienced. The initial arrhythmia was predominantly ventricular fibrillation (VF) or pulseless ventricular tachycardia (Figure 1); 94/145 (65%) reported that CPR was interrupted at least once because CPRIC features appeared (Figure 2).

Figure 3 shows reported CPRIC clinical features identified by practitioners. During CPR, 111/145 (76.6%) practitioners reported three or more movements.

Mechanical CPR devices were in use in 59% of cases (Figure 4). CPRIC cases were managed by patient reassurance (29%), drug therapy (20%), other action (7%) or without any specific intervention (44%); 31/145 (21.4%) of respondents contacted Medico for advice. In 128/145 (88%) cases, the patient was transferred to hospital and in 92/145 (63%) return of spontaneous circulation (ROSC) occurred (Figure 5).

In the three vignettes, practitioners with experience of OHCA were asked about possible

14%

68%

14%

4%

Asystole

Pulseless electrical activity

Pulseless ventricular tachycardia

Ventricular fibrillation

Figure 1. Initial rhythm noted by respondents (n=145)

14%

65%

68%

35%

14%

4%

Figure 2. CPR interrupted (n=145)

No

Yes

Journal of Paramedic Practice • Vol 14 No 9

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