Helping Those Who Help
2018; Lippincott Williams & Wilkins; Volume: 11; Issue: 9 Linguagem: Inglês
10.1161/circoutcomes.118.004702
ISSN1941-7705
AutoresPaul Snobelen, Jeffrey L. Pellegrino, Gordon Nevils, Katie N. Dainty,
Tópico(s)Healthcare professionals’ stress and burnout
ResumoHomeCirculation: Cardiovascular Quality and OutcomesVol. 11, No. 9Helping Those Who Help Free AccessArticle CommentaryPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessArticle CommentaryPDF/EPUBHelping Those Who HelpThe Lay Responder Post-Arrest Support Model Paul J. Snobelen, Jeffrey L. Pellegrino, PhD, MPH, Gordon S. Nevils and Katie N. Dainty, PhD Paul J. SnobelenPaul J. Snobelen Paul Snobelen, Peel Regional Paramedic Services, 1600 Bovaird Dr E, Brampton, ON L6R 3S8, Canada. Email E-mail Address: [email protected] Peel Regional Paramedic Services, Department of Community Programs, Regional Municipality of Peel, Ontario, Canada (P.J.S., G.S.N.). , Jeffrey L. PellegrinoJeffrey L. Pellegrino Aultman College of Nursing & Health Sciences, Department of Health Sciences, Canton, OH (J.L.P.). , Gordon S. NevilsGordon S. Nevils Peel Regional Paramedic Services, Department of Community Programs, Regional Municipality of Peel, Ontario, Canada (P.J.S., G.S.N.). and Katie N. DaintyKatie N. Dainty North York General Hospital, Department of Research and Innovation, Ontario, Canada (K.N.D.). Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (K.N.D). Originally published10 Sep 2018https://doi.org/10.1161/CIRCOUTCOMES.118.004702Circulation: Cardiovascular Quality and Outcomes. 2018;11:e004702The Problem at HandIn 2016, 46.1% of the >350 000 out-of-hospital cardiac arrests (OHCA) in the United States received bystander cardiopulmonary resuscitation (CPR).1 Viewed differently, there are potentially ≈161 000 lay responders psychologically traumatized from the experience.2,3 Immediate, high-quality CPR and rapid automated external defibrillator (AED) application by bystanders improves outcomes for an OHCA, leading the International Liaison Committee on Resuscitation to highly recommend CPR training and provision of CPR/AED by bystanders before emergency medical services arrival and Public Access Defibrillation programs.4,5 However, to date, no recommendations or provisions exist to address the support of lay rescuers after being involved in these traumatic events.International resuscitation guidelines inform training bystanders, but Emergency Medical Services (EMS) practices post-event do not proactively address mental health support of lay responders, creating a potential risk of additional victims. Recent scholarship draws attention to lay responders susceptibility to mental trauma post-event, but no recommendations have emerged.6,7 To both promote CPR/AED and protect everyone involved in a resuscitation, the Peel Regional Council (Ontario, Canada) approved an enhanced CPR and a Public Access Defibrillation Program in 2014, including a lay responder support program. The lay responder support component focuses on those who witness and participate directly or indirectly in an OHCA. The program, facilitated by the Community Safety Program Specialist (CSPS) and independent of direct paramedic service initiatives, contributes to the quality of the services provided and community engagement with the paramedic service. Here, we share our experiential perspective on the Lay Responder Support Model (LRSM) development and implementation.LRSM as Data and Engagement ToolEstablishing a systematic means to collect individual lay responder experiences emerged from an iterative process of 66 OHCA involving 272 lay responders between May 13, 2015, and March 1, 2018, to understand why people helped and the psychological effect of the response post-incident.2 Initial data demonstrated unique information and knowledge about the context of the incident and lay responder reactions compared with current literature on barriers and intentions to help.8,9 The 3 stages of the LRSM (Figure) provide a methodological approach.Download figureDownload PowerPointFigure. Lay responder post-arrest support stages.Stage 1: Identifying and Engaging Lay Responders and BystandersIndividuals involved with the incident, from witnesses to CPR/AED providers, are identified to the CSPS through 3 means, within 2 to 12 hours:1. direct contact from the paramedics involved in the incident;2. direct contact from the paramedic supervisor attending the OHCA; and3. notification from the AED user or organization where the event occurred.The CSPS collects data from semistructured interviews of witnesses and EMS and technical data from an AED device.Stage 2: DebriefingThe CSPS engages lay responders, who are invited and voluntarily participate, in a debriefing session lasting 1.5 to 2 hours, facilitated by a trained practitioner. Happening 24 to 48 hours post-event, the debriefing allows lay responders to contextualize their reaction to the event and objective information brought by CSPS.A 4-phase debriefing conversation is used to establish trust and allow full articulation of concerns, questions, and thoughts of lay responders:1. introduction;2. review technical data, performance, and exploration of lay responder's thoughts, based on clinically informed assessments;3. communicating common symptoms and stress reduction techniques; and4. follow-up and closure.Throughout stage 2, the facilitator screens and addresses psychological first aid needs as they emerge. Emphasis is placed on normalizing their experience and removing any stigma attached to accessing additional mental health care. Local types of support provided include professional care, nonprofessional care, and self-care resources.Stage 3: Follow-up and Referral for Professional SupportApproximately 1 week post-event, a secondary follow-up occurs via phone, email, or in-person. This engagement ascertains how the lay responder used any of the care options provided and solicits feedback on care options or the follow-up process. If the lay responder communicates a continuing struggle with symptoms impacting and interfering with everyday life, the facilitator offers a coordinated/facilitated referral for mental health support.Our Experience to DateEach stage provided insights into areas of mental health awareness and support. Stage 1 facilitates the opportunity to ask open-ended questions to those directly or indirectly involved with the event, such as times, lay responder actions, relationship to the patient, equipment used or available, and prior training, along with technical information from device logs, to prepare the CSPS as what to anticipate during the debriefing.Stage 2 debriefing addresses the technical aspects of performing CPR/AED and responds to questions and concerns lay responders have as to what they observed, results of their actions, and the victim's presentation during the event, to mitigate potential emotional trauma that may occur in response to their perception of events or action. Information on common emotional reactions helps participants identify any abnormal reactions. The data collection process incorporates these elements and guides facilitator. Stage 3 follow-up occurs if lay responders require or might benefit from additional support/interventions facilitated by mental health professionals to address the effects from acting to save a life. Stage 2 and support resources appear to be the pivotal part in the follow-up process of normalization or connecting to professional help.The development and purpose of the LRSM is to provide a systematic process to reduce the initial distress caused by acting to save a life when a lay responder may be left questioning their actions, abilities, or capacity to help in the future. With 76% of the lay responders who participated demonstrating one or multiple aspects of acute physical and psychological reactions to that event, we have evidence to support the development of specific resources. In addition, the LRSM collection of data throughout the post-event experience provides agencies and professional responders insights into the factors motivating an individual to respond and assist others.We, independently, found similar mental health needs as Møller et al10 who debriefed OHCA lay responders through emergency medical dispatchers. Their debriefing also positively influenced the lay responder's ability to cope with the emotional reactions and cognitive perception of their own performance and motivated improvement of CPR skills.Institutionalization of the LRSM requires financial commitment for a facilitator and training of EMS network to identify lay responders. Our agency recommends that the scope of practice be considered first to set expectations of the organization, facilitators, and the public. This helps build trust with the mental health providers and helps build networks of support. Also, facilitators need training and experience in debriefings, and certified in a program such as Psychological/Mental Health First Aid.The current use of the LRSM is limited to lay responders who are not next of kin or related to the individual who suffered the OHCA. The LRSM does not factor in the additional facets of family members dealing with survivors or nonsurvivors. The LRSM also does not employ a longitudinal follow-up process needed to understand long-term implications of responding to an OHCA or the value of the model itself. Future collaboration with lay responder networks, for example, The Bystander Support Network (http://bystandernetwork.org/), would contribute to future research.Summary PerspectiveThe ISTSS (International Society for Traumatic Stress Studies) concluded in 2000 that little evidence exists that debriefing prevents psychopathology, which has never been the intention of the LRSM. As recognized by the ISTSS, LRSM debriefing, as part of a comprehensive program, helps facilitate the screening of those at risk and disseminate education and referral information.11 We feel that the LRSM addresses a public mental health need for those involved in responding to emergencies and also provides quality improvement information needed by EMS organizations to better connect their service to the public and mental health networks. Utilization of the support model provides a framework that supports lay responders with technical feedback and some grief and loss support, which contributes to reducing the initial distress caused by an individual acting to save a life where that individual may be left questioning their actions, abilities, or capacity to help. The model also provides direction for additional support streams in the event an individual may require professional help. This is very much in line with the practice guidelines supported by the ISTSS which state that more complex interventions for those individuals at highest risk may be the best way to prevent the development of post traumatic distress disorder (PTSD) following trauma. Discussion of natural processes and psychology can help a traumatic event to be normalized for the lay responders regardless of the outcome. By using scientific principles and organizing their actions into a structured timeline to focus on the positive response and how the lay responder made a difference, we feel the LRSM provides a novel approach to the serious issue of lay responder support.AcknowledgmentsWe acknowledge and thank the lay responders and bystanders who acted to save a life by providing care to someone who suffered a sudden cardiac arrest and participated in the Peel Regional Paramedic Services lay responder postarrest support program. The authors also thank the frontline Peel Regional Paramedics that made it possible to link those that acted to save a life with the Lay Responder Support Model.DisclosuresNone.FootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.https://www.ahajournals.org/journal/circoutcomesPaul Snobelen, Peel Regional Paramedic Services, 1600 Bovaird Dr E, Brampton, ON L6R 3S8, Canada. Email Paul.[email protected]caReferences1. American Heart Association. Cardiac Arrest Statistics. CPR First Aid Emerg Cardiovasc Care.2017. http://cpr.heart.org/AHAECC/CPRAndECC/General/UCM_477263_Cardiac-Arrest-Statistics.jsp. Accessed November 2, 2017.Google Scholar2. Mausz J, Snobelen P, Tavares W. "Please. Don't. Die.": a grounded theory study of bystander cardiopulmonary resuscitation.Circ Cardiovasc Qual Outcomes. 2018; 11:e004035. doi: 10.1161/CIRCOUTCOMES.117.004035LinkGoogle Scholar3. Mathiesen WT, Bjørshol CA, Braut GS, Søreide E. Reactions and coping strategies in lay rescuers who have provided CPR to out-of-hospital cardiac arrest victims: a qualitative study.BMJ Open. 2016; 6:e010671. doi: 10.1136/bmjopen-2015-010671CrossrefMedlineGoogle Scholar4. Travers AH, Perkins GD, Berg RA, Castren M, Considine J, Escalante R, Gazmuri RJ, Koster RW, Lim SH, Nation KJ, Olasveengen TM, Sakamoto T, Sayre MR, Sierra A, Smyth MA, Stanton D, Vaillancourt C; Basic Life Support Chapter Collaborators. Part 3: Adult basic life support and automated external defibrillation: 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations.Circulation. 2015; 132(16 suppl 1):S51–S83. doi: 10.1161/CIR.0000000000000272LinkGoogle Scholar5. The Public Access Defibrillation Trial Investigators. Public-access defibrillation and survival after out-of-hospital cardiac arrest.N Engl J Med. 2004; 351:637–646. doi: 10.1056/NEJMoa040566CrossrefMedlineGoogle Scholar6. Daya MR, Schmicker RH, May S, Morrison LJ. Current Burden of Cardiac Arrest in the United States: Report from the Resuscitation Outcomes Consortium. Paper commissioned by the Committee on the Treatment of Cardiac Arrest: Current Status and Future Directions.2015. http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2015/ROC.pdf. Accessed August 15, 2018.Google Scholar7. International Federation of Red Cross Red Crescent Societies. International First Aid and Resuscitation Guidelines 2016. Geneva, Switzerland: International Federation of Red Cross Red CrescentSocieties; 2016.Google Scholar8. Ong ME, Quah JL, Ho AF, Yap S, Edwin N, Ng YY, Goh ES, Leong BS, Gan HN, Foo DC. National population based survey on the prevalence of first aid, cardiopulmonary resuscitation and automated external defibrillator skills in Singapore.Resuscitation. 2013; 84:1633–1636. doi: 10.1016/j.resuscitation.2013.05.008CrossrefMedlineGoogle Scholar9. Platz E, Scheatzle MD, Pepe PE, Dearwater SR. Attitudes towards CPR training and performance in family members of patients with heart disease.Resuscitation. 2000; 47:273–280.CrossrefMedlineGoogle Scholar10. Møller TP, Hansen CM, Fjordholt M, Pedersen BD, Østergaard D, Lippert FK. Debriefing bystanders of out-of-hospital cardiac arrest is valuable.Resuscitation. 2014; 85:1504–1511. doi: 10.1016/j.resuscitation.2014.08.006CrossrefMedlineGoogle Scholar11. Foa EB, Keane TM, Friedman MJ. Guidelines for treatment of PTSD.J Trauma Stress. 2000; 13:539–588.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Sawyer K (2022) Surviving cardiac arrest - what do we know about recovery & survivorship?, Current Opinion in Critical Care, 10.1097/MCC.0000000000000935, 28:3, (256-261), Online publication date: 1-Jun-2022. Dainty K, Colquitt B, Bhanji F, Hunt E, Jefkins T, Leary M, Ornato J, Swor R and Panchal A (2022) Understanding the Importance of the Lay Responder Experience in Out-of-Hospital Cardiac Arrest: A Scientific Statement From the American Heart Association, Circulation, 145:17, (e852-e867), Online publication date: 26-Apr-2022.Brooks S, Clegg G, Bray J, Deakin C, Perkins G, Ringh M, Smith C, Link M, Merchant R, Pezo-Morales J, Parr M, Morrison L, Wang T, Koster R and Ong M (2022) Optimizing Outcomes After Out-of-Hospital Cardiac Arrest With Innovative Approaches to Public-Access Defibrillation: A Scientific Statement From the International Liaison Committee on Resuscitation, Circulation, 145:13, (e776-e801), Online publication date: 29-Mar-2022. Brooks S, Clegg G, Bray J, Deakin C, Perkins G, Ringh M, Smith C, Link M, Merchant R, Pezo-Morales J, Parr M, Morrison L, Wang T, Koster R and Ong M (2022) Optimizing outcomes after out-of-hospital cardiac arrest with innovative approaches to public-access defibrillation: A scientific statement from the International Liaison Committee on Resuscitation, Resuscitation, 10.1016/j.resuscitation.2021.11.032, 172, (204-228), Online publication date: 1-Mar-2022. Brinkrolf P, Metelmann B, Metelmann C, Baumgarten M, Scharte C, Zarbock A, Hahnenkamp K and Bohn A (2021) One out of three bystanders of out-of-hospital cardiac arrests shows signs of pathological psychological processing weeks after the incident - results from structured telephone interviews, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 10.1186/s13049-021-00945-8, 29:1, Online publication date: 1-Dec-2021. Stroop R, Eckert M, Poschkamp T and Goersch H (2020) Evaluation psychischer Belastungssituationen der Smartphone-basierten Ersthelferalarmierung "Mobile Retter"Evaluation of psychological stress situations of first responders alerted by the smartphone-based Mobile Rescue system, Notfall + Rettungsmedizin, 10.1007/s10049-020-00773-w, 24:5, (835-845), Online publication date: 1-Aug-2021. Heffernan E, Mc Sharry J, Murphy A, Barry T, Deasy C, Menzies D and Masterson S (2021) Community first response and out-of-hospital cardiac arrest: a qualitative study of the views and experiences of international experts, BMJ Open, 10.1136/bmjopen-2020-042307, 11:3, (e042307), Online publication date: 1-Mar-2021. September 2018Vol 11, Issue 9 Advertisement Article InformationMetrics © 2018 American Heart Association, Inc.https://doi.org/10.1161/CIRCOUTCOMES.118.004702PMID: 30354553 Originally publishedSeptember 10, 2018 Keywordsfirst aidcardiopulmonary resuscitationEmergency Medical Servicesmental healthout-of-hospital cardiac arrestPDF download Advertisement SubjectsCardiopulmonary Resuscitation and Emergency Cardiac CareEthics and PolicyHealth ServicesMental HealthQuality and Outcomes
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