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Emergency physicians’ experience of stress during resuscitation and strategies for mitigating the effects of stress on performance
  1. Christopher James Groombridge1,2,3,
  2. Amit Maini1,2,3,
  3. Darshini Ayton4,
  4. Sze-Ee Soh4,
  5. Nicola Walsham5,
  6. Yesul Kim1,3,
  7. De Villiers Smit2,4,
  8. Mark Fitzgerald1,3
  1. 1 National Trauma Research Institute, Alfred Health, Melbourne, Victoria, Australia
  2. 2 Emergency & Trauma Centre, Alfred Hospital, Melbourne, Victoria, Australia
  3. 3 Central Clinical School, Monash University, Melbourne, Victoria, Australia
  4. 4 Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
  5. 5 Emergency Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
  1. Correspondence to Dr Christopher James Groombridge, National Trauma Research Institute, Alfred Health, Melbourne, VIC 3004, Australia; cgroombridge{at}


Objective This study explored the perspectives and behaviours of emergency physicians (EPs), regularly involved in resuscitation, to identify the sources and effects of any stress experienced during a resuscitation as well as the strategies employed to deal with these stressors.

Methods This was a two-centre sequential exploratory mixed-methods study of EPs consisting of a focus group, exploring the human factors related to resuscitation, and an anonymous survey. Between April and June 2020, the online survey was distributed to all EPs working at Australia’s largest two major trauma centres, both in Melbourne, and investigated sources of stress during resuscitation, impact of stress on performance, mitigation strategies used, impact of the COVID-19 pandemic on stress and stress management training received. Associations with gender and years of clinical practice were also examined.

Results 7 EPs took part in the focus group and 82 responses to the online survey were received (81% response rate). The most common sources of stress reported were resuscitation of an ‘unwell young paediatric patient’ (81%, 95% CI 70.6 to 87.6) or ‘unwell pregnant patient’ (71%, 95% CI 60.1 to 79.5) and ‘conflict with a team member’ (71%, 95% CI 60.1 to 79.5). The most frequently reported strategies to mitigate stress were ‘verbalising a plan to the team’ (84%, 95% CI 74.7 to 90.5), ‘implementing a standardised/structured approach’ (73%, 95% CI 62.7 to 81.6) and ‘asking for help’ (57%, 95% CI 46.5 to 67.5). 79% (95% CI 69.3 to 86.6) of EPs reported that they would like additional training on stress management. Junior EPs more frequently reported the use of ‘mental rehearsal’ to mitigate stress during a resuscitation (62% vs 22%; p<0.01) while female EPs reported ‘asking for help’ as a mitigator of stress more frequently than male EPs (79% vs 47%; p=0.01).

Conclusions Stress is commonly experienced by EPs during resuscitation and can impact decision-making and procedural performance. This study identifies the most common sources of stress during a resuscitation as well as the strategies that EPs use to mitigate the effects of stress on their performance. These findings may contribute to the development of tailored stress management training for critical care clinicians.

  • resuscitation

Data availability statement

Data are available upon reasonable request. The data underlying this article will be shared on reasonable request to the corresponding author.

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Data availability statement

Data are available upon reasonable request. The data underlying this article will be shared on reasonable request to the corresponding author.

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  • Handling editor Ellen J Weber

  • Twitter @cjgroombridge

  • Contributors All authors made substantial contributions. CG, AM, DA, SES and MF did the conception and design of the study. CG, AM, DA, NW and YK did the data acquisition. CG, SES and MF did data analysis and interpretation. CG, AM, DA, NW and YK drafted the article. SES, DVS and MF revised critically for intellectual content. All authors have given approval of the version submitted. CG is the guarantor and accepts full responsibility for the finished work and the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.