Out-of-hospital cardiac arrest: comparing organised groups to individual first responders: A qualitative focus group study

Background: Fast delivery of high-quality cardiopulmonary resuscitation is crucial in improving patient outcome after out of hospital cardiac arrest. First responders (trained laypersons) are dispatched to shorten time to basic life support and can be organised in groups or individually.

Objective: A comparison of factors enabling or impairing first responders' engagement in groups and as individuals are unknown. Therefore, we investigated these factors.

Design: Qualitative comparison.

Setting: We set up six focus groups from March to June 2017 in the Canton of Bern, Switzerland. Thirteen group and 13 individual first responders participated.

Intervention: Interviews were audio-recorded, transcribed, coded and analysed following a thematic analytic approach. Two researchers coded the transcripts separately, identified, discussed and adjusted categories, themes and subthemes.

Results: Factors supporting first responders' engagement are: additional training, support from peers and society, satisfaction of personal desires (all important for all first responders), interdisciplinary collaboration (important for group first responders).Factors impairing first responders' engagement are: individual first responders lack training opportunities and collaboration, individual first responders lack support from peers and society, all first responders report lack of medical knowledge/skills and technical problems, confidentiality issues, legal insecurity and ethical concerns bother all first responders, intimidation by 'professional first responders' and professional burden. First responders organised in groups benefit from more training, enhanced peer support and collaboration with other groups. Individual first responders lack training opportunities and collaboration with emergency medical services.

Conclusion: Team spirit and peer-support engages group first responders, whereas individual first responders are impaired by lack of social support. Involvement with society triggers both first responder types to become and stay first responders. As first responders in groups have substantial additional benefits, enhancing such groups might strengthen current first responder systems.