Abstract
This study examines the impact of a newly developed structured training on Singapore paramedics’ psychological comfort before the implementation of a prehospital termination of resuscitation (TOR) protocol. Following a before and after study design, the paramedics underwent a self-administered questionnaire to assess their psychological comfort level applying the TOR protocol, 22 months before and one month after a 3-h structured training session. The questionnaire addressed five domains: sociocultural attitudes on resuscitation and TOR, multi-tasking, feelings towards resuscitation and TOR, interactions with colleagues and bystanders and informing survivors. Overall psychological comfort total (PCT) scores and domain-specific scores were compared using the paired t-test with higher scores representing greater comfort. Ninety-six of the 345 eligible paramedics responded. There was no statistically significant change in the mean PCT scores at baseline and post-training; however, the “feelings towards resuscitation and TOR” domain improved by 4.77% (95% CI 1.42 to 8.13 and p = 0.006) and the multi-tasking domain worsened by 4.11% (95% CI −7.82 to −0.41 and p = 0.030). While the structured training did not impact on the overall psychological comfort levels, it led to improvements in the feelings of paramedics towards resuscitation and TOR. Challenges remain in improving paramedics’ psychological comfort levels towards TOR.
Highlights
In suitable patients, field termination of resuscitation (TOR) by paramedics has been shown to be effective in reducing conveyance of futile resuscitations to the hospital [1], conserving limited resources [2] and averting dangerous high-speed transports [3]
TOR protocols have been practiced in Canada and the United States of America [2] for more than 20 years, and there is a trend towards worldwide adoption of such TOR protocols
Percentage to respondents’ characteristics demonstrated no statistically significant results apart from “age”, which had a p value of 0.049
Summary
Field termination of resuscitation (TOR) by paramedics has been shown to be effective in reducing conveyance of futile resuscitations to the hospital [1], conserving limited resources [2] and averting dangerous high-speed transports [3]. Prehospital TOR protocols have not been adopted in many Asian countries for various reasons. These include differences in the sociocultural context surrounding death [4]. The “rescue culture” mentality and the perception of death as an unsuccessful outcome of many prehospital emergency medical services (EMS) [6] limit the uptake for any TOR protocol.
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