Emergency medical service provider decision-making in out of hospital cardiac arrest: An exploratory study

© 2017 The Author(s). Background: There are approximately 60,000 out-of-hospital cardiac arrests (OHCA) in the United Kingdom (UK) each year. Within the UK there are well-established clinical practice guidelines that define when resuscitation should be commenced in OHCA, and when resuscitation should cease. Background literature indicates that decision-making in the commencement and cessation of resuscitation efforts in OHCA is complex, and not comprehensively understood. No relevant research from the UK has been published to date and this research study seeks to explore the influences on UK Emergency Medical Service (EMS) provider decision-making when commencing and ceasing resuscitation attempts in OHCA. The aim of this research to explore the influences on UK Emergency Medical Services provider decision-making when commencing and ceasing resuscitation attempts in OHCA. Methods: Four focus groups were convened with 16 clinically active EMS providers. Four case vignettes were discussed to explore decision-making within the focus groups. Thematic analysis was used to analyse transcripts. Results: This research found that there are three stages in the decision-making process when EMS providers consider whether to commence or cease resuscitation attempts in OHCA. These stages are: the call; arrival on scene; the protocol. Influential factors present at each of the three stages can lead to different decisions and variability in practice. These influences are: factual information available to the EMS provider; structural factors such as protocol, guidance and research; cultural beliefs and values; interpersonal factors; risk factors; personal values and beliefs. Conclusions: An improved understanding of the circumstantial, individual and interpersonal factors that mediate the decision-making process in clinical practice could inform the development of more effective clinical guidelines, education and clinical decision support in OHCA. These changes have the potential to lead to greater consistency. and EMS provider confidence, with the potential for improved patient outcome from OHCA

Effects-directed analysis of sediments from polluted marine sites in Norway

The environmental status of two polluted marine sites in Norway was investigated by a combination of target chemical analysis and effect-directed analysis (EDA). The two selected sites, the Grenland area and Oslo harbor, in addition to two reference sites, were classified according to the Norwegian environmental classification system based upon results of the target chemical analyses. The polluted sites were characterized by high levels of metals, polycyclic aromatic hydrocarbons (PAH), and polychlorinated biphenyls (PCB). High levels of organotin compounds were also detected in Oslo harbor. The aryl hydrocarbon receptor (AhR) agonist activity in extracts of sediments from marine sites close to Oslo, Oslo harbor, and Grenland were investigated using the CALUX (chemical-activated luciferase expression) assay, which showed elevated levels of activity. As expected from the history of dioxin release into the Grenland area, the results were highest in this area. The presence of estrogen receptor (ER) and androgen receptor (AR) antagonists was also detected in the sediment extracts. Following fractionation of the sediment extracts, EDA was used to tentatively identify the AhR agonists. The compounds responsible for AhR agonist activity in samples from Oslo harbor were isolated in fraction 13, and to a lesser extent in fractions 9-11. In Grenland, the main activity was found in the more polar fractions, namely fractions 14-18. The AhR agonists identified in Oslo harbor were mainly PAH, while in the Grenland area the compounds identified were mainly nitrogen/oxygen-containing polyaromatic compounds (N/O-PAC)