Ambulance Clinicians' Experiences of Attending OHCA in Children

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.

Work Package 2:

The research team will conduct an online survey of ambulance clinicians working across UK ambulance services. The survey will be distributed through ambulance service sites across the UK and through social media.

Questions will include Likert-style and open questions to assess clinician attitudes and views in relation to their preparedness to respond to cardiac arrests in children. Questions will also explore previous experience of attending these incidents.

Recognising that clinicians involved in the resuscitation of a child may be at risk of psychological injury, respondents who report previous exposure to OHCA incidents involving children will be administered the validated 'Impact of Event Scale - Revised' (IES-R) questionnaire as part of the survey. IES-R is a 22-question instrument designed to measure symptoms of post-traumatic stress disorder (PTSD) in reference to a specific traumatic event. All participants who have attended OHCA incidents involving an adult will be administered IES-R with reference to the most recent event which will provide a comparator group to quantify if differences in the response to adult and child OHCA exist

Work Package 3:

Semi-structured interviews will be undertaken with 12-15 clinicians who have recently (in the previous 12 months) attended a child with out of hospital cardiac arrest (recent exposure interview cohort). In these semi-structured interviews, the research team will explore the clinicians experience during and following the incident, their perceived preparedness for attending the incident and their experiences of post-event support. A topic-guide will be developed for the interview which will include an opportunity to explore any emergent issues or concepts from the analysis of the clinician survey (WP2).

In addition, a small number of interviews (3-4) will be undertaken with clinicians who attended an out of hospital cardiac arrest incident involving a child earlier in their career (>12 months ago; historic exposure interview cohort). These interviews will follow the same format but will explore how perceptions and experiences of these events may have changed over time.

The research team will arrange 2-3 focus group discussions with specialist critical care ambulance clinicians (up to 6 clinicians per focus group; specialist clinician focus group cohort). These clinicians have a higher rate of exposure to out of hospital cardiac arrest incidents involving children, and by the nature of their dispatch models tend to arrive on scene later once interventions have been started. They will therefore have a unique insight into how their colleagues react to these incidents and the concerns expressed by these colleagues at the time or immediately following an incident.

The aim of these focus group discussions will be to explore this cadre of clinicians' experience of attending these events which may span many years and include a significant number of different events. Topic guides will be developed which will be influenced by the emerging themes from the clinician interviews. Where focus group discussions prove difficult to arrange, individual semi-structured interviews will be undertaken with eligible clinicians using the same topic guides.