Chain of survival at mass gatherings: A case series of resuscitation events

Background: At a large public event, or mass gathering, various factors influence patient presentations, which bring challenges to patient care. The chain of survival has been investigated in the prehospital setting; however this has not explicitly included the mass-gathering environment.

Objective: This study sought to determine the facilitators and barriers to the chain of survival at mass gatherings.

Methods: This case series research was exploratory and descriptive, using the analysis of personal experiences of resuscitation. Participants were members of St John Ambulance Australia who had participated actively in a resuscitation event in 2007. Telephone interviews were used as a means of data collection. Participant narrative was recorded electronically, transcribed verbatim, and analyzed thematically using a well established human science approach.

Results: The thematic analysis revealed five main themes and a number of sub-themes. Four of the main themes were aligned easily with the four chain of survival links. The remaining main theme outlined a new link in the chain of survival of specific importance to mass gatherings, ‘early planning’. Additionally, a number of sub-themes were identified, which exemplified various facilitators and barriers to the chain of survival in this environment.

Conclusions: This research highlights various barriers and facilitators to the chain of survival in the mass-gathering environment. Additionally, the unique “early planning” link in the chain of survival as described in this research highlights the importance of a preparatory phase for responders at mass gatherings.

Reference: Ranse J, Zeitz K: Chain of survival at mass gatherings: A case series of resuscitation events. Prehospital Disaster Medicine. 2010;25(5):465–471.

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R-on-T resulting in ventricular fibrillation post elective cardioversion: A case study

Elective cardioversion is a common and effective therapy for many atrial arrhythmias, however the procedure is not without risk. One risk from cardioversion is the R-on-T phenomenon. This article provides an overview of anatomy and physiology relating to R-on-T, a case of R-on-T following elective cardioversion for atrial fibrillation and important considerations for elective cardioversion in the emergency department environment.

Ranse J, Luther M, Sargent L. R-on-T resulting in ventricular fibrillation post elective cardioversion: A case study. Australasian Emergency Nursing Journal. 2009;12(3):120-122.

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Graduate nurses’ lived experience of in-hospital resuscitation: A hermeneutic phenomenological approach

Free full-text article is available here (PDF) 

Aim: The purpose of this research was to explore, describe and interpret the lived experience of graduate [junior] Registered Nurses who have participated in an inhospital resuscitation event within the non-critical care environment.

Method: Using a hermeneutic phenomenological design, a convenience sample was recruited from a population of graduate Registered Nurses with less than 12 months experience. Focus groups were employed as a means of data collection. Thematic analysis of the focus group narrative was undertaken using a well-established human science approach.

Findings: Responses from participants were analysed and grouped into four main themes: needing to decide, having to act, feeling connected and being supported. The findings illustrate a decision-making process resulting in participants seeking assistance from a medical emergency team based on previous experience, education and the perceived needs of the patient. Following this decision, participants are indecisive, questioning their decision. Participants view themselves as learners of the resuscitation process being educationally prepared to undertake basic life support, but not prepared for roles in a resuscitation event expected of the Registered Nurse, such as scribe. With minimal direction participants identified, implemented and evaluated their own coping strategies. Participants desire an environment that promotes a team approach, fostering involvement in the ongoing management of the patient within a ‘safe zone’.

Conclusion: Similarities are identifiable between the graduate nurses’ experience and the experience of bystanders and other healthcare professional cohorts, such as the chaotic resuscitation environment, having too many or not enough participants involved in a resuscitation event, being publicly tested, having a decreased physical and emotional reaction with increased resuscitation exposure and having a lack of an opportunity to participate in debriefing sessions. Strategies should be implemented to provide non-critical care nurses with the confidence and competence to remain involved in the resuscitation process, firstly to provide support for less experienced staff and secondly to participate in the ongoing management of the patient. Additionally, the need for education to be contextualised and mimic the realities of a resuscitation event was emphasised.

Ranse J, Arbon P. Graduate nurses’ lived experience of in-hospital resuscitation – a hermeneutic phenomenological approach. Australian Critical Care. 2008;21(1):38-47

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Medical emergency teams: graduate nurses interactions, attitudes and perceptions during resuscitation events in the non-critical care environment

Ranse J. Medical emergency teams: graduate nurses interactions, attitudes and perceptions during resuscitation events in the non-critical care environment; paper presented at the ANZICS/ACCCN Intensive Care Annual Scientific Meeting, Rotorua, New Zealand, 26th October 2007.

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Graduate nurses’ lived experience of in-hospital resuscitation – a hermeneutic phenomenological approach

This poster presents a summary of my research work undertaken as part of the Master of Critical Care Nursing. This poster received the 'Best poster presentation' prize at the 6th International Conference for Emergency Nurses, Melbourne, Australia.

Ranse J. Graduate nurses’ lived experience of in-hospital resuscitation – a hermeneutic phenomenological approach, poster presented at the 6th International Conference for Emergency Nurses, Melbourne, Australia, 12th October 2007.

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Thesis: In-hospital resuscitation: Graduate nurses’ lived experience in the non-critical care environment – a hermeneutic phenomenological approach

In resuscitation teachings to newly Registered Nurses, we place an emphasis on process of Airway, Breathing and Circulation - in reality this is not their role. In a resuscitation, the newly Registered Nurse will be scribing, drawing-up medications and scouting for equipment. As such, the in-hospital training of such cohorts needs to be addressed to meet the realities of the newly Registered Nurses role. This example is one of a number of findings related to my thesis, which was completed in partial fulfilment for the award: Master of Critical Care Nursing.

Reference: Ranse J. In-hospital resuscitation: graduate nurses’ lived experience in the non-critical care environment – a hermeneutic phenomenological approach [thesis]. University of Canberra. 2006.

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Exploring the volunteer first aiders’ experience post-resuscitation

Objectives: This study aims to identify themes associated with St John volunteer first aiders’ post-resuscitation experience following an out-of-hospital sudden cardiac arrest, and to make suggestions for future practice in education and research.

Methods: This study was exploratory and descriptive in design, utilising a single focus group as a means of data collection. All five participants from a single resuscitation event participated in the focus group. The focus group was electronically recorded and transcribed verbatim. The results were then thematically analysed.

Findings: The focus group participants described four themes associated with successful resuscitation of a casualty following sudden cardiac arrest. These themes were: postresuscitation casualty management; interactions with health care professionals; critical incident stress management and learning about the casualty’s outcome.

Discussion: Education of first aid service providers should include post-resuscitation casualty management, this could be achieved by including the chain of survival in its entirety rather than the DRABCD (danger, response, airway, breathing, circulation and defibrillation) resuscitation action plan only. Similarly, ambulance paramedics require an understanding of semi-automatic external defibrillators as used by first aid service providers. In particular, the limitations of semi-automatic external defibrillators should be included in education programs for ambulance paramedics and emergency department staff. Finally, first aid service providers should implement formal mechanisms to provide feedback to participants regarding casualty outcomes following a critical event.

Reference: Ranse J, Burke B. Exploring the volunteer first aiders’ experience post-resuscitation. Journal of Emergency Primary Health Care. 2006;4(3):10p

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Cardiac arrest: can the in-hospital chain of survival be improved?

Survival from cardiac arrest decreases between 7 and 10% each minute defibrillation is delayed. Within the pre-hospital care environment, public access defibrillation programs and first-responders utilise semi-automatic external defibrillators to effectively increase survival following cardiac arrest from approximately 10% to approximately 60%. However, survival from an in-hospital cardiac arrest remains at approximately 10% despite the introduction of medical emergency teams. This discussion paper examines various methods to increase the in-hospital survival rate following a cardiac arrest, such as the implementation of first-responder semi-automatic external defibrillator programs and increasing education standards in basic and advanced cardiac life support.

Reference: Ranse J. Cardiac arrest: can the in-hospital chain of survival be improved? Australasian Emergency Nursing Journal. 2006;9(1):23-27.

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