Stress reactions and perceived difficulties of lay responders to a medical emergency

Aug 2 2006

Even though they are trained in CPR, people hesitate to take action when an emergency unfolds in front of them. But the cause, a study has found, is more likely to be confusion than stress.

A study conducted by several researchers surveyed 1,243 lay people trained in CPR (cardiopulmonary resuscitation) who took part in a clinical trial. Most of them said they experienced low stress levels when faced with responding to a person in medical distress. "Most lay responders did not view the experience as onerous, but there are people who had negative experiences," said Dr. David Feeny, a professor of Public Health Sciences at the University of Alberta, Edmonton, Canada, and one of the co-authors on the study. Also contributing to the study were researchers from the University of Pennsylvania, University of Pittsburgh, University of Washington, as well as medical workers and health centres.

The study was published recently in the journal Resuscitation.

Random cardiac arrest is a leading cause of death in North America and lay responder CPR rates remain low.

Respondents did indicate that practical issues such as crowd control and skill performance concerned them more than their emotions. Concerns included barriers to responding such as communication with confused and combative patients; skills such as accessing airways or taking accurate pulse checks; accessing the victim in awkward, dark or cramped areas; harnessing their own feelings of panic; and dealing with the characteristics of the victim, such as bleeding, jerking, vomiting, age and size.

Of the respondents who did indicate high stress levels, they tended to be women or non-native English speakers, possibly because females felt more comfortable confessing to stress, and because those with language issues felt unsure about communicating with the victims they were trying to help. Younger people also reported higher levels of stress in response situations.

The study found that laypersons responding to situations thought to be heart attacks had higher stress levels than those involved in other events, due to the seriousness of the condition. Stress levels were also higher in residential than in public settings.

In order to help lay responders deal better with these issues, the researchers suggest communities do two things: develop a system to track lay responders after an incident so they can be offered counselling; and secondly, offer debriefing for volunteers who take CPR courses, as they do for professional medical emergency responders.

"If you talk to emergency medical personnel, they have learned to have professional counselling available," said Dr. Feeny. "Lay responders really do need to talk to someone who has been there to put it into perspective and calm down. We train them to perform a physical skill, but not how to handle the grief of the family and their own feelings. These can be horrendous situations."

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