Steve Brummell
Cardiopulmonary Resuscitation in the Emergency Department
In spite of media images to the contrary, unsuccessful resuscitation in Emergency Departments is the most common outcome. Staff involved in cardiopulmonary resuscitation must therefore evolve strategies for dealing with both the stresses of resuscitation and sudden death. This paper presents findings from a doctoral study exploring resuscitation practices within Emergency care, to identify how team members construct a cardiac arrest, and conceptualise death and dying.
An ethnographic approach was employed to capture practices that were socially constructed within emergency care. Data collection was in two Emergency Departments in the North of the UK, one semi-urban and one urban, using participant observation and interviews. Participant observation of resuscitation attempts was undertaken in the semi urban primary unit only. Semi structured interviews of nursing and medical staff were undertaken in both units.
The approach to analysis involved the integration of fieldnotes, analytical memos and interview data to construct cases for interpretation. Data revealed complex resuscitation categories constructed by participants to differentiate resuscitation situations. These categories were constructed for each patient using a combination of bodily and technical information that were indicative of dying, but were given meaning by their social context. Locating the patient within the resuscitation categories was the main determinant of whether resuscitation should continue, and if so, for how long. Determining the point when resuscitation was withdrawn required the alignment of technical with bodily dying, enabling participants to construct an acceptable death.