Out-of-Hospital Cardiac Arrest and Community First Response in Ireland: Building Evidence for Policy and Practice

INTRODUCTION – Out-of-Hospital Cardiac Arrest (OHCA) is a devastating health event which causes over 2,000 unexpected deaths in Ireland annually. OHCAs are responded to by emergency medical services (EMS) in the community. Death from OHCA is frequent but not inevitable. In Ireland we live in a wide variety of settings and the EMS cannot reach every person on time, every time. As a result, individuals and groups have provided a volunteer community response to OHCA for many years. These individuals are known as community first responders (CFRs*). They are trained in CPR and AED (Automated External Defibrillator) use and work alongside the EMS to attend OHCA calls in their community, providing lifesaving skills and supporting the EMS, patients and families. It is not clear how community response to OHCA works in Ireland and data is limited in this regard.

AIM – Using the Nominal Group Technique (NGT), this project will investigate how OHCA community response works in Ireland, consulting a range of stakeholders, including CFRs, EMS, patients, clinicians, and researchers, on which data are best to collect and how information can be utilised to improve the community response service.

OBJECTIVE - To establish the information gathering and analysis needed to inform Irish community response to OHCA. The expected outcome from this project is that quality information on community response will be generated, which can be used to inform policies that will optimise the practice of community response to OHCA in Ireland. This information will be agreed upon during a consultation meeting, employing the NGT, to ascertain which data is considered core to community response data collection. These data will be considered the minimum to collect during community response to OHCA, whilst other identified data will be recorded and considered for collection also. The NGT process will also establish how best to integrate and analyse this data, while also identifying barriers and facilitators to data collection.


*CFRs are volunteers mobilised by the EMS to respond to OHCA calls in their community. They are trained in CPR and AED use, and work alongside the EMS supporting patients and families when an OHCA call is made. They are sometimes first on scene, performing CPR and administering an AED, as well as collecting patient data, including current patient condition and past medical history.

Contributors

Principal Investigator - Masterson, S.

Heffernan, E. Keegan, D. McSharry, J. Barry, T. Deasy, C. Menzies, D. Egan, J. Murphy, A. O’Donnell, C.

National University of Ireland Galway, National Ambulance Service, Prehospital Emergency Care Council, Health Service Executive

Further Study Information

Current Stage: Ongoing
Date: December 2018 - October 2021
Funding source(s): Health Research Board (HRB); Prehospital Emergency Care Council (PHECC); National Ambulance Service (NAS)


Health Area

Disease Category: Heart & circulation

Disease Name: Cardiac arrest

Target Population

Age Range: 18 - 120

Sex: Either

Nature of Intervention: Other

Stakeholders Involved

- Clinical experts
- Consumers (patients)
- Patient/ support group representatives
- Policy makers
- Researchers
- Other

Study Type

- COS for clinical trials or clinical research
- COS for practice

Method(s)

- Consensus meeting
- Nominal group technique (NGT)
- Semi structured discussion
- Survey

The nominal group technique (NGT) will facilitate idea generation and consensus development with a range of stakeholder groups, identifying core CFR data for collection and analysis, as well as the barriers and facilitators to this process. This method was chosen as it gives participants an equal opportunity to give their opinion and perspective through private ranking of ideas. Approximately 20 participants will be recruited to represent various stakeholder groups (e.g. CFRs, patients, clinicians, researchers). Project collaborators will assist recruitment by employing purposive sampling, nominating suitable participants from stakeholder groups. Prior to the consensus meeting, participants will be sent an online survey, generated through Microsoft Forms, which will ask questions related to CFR data collection and usage. The research team will analyse the responses and summarise these for participants at the online meeting. The consensus meeting will last approximately 2-3 hours and be facilitated by members of the research team using the video platform Zoom. The research team will first outline the format of the meeting and present pre-generated lists of responses to the participants. Participants will then be divided into small groups and placed in break out rooms to discuss the topics of the online survey. Each participant will privately rank the responses generated from the survey to prioritise what they consider to be the most important CFR data to collect, use and analyse, and identify barriers and facilitators to collection, integration, and analyses. After first round ranking, the research team will calculate and analyse the group responses. All participants will join the main room where a representative from each group or the group facilitator will summarise the group’s discussion. The research team will facilitate an overall discussion of the responses. A second round of ranking may take place if a prioritisation list is not clear after first round ranking.

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