Training and educational paperStress reactions and perceived difficulties of lay responders to a medical emergency☆
Introduction
Out of hospital cardiac arrest (OOH-CA) is a leading cause of death in North America.1 Early cardiopulmonary resuscitation (CPR) is the only treatment for OOH-CA prior to the arrival of an automated external defibrillator (AED) and advanced cardiac life support.2 Although millions of laypersons in developed countries have been trained in CPR over the last four decades, lay responder CPR rates remain low.3 One hypothesis about why laypersons fail to take immediate action after witnessing an event is that the stress and anxiety of the situation impairs their willingness to respond. Few investigators have focused on the reactions of lay responders and the difficulties they experience during an actual attempted resuscitation,4, 5 and we found none that this included reactions of lay responders who used an AED. Gaining insight into how laypersons feel after responding to a cardiac arrest may improve CPR training and prepare others to respond to a medical emergency.
This study attempts to quantify the amount of stress experienced by trained lay responders to a cardiac emergency and to identify characteristics that may be associated with their reactions to the event. Numeric ratings of stress level and qualitative comments were obtained from laypersons who responded to an emergency episode during the Public Access Defibrillation (PAD) Trial.6 Qualitative data were gathered to identify what they perceived to be the most difficult aspect of assisting in order to fill the gap in knowledge about why bystander CPR rates remain so low.
The PAD Trial was a prospective randomized community based multi-center clinical trial that recruited public and residential facilities or “community units” (e.g., office buildings, shopping centers, gated communities) that were expected to have a relatively high frequency of cardiac arrests. In total, 1260 community facilities from 24 research centers in the U.S. and Canada participated and received training in either CPR-only or CPR + AED. The PAD Trial was approved by the Institutional Review Board (IRB) of the Coordinating Center and by IRBs of participating sites.7
At each facility, a team of layperson volunteers, typically employees or residents, consented to be a volunteer and was trained to recognize OOH-CA, access the emergency medical system (EMS), and begin CPR. Layperson volunteers in the CPR + AED facilities were also trained to defibrillate OOH-CA victims using one of three AED models used in the trial. Training was standardized and consistent with the American Heart Association HeartSaver ABC and HeartSaver AED programs, although other curricula were acceptable, provided the course length, student to instructor ratio, training style, and practice time met predefined criteria. Details of the trial design and the results have been published elsewhere.6, 8
Section snippets
Methods
The design of this study employed a mixed methodology; both quantitative and qualitative data were analyzed. As part of the main study, PAD Trial staff interviewed study volunteers who participated in an emergency episode. Participation included involvement at any level, from opening the door for medics to performing CPR and/or using an AED. An episode was broadly defined to include choking or unconsciousness (e.g., from a seizure, cardiac arrest, syncope or non-cardiac causes) and often
Quantitative results
Reported stress levels were low overall. However, volunteer lay responders who were involved in a presumed cardiac arrest reported a median stress level of 2.0 versus 1.0 for those involved in an event that was not a cardiac arrest (Table 1). In univariate analysis, higher stress levels were found in women, in volunteers who spoke English as a second language, and in volunteers who participated in events that occurred in residential settings. In a forward stepwise linear regression, volunteer
Discussion
The results of this study suggest that most of lay responders were not significantly stressed by their participation. This could be because they had volunteered for the study and had already reflected on their potential to assist in an emergency. Overall, their stress was mild, albeit higher in certain groups (female, non-English native speakers) and in residential settings and situations involving a presumed cardiac arrest. Some reasons that non-native English speakers might have expressed
Acknowledgements
The authors gratefully acknowledge the assistance of Janet Deatrick PhD, RN with the analysis of the qualitative data. Supported by contract #N01–HC–95177 from the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD. Additional support by: American Heart Association, Dallas, TX; Medtronic, Incorporated, Minneapolis, MN; Guidant Foundation, Indianapolis, IN; Cardiac Science/Survivalink, Incorporated, Minneapolis, MN; Medtronic Physio-Control Corporation,
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A Spanish translated version of the summary of this article appears as Appendix in the online version at doi:10.1016/j.resuscitation.2005.10.029.