Background
Following the emergence of COVID-19, there have been local and national changes in the way emergency medical service staff respond to and treat patients in out-of-hospital cardiac arrest. The views of emergency medical service staff on the impacts of COVID-19 on out-of-hospital cardiac arrest resuscitation have not previously been explored. This study aimed to explore the views of emergency medical service staff on the impacts of COVID-19 on out-of-hospital cardiac arrest resuscitation.
Methods
A qualitative phenomenological enquiry was used to explore the views of emergency medical service staff. A purposive sample of n=20 participants of various clinical grades was selected from National Health Service emergency medical service providers in the UK. Data was collected using semi-structured interviews, transcribed verbatim and analysed using inductive thematic analysis.
Results
Three main themes were found; service pressures; decision-making and moral injury. The impacts varied according to clinical grade, location and guidelines.
COVID-19 reduced resources, availability of staff and in-hospital capacity. Change fatigue was found due to the continuous updates of clinical guidelines. There was a disconnect between guidelines and the clinical practice of staff. Staff generally felt supported to make best interest ethical decisions when resuscitation was ineffective. In certain patient groups, staff increased their risk of transmission, compromising recommended levels of personal protective equipment to improve communication and reduce delays to care. The emotional impacts of prolonged and frequent exposure to patient death were apparent.
Conclusion
This study found positive outcomes, but also negative impacts important to inform EMS systems. COVID-19 created delays to resuscitation which were multifaceted. Staff developed new ways of working to overcome the barriers of personal protective equipment. There was little impact on resuscitation procedures. Emergency medical service providers should consider how to limit organisational change and better support the emotional responses of staff.

The impact of COVID-19 on emergency medical service led out of hospital cardiac arrest resuscitation: A qualitative study

Implementation of the Guidelines - How do we put the new ERC Guidelines into practice?

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