1 ; 1 ; in Month : December (2020) Article No : sjimgr-v1-1002
Olagnero JM, Prisciandaro I, Bortolin M

Abstract
Introduction: 118 Turin EMS emergency nurses often work as team leaders on the ambulance and sometimes find themselves in the conditions of having to decide whether to resuscitate and if to interrupt the resuscitation of patient’s victims of out-of-hospital cardiac arrest (OHCA). This study aims to evaluate the OHCA patients managing and end-of-life decisions by emergency nurses on MSAB of the 118 Turin EMS. Materials and Methods: A semi-structured questionnaire was created and distributed anonymously to 109 nurses working without physician on ambulances in order to investigate end-of-life decisions through questions aimed to explore the most aspects of OHCA management. Results: The questionnaire was completed by 62 (57%) nurses; 98% (61) are certified Advanced Life Support. On average, nurses report each one 2 OHCA per month managed in autonomy. Features that most influence resuscitation decision are end-of-life cancer pathology (95%, 58), witnessed arrest (82%, 50), BLS in progress (70%, 43), severe disability/bedridden (66%, 40) and OHCA occurred less than 10 minutes (64%, 39). For 65% (40) anxiety is limited during OHCA management but legal protection is perceived inadequate. Discussion: The features influence revive decision appear mostly in line with literature. Emergency nurses appear experienced and trained; nevertheless, uniform behaviour in end-of-life decision is not always observed. The national legislation and the literature concerning the end-of-life decisions by "non-medical" is mostly unclear; therefore, nurses would like standardized protocols (58%) and comparison with relatives (85%) and with physician by phone (92%). Conclusion: Turin EMS emergency nurses sometimes take end-of-life decisions; however, protocols and training courses on legal and bioethical aspects would be needed or improved.

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