How do bystanders cope following witnessing an out-of-hospital cardiac arrest?
It is known that survivors of an out-of-hospital cardiac arrest (OHCA) have a high probability of experiencing post-traumatic stress disorder, but less is known about the effects on bystanders and witnesses of OHCA. This study analysed bystanders' psychological processing of OHCA and examined the potential impact of bystanders performing resuscitation and the influence of the relationship between bystander and patient (stranger vs. family/friend of the patient) on psychological processing.
Bystanders, who witnessed OHCA in the city of Munster (Germany), were included in this study. Telephone interviews were carried out and followed a semi-standardised questionnaire consisting of 116 items to explore a range of topics such as the location of the incident, the relationship between bystander and patient, and the individual characteristics of the bystander such as gender, age and highest qualification/degree. The interviews took place no sooner than 1 week post OHCA as emotions and psychological processing can be expected to change and evolve within the first days
In all, 89 telephone interviews were included in the analysis and statements given in response were rated by independent researchers into one of four categories: signs of pathological psychological processing (answers such as ‘flashbacks’, ‘thin-skinned’, ‘jumpy’, ‘feeling of guilt’); physiological psychological processing (answers such as ‘affected’, ‘very sad’); no signs of psychological distress due to the OHCA (answers such as ‘content’, ‘getting along’), and not distinctly appraisable (ambiguous phrasing; answers couldn't be allocated to the aforementioned groups).
In one-third of cases, signs of pathological psychological processing could be detected. Perhaps surprisingly, no statistically significant differences in the psychological processing could be shown for gender, age, relationship to the patient, current employment in the health sector, location of cardiac arrest or number of additional bystanders. However, bystanders who performed resuscitation had a higher rate of ‘no signs of psychological distress after witnessing OHCA’ than those who did not perform resuscitation. This suggests that performing resuscitation seems to help coping with witnessing OHCA.
Get ‘Appy’ to reduce drug errors in the management of paediatric cardiac arrest
The out-of-hospital environment presents a high risk for medication errors, especially in critical paediatric situations, such as out-of-hospital cardiac arrest (OHCA). This study sought to assess the efficacy of a mobile app to reduce the occurrence of medication errors during simulated paediatric OHCA scenarios.
The multicentre trial took place in Switzerland and enrolled 150 advanced paramedics with drug preparation autonomy. Each participant completed a standardised, video-recorded, 20-minute OHCA scenario concerning an 18-month-old child. Participants were randomised on a 1:1 ratio to either follow conventional drug preparation methods without assistance or use an app designed to assist with paediatric drug preparation. They were tested on sequential preparations of four intravenous emergency drugs of varying degrees of preparation difficulty (epinephrine, midazolam, 10% dextrose, and sodium bicarbonate). A standardised 5-minute teaching session on how to use the app was provided prior to undertaking the scenario.
The primary outcome was the rate of medication errors, defined as a failure in drug preparation according to predefined, expert consensus-based criteria, while secondary outcomes included times to drug preparation and delivery.
There were 191 medication errors identified in the 304 preparations using the conventional method (62.8%; 95% CI, 57.1–68.3%) but only 17 errors were identified in the 296 preparations using the app (5.7%; 95% CI, 3.4–9.0%). Most errors in drug preparations were due to a dose deviation greater than 10% of the prescribed dose.
The proportion of medication errors decreased in absolute terms by 66.5% (95% CI, 32.6–83.8%; P<0.001) when using the app, while the mean time to drug preparation decreased by 40 seconds (95% CI, 23–57 seconds; P<0.001), and the mean time to drug delivery decreased by 47 seconds (95%CI, 27-66 seconds; P<0.001). In this simulation study, the use of a mobile app significantly decreased the rate of medication errors and time to drug delivery for emergency drug preparation in a prehospital setting. Dedicated mobile apps have the potential to improve medication safety and change practices in paediatric emergency medicine.