Decision making by emergency physicians when assessing cardiac arrest patients on arrival at hospital.
OBJECTIVE
To investigate the factors which influence decision making by experienced emergency physicians when they decide whether to (a) pronounce 'life extinct' in adult patients with non traumatic cardiac arrest while in the ambulance, or (b) bring them into the resuscitation room in the Emergency Department for further assessment/management.


METHODS
Qualitative study involving semi structured interviews and a focus group.


METHODS
Accident & Emergency (A&E) departments in the Yorkshire region.


METHODS
Fifteen emergency physicians (two clinical fellows, nine specialist registrars and four consultants) working in the Yorkshire region.


RESULTS
Six main themes were identified that impacted upon the decision making process: the doctor's past experience, ambulance service issues, prehospital care, patient characteristics, presence and views of relatives, and organisational issues.


CONCLUSIONS
The reasoning behind decisions made when a patient arrives at the Emergency Department in cardiac arrest is multifactorial. Strict guidelines would be difficult to construct since individuals vary in the importance they attach to different factors.
Lockey
A S
AS
Emergency Department, York District Hospital, Wigginton Road, York YO31 8HE, UK. alockley@totalise.co.uk
Hardern
R D
RD
D000328:Adult; D000552:Ambulances; D001291:Attitude of Health Personnel; D003657:Decision Making; D004632:Emergency Medical Services; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D007398:Interpersonal Relations; D017063:Outcome Assessment, Health Care; D010820:Physicians / Q000523:psychology*; D012151:Resuscitation