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Published online: 2024-03-21
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The impact of COVID-19 pandemia on ethical dilemmas in prehospital resuscitation practices

Ali Ekşi1, Süreyya Gümüşsoy1, Sevgi Öztürk1
Affiliations
  1. Atatürk Health Care Vocational School, Ege University

open access

Ahead of Print
ORIGINAL ARTICLES
Published online: 2024-03-21

Abstract

Introduction: This study aims to evaluate the impact of the COVID-19 pandemic process on ethical dilemmas experienced in prehospital resuscitation practices.

Material and methods: The study was conducted on 695 emergency medical services employees. A “questionnaire form” consisting of 20 questions developed by the researchers in line with the literature was used as a data collection tool.

Results: In the pandemic period, ethical dilemmas in deciding to perform CPR on suspected or identified COVID-19 patients have increased in 52.5% of the participants, whereas ethical dilemmas in deciding to terminate CPR have increased in 41.3%. Moreover, a statistically significant difference was found between the increasing status of the ethical dilemmas of the participants in making the decision to start CPR in EMS and terminate CPR in the COVID-19 pandemic process and the status of having a diagnosis of COVID-19, the state of having complete personal protective equipment during CPR, and the state of applying advanced airway techniques on suspected or identified COVID-19 patients.

Conclusions: Although the COVID-19 pandemic process has increased the ethical dilemmas of emergency medical services employees in relation to CPR application, such dilemmas do not affect their decision to start or end CPR.

Abstract

Introduction: This study aims to evaluate the impact of the COVID-19 pandemic process on ethical dilemmas experienced in prehospital resuscitation practices.

Material and methods: The study was conducted on 695 emergency medical services employees. A “questionnaire form” consisting of 20 questions developed by the researchers in line with the literature was used as a data collection tool.

Results: In the pandemic period, ethical dilemmas in deciding to perform CPR on suspected or identified COVID-19 patients have increased in 52.5% of the participants, whereas ethical dilemmas in deciding to terminate CPR have increased in 41.3%. Moreover, a statistically significant difference was found between the increasing status of the ethical dilemmas of the participants in making the decision to start CPR in EMS and terminate CPR in the COVID-19 pandemic process and the status of having a diagnosis of COVID-19, the state of having complete personal protective equipment during CPR, and the state of applying advanced airway techniques on suspected or identified COVID-19 patients.

Conclusions: Although the COVID-19 pandemic process has increased the ethical dilemmas of emergency medical services employees in relation to CPR application, such dilemmas do not affect their decision to start or end CPR.

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Keywords

cardiopulmonary resuscitation; COVID-19; ethical dilemma; personal protective equipment; prehospital emergency medical services

About this article
Title

The impact of COVID-19 pandemia on ethical dilemmas in prehospital resuscitation practices

Journal

Disaster and Emergency Medicine Journal

Issue

Ahead of Print

Article type

Research paper

Published online

2024-03-21

Page views

36

Article views/downloads

29

Keywords

cardiopulmonary resuscitation
COVID-19
ethical dilemma
personal protective equipment
prehospital emergency medical services

Authors

Ali Ekşi
Süreyya Gümüşsoy
Sevgi Öztürk

References (32)
  1. Ekşi̇ A. Afet yönetiminde içsel denetim araci olarak etik. Uluslararası İktisadi ve İdari İncelemeler Dergisi. 2015; 0(15).
  2. Kooli C. COVID-19: Public health issues and ethical dilemmas. Ethics Med Public Health. 2021; 17.
  3. Kooli C. Navigating post-covid healthcare challenges: towards equitable, sustainable, and ethical policy making. Avicenna. 2023; 2023(1).
  4. Kooli C. COVID-19 and the mental health of professionals in the health sector in the UAE: an analytical study. Avicenna. 2021; 2021(2).
  5. Maguire BJ, O’Neill BJ, Shearer K. et al.The ethics of PPE and EMS in the COVID-19 era. JEMS 2021. https://www.jems.com/exclusives/ethics-of-ppe-and-ems-in-the-covid-19-era/ (12.05.2021).
  6. Shekhar AC, Mercer C, Blumen I, et al. Suboptimal rates of return of spontaneous circulation with prehospital CPR in the COVID-19 era. Resuscitation. 2020; 154: 50–51.
  7. Lyngby RM, Händel MN, Christensen AM, et al. Effect of real-time and post-event feedback in out-of-hospital cardiac arrest attended by EMS - A systematic review and meta-analysis. Resusc Plus. 2021; 6.
  8. Edelson DP, Sasson C, Paul SC, et al. Emergency Cardiovascular Care Committee and Get With the Guidelines-Resuscitation, Adult and Pediatric Task Forces of the American Heart Association in Collaboration With the American Academy of Pediatrics, American Association for Respiratory Care, American Society of Anesthesiologists, and the Society of Critical Care Anesthesiologists, American Heart Association ECC Interim COVID Guidance Authors. Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With The Guidelines-Resuscitation Adult and Pediatric Task Forces of the American Heart Association. Circulation. 2020; 141(25): e933–e943.
  9. European Resuscitation Cuncil. Current information about resuscitation in times of COVID-19 is shared below. https://www.erc.edu/covid (10.05.2021).
  10. Naing L, Winn T, Rusli BN. Practical ıssues ın calculating the sample size for prevalence studies. Arch Orofac Sci. 2006; 1: 9–14.
  11. Faul F, Erdfelder E, Buchner A, et al. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009; 41(4): 1149–1160.
  12. Chow SC, Shao J, Wang H, Lokhnygina Y. Sample size calculations in clinical research. 3rd ed. Chapman and Hall/CRC 2018.
  13. Robert R, Kentish-Barnes N, Boyer A, et al. Ethical dilemmas due to the Covid-19 pandemic. Ann Intensive Care. 2020; 10(1): 84.
  14. Edelson DP, Sasson C, Chan PS, et al. American Heart Association ECC Interim COVID Guidance Authors. Interim guidance for basic and advanced life support in adults, children, and neonates with suspected or confirmed COVID-19: from the emergency cardiovascular care committee and get with the guidelines-resuscitation adult and pediatric task forces of the american heart association. Circulation. 2020; 141(25): e933–e943.
  15. Bhatraju PK, Ghassemieh BJ, Nichols M, et al. Covid-19 in critically ill patients in the Seattle region: case series. N Engl J Med. 2020; 382(21): 2012–2022.
  16. Wang D, Hu Bo, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020; 323(11): 1061–1069.
  17. Centers for Disease Control and Prevention. Information for clinicians on therapeutic options for COVID-19 patients. Office of the Associate Director for Communication, Digital Media Branch, Division of Public Affairs; 2020. Apr 7. https://www.cdc.gov/coronavirus/2019-ncov/hcp/therapeutic-options.html/ (07.04.2020).
  18. Ng QX, Lee EZh, Tay JAm, et al. Impact of COVID-19 'circuit-breaker' measures on emergency medical services utilisation and out-of-hospital cardiac arrest outcomes in Singapore. Emerg Med Australas. 2021; 33(1): 149–151.
  19. Sen-Crowe B, Sutherland M, McKenney M, et al. Cardiopulmonary resuscitation during the COVID-19 pandemic: maintaining provider and patient safety. Am J Emerg Med. 2021; 46: 714–716.
  20. Kramer JB, Brown DE, Kopar PK. Ethics in the time of coronavirus: recommendations in the COVID-19 pandemic. J Am Coll Surg. 2020; 230(6): 1114–1118.
  21. Rauch S, van Veelen MJ, Oberhammer R, et al. Effect of wearing personal protective equipment (PPE) on CPR quality in times of the COVID-19 pandemic-a simulation, randomised crossover trial. J Clin Med. 2021; 10(8).
  22. Lin LW, Hung TY. Swivel-HEPA-ETT (SHE) bougie and HEPA-ETT (HE) methods for safe intubation while managing patients with COVID-19. Emerg Med J. 2020; 37(5): 256–257.
  23. Kramer DB, Lo B, Dickert NW. CPR in the covid-19 era: an ethical framework. N Engl J Med. 2020; 383(2): e6.
  24. Yang WS, Hou SW, Lee BC, et al. Taipei azalea: supraglottic airways (SGA) preassembled with high-efficiency particulate air (HEPA) filters to simplify prehospital airway management for patients with out-of-hospital cardiac arrests (OHCA) during coronavirus disease 2019 (COVID-19) pandemic. Resuscitation. 2020; 151: 3–5.
  25. ECRI Institute. Mechanical ventilation of SARS patients: lessons from the 2003 SARS outbreak.
  26. Hart J, Tracy R, Johnston M, et al. Recommendations for prehospital airway management in patients with suspected COVID-19 infection. West J Emerg Med. 2020; 21(4): 809–812.
  27. Guan WJ, Ni ZY, Hu Yu, et al. China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020; 382(18): 1708–1720.
  28. Torabi M, Borhani F, Abbaszadeh A, et al. Experiences of pre-hospital emergency medical personnel in ethical decision-making: a qualitative study. BMC Med Ethics. 2018; 19(1): 95.
  29. Jung H, Lee MiJ, Cho JW, et al. WinCOVID-19 consortium. External validation of multimodal termination of resuscitation rules for out-of-hospital cardiac arrest patients in the COVID-19 era. Scand J Trauma Resusc Emerg Med. 2021; 29(1): 19.
  30. Goodloe, JM. Cardiac arrest resuscitation in the COVID-19 era. American College of Emergency Physicians. https://www.acep.org/corona/covid-19-field- (16.10.2023).
  31. Sandroni C, Skrifvars MB, Nolan JP. The impact of COVID-19 on the epidemiology, outcome and management of cardiac arrest. Intensive Care Med. 2021; 47(5): 602–604.
  32. Kulkarni AP, Singh Y, Garg H, et al. Cardiopulmonary resuscitation during COVID-19 pandemic: outcomes, risks, and protective strategies for the healthcare workers and ethical considerations. Indian J Crit Care Med. 2020; 24(9): 868–872.

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