A Qualitative Analysis of the Experiences of EMS Clinicians in Recognizing and Treating Witnessed Cardiac Arrests.

BACKGROUND: Survival from out of hospital cardiac arrest (OHCA) increases when effective cardiopulmonary resuscitation (CPR) and defibrillation are performed early. Patients who suffer OHCA in front of emergency medical services (EMS) clinicians have greater likelihood of survival, but little is known about how EMS clinicians think about and experience those events. We sought to understand how EMS clinicians assessed patients who devolved to cardiac arrest in their presence and uncover the perceived barriers and facilitators associated with recognizing and treating witnessed OHCAs. METHODS: EMS clinicians who had attended an EMS-witnessed OHCA and consented to participate were interviewed within 72 hours of the index case. Transcripts of the interviews were coded through the consolidated framework for implementation research to understand enabling and constraining factors involved and the predictability and anticipation of OHCA and subsequent management of patient care. Utstein data points, interventions, and associated times were extracted from the medical records. RESULTS: We interviewed 29 EMS clinicians who attended 27 EMS-witnessed OHCAs. Twenty-six (96.3%) of the EMS-witnessed OHCAs were preceded by prodromal symptoms and were classified as predictable. Of the predictable cases, clinicians anticipated 53.8% of them and attributed the prodromes of other cases to serious but not peri-arrest etiologies. Participants described various environmental, crew, and intrapersonal enabling and constraining factors associated with recognizing and treating EMS-witnessed OHCAs. Environmental elements included issues of safety and physical locations, crew elements included familiarity with their partners and working with them in the past, and intrapersonal elements included abilities to collect information and stress associated with responding to and managing the calls. CONCLUSION: Recognition and treatment of EMS-witnessed OHCAs are influenced by numerous environmental, crew, and intrapersonal factors. Future training and education on OHCA should include diverse locations, situations, and crew make-up, along with nontraditional patient complaints to broaden experiences associated with cardiac arrest management.

Lead loading of urban roadways by motor vehicle wheel weights: some Australian observations using novel methodology.

Wheel weights fall off motor vehicles, accumulate on urban roadways and contribute to lead loading of the environment. The objective of the present research was to determine mass distribution, deposition rate, residence time, mass loss, and lead loading per annum on roadways in Melbourne, the capital city of Victoria, Australia. We surveyed wheel weights on 3-3.5 km segments of local/secondary roads over five years, and an 8.2 km segment of a primary arterial road over five month periods. The approach to steady state was also monitored using Global Positioning System (GPS) tracking of the position of weights deposited by motor vehicles. The average deposition rate and residence time were estimated using Poisson modeling of the observations. The distribution of wheel weight masses generally reflected the quantities supplied to the new car and tire market, with the 10 to 30 g range making up almost 70% of the total observed. The number of wheel weights observed was correlated with the commercial content of the route, but residence times depended on the location. The weighted average mass loss of wheel weights deposited on a primary arterial road was 5.9% and the average residence time was 38.1 days. Lead loading on Melbourne roadways was estimated to be 10.9 tonnes/year with 10.3 tonnes/year as intact pieces and 0.6 tonne/year as particulates (or dissolved).