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Beyond prognostication: ambulance personnel’s lived experiences of cardiac arrest decision-making
  1. Natalie Elizabeth Anderson1,2,
  2. Merryn Gott1,
  3. Julia Slark1
  1. 1 Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
  2. 2 Adult Emergency Department, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
  1. Correspondence to Natalie Elizabeth Anderson, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1142, New Zealand; na.anderson{at}


Introduction The purpose of this study was to explore ambulance personnel’s decisions to commence, continue, withhold or terminate resuscitation efforts for patients with out-of-hospital cardiac arrest.

Method Semistructured interviews with a purposive sample of 16 demographically diverse ambulance personnel, currently employed in a variety of emergency ambulance response roles, around New Zealand.

Results Participants sought and integrated numerous factors, beyond established prognostic indicators, when making resuscitation decisions. Factors appeared to be integrated in four distinct phases, described under four main identified themes: prearrival impressions, immediate on-scene impressions, piecing together the big picture and transition to termination of resuscitation. Commencing or continuing resuscitation was sometimes a default action, particularly where ambulance personnel felt the context was uncertain, unfamiliar or overwhelming. Managing the impact of termination of resuscitation and resulting scene of a death required significant confidence, psychosocial skills and experience.

Conclusion This unique, exploratory study provides new insights into ambulance personnel’s experiences of prehospital resuscitation decision-making. Prognostication in out-of-hospital cardiac arrest is known to be challenging, but results from this study suggest that confidence in a poor prognosis for the cardiac arrested patient is only part of the resuscitation decision-making picture. Results suggest ambulance personnel may benefit from greater educational preparation and mentoring in managing the scene of a death to avoid inappropriate or prolonged resuscitation efforts.

  • cardiac arrest
  • paramedics
  • prehospital care
  • resuscitation
  • qualitative research

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  • Twitter @CerebralNurse (Natalie Elizabeth Anderson)

  • Contributors All those entitled to authorship are listed as authors, and all authors have made substantial contributions to the conception, design and undertaking of the research, drafting and revising the manuscript and final approval of the submitted version.

  • Competing interests None declared.

  • Ethics approval University of Auckland Human Ethics Committee (Reference No 016147) and the emergency ambulance service

  • Provenance and peer review Not commissioned; externally peer reviewed.