Table 3 Included articles matrix

Axelsson et al.,

(1996) [23]

Sweden

To describe bystander-initiated CPR, the circumstances, & their experiences

742 bystanders who completed CPR between 1990–1994

Mixed Methods, phone interviews & postal questionnaires

93% of bystanders indicated that performing CPR was a mainly positive experience & reported positive interactions with ambulance crew. Bystanders had poor access to post-event debriefing opportunities

5

Axelsson et al.,

(1998) [24]

Sweden

To identify the factors influencing the psychological reactions to performing CPR during an actual emergency reported by the bystanders

544 bystanders who completed CPR between 1992–1995

Mixed Methods, survey & telephone interviews

Two key factors influenced bystander psychological reactions:

1) Victim outcome, including unknown outcome; 2) Debriefing of bystanders post-event

5

Axelsson et al.,

(2000) [25]

Sweden

To identify the factors influencing the psychological reactions to performing CPR during an actual emergency reported by the bystanders

19 bystanders who had performed CPR between 1997–1998

Qualitative, individual interviews

Five key themes were identified as affecting bystanders’ experience in performing CPR: 1: Acting out of humanity; 2: Competence of CPR; 3: Feelings of obligation; 4: Feelings of courage; 5: Feeling exposed

1, 2,

Bremer et al.,

(2009) [26]

Sweden

To describe the experiences of significant others present at out-of-hospital cardiac events focusing on ethical aspects & values

Seven significant others

Qualitative, individual interviews

Significant others reported the following themes in their experience of out-of-hospital-cardiac arrest: unreality in reality; overwhelming responsibility; inadequacy & limitation; hope & hopelessness; ethical considerations; insecurity about the future; & the trembling of life

1, 2, 4

Carter et al.,

(2019) [27]

Canada

To evaluate patient/family satisfaction & paramedic comfort & confidence in the provision of a novel palliative care in the home programme

18 family members & caregivers

Mixed methods,

two-stage data collection (Part A patient/family & Part B paramedic)

Mailed & online surveys, & phone interviews

The delivery of palliative care in the home by paramedics resulted in high patient/family satisfaction. Families & patients reported that receiving end-of-life care by paramedics in the home enabled care wishes to be fulfilled, peace of mind for the caregivers, & help during emergency situations

2, 4

Case et al.,

(2021) [28]

Australia

To explore the psychological adjustment & experiential perspectives of survivors & families in the second year after out-of-hospital cardiac arrest (OHCA)

12 family members

Mixed methods,

semi-structured interviews & a post-traumatic-stress-disorder (PTSD) psychological assessment

Family descriptions of persistent trauma symptoms & are at risk of developing psychological disorders such as PTSD, emphasising the distinct support needs of family post-event

2, 5

Critz. (1989) [29]

USA

To describe the attitudes & experiences of family members with respect to death determination in the home for terminally ill patients

53 family members who experienced death determination of terminally ill patients in the home

Mixed methods, mailed survey consisting of set & free answer sections

There is a large variety of practices in terms of emergency medical services response to death determination of terminally ill patients in the home. Common feelings the family experience at this time are sadness, relief, & anger

2, 3, 5

Dainty et al.,

(2021) [30]

Canada

Partnering with survivors & families to determine research priorities for adult out-of-hospital cardiac arrests

A diverse group with OHCA experiences including survivors, family members, health care professionals, & researchers

Mixed methods,

survey & focus groups

Care required for families, bystanders & patients was identified as a top research priority. Post-event support was highlighted as important

5

De Stefano et al., (2016) [31]

France

To understand family members’ experiences during CPR

30 family members who had family members die during an OHCA

Qualitative, phone interviews

Family presence during OHCA can help to ameliorate the pain of the death, through the feeling of having helped to support the patient during the passage from life to death & of having participated in this important moment

2, 3, 4, 5

Delbridge et al.,

(1996) [32]

USA

To determine whether family members accept field termination of unsuccessful out-of-hospital cardiac arrest resuscitation

‘Closest Family member’ of 42 unsuccessful resuscitations terminated out-of-hospital (n = 25) & in ED (n = 17)

Quantitative prospective cohort study, structured interviews

Results suggest that family members accept termination of unsuccessful cardiac arrest resuscitations in the field & ED equally well. Furthermore, family members of patients for whom resuscitation efforts are terminated in the field, compared with those of patients who are first transported to an ED, show similar satisfaction with regard to the manner in which they were informed of the death & the overall care provided by the EMS system

3, 4, 5

Edwardsen et al., (2002) [33]

USA

To determine the acceptance by family members regarding non-transport of patients in cardiac arrest following unsuccessful resuscitation occurring in private residences

33 adults from 21 families who were present at the time of the patient’s death

Mixed methods,

Survey & telephone interviews

All 21 families (100%) of the non-transported patients were satisfied with both the medical care & the emotional support provided by EMS

Family members of three of the 12 (25%) transported patients stated they would have preferred to have the patient die at home instead of being transported

3, 4

Fallat et al.,

(2019) [31]

USA

To understand how family members view the ways EMS & other first responders interact with distressed family members during an intervention involving a recent or impending paediatric death

15 parents of seven deceased children or young adults who had interactions with first responders

Qualitative, parent Interviews

There was a minimal amount of awareness of family-centred practice by the various providers (EMS, police, ED staff & coroners) even in cases where the child was declared deceased on scene. Communication between providers & families was a key factor in the experience

3, 4, 5

Forsgarde et al.,

(2021) [34]

Sweden

To describe extended collaboration in situations when an ambulance was called, as experienced by older patients, a significant other, & ambulance- & primary healthcare (PHC) centre personnel

An extended collaboration group of older patients (n = 3) & significant other (n = 1), ambulance personnel (n = 3) & PHC personnel (n = 4)

Qualitative, individual interviews using reflective lifeworld research (RLR) approach

Extended collaboration when an ambulance is called gives support in decisions through dialogue. Dialogue increases certainty through experience- & knowledge-sharing between all involved (patient, family, ambulance & PHC personnel)

2, 3

Forslund et al.,

(2008) [35]

Sweden

To illuminate how spouses to persons with acute chest pain experienced the alarm situation, the emergency call & the prehospital emergency care

Nine significant others of adult patients requiring emergency medical services

Qualitative, individual interviews

Identified key feelings which spouses experience during a spouses acute chest pain. Themes included aloneness, uneasiness, & responsibility

1, 2

Holmberg et al.,

(2016) [3]

Sweden

To elucidate meanings of the relationship with the clinicians in the emergency ambulance care setting as experienced by the patients’ significant other

Nine significant others of adult patients requiring emergency medical services

Qualitative, individual interviews

The main theme of ‘being lonely together’ was identified. Significant others share the struggle with the affected person while also experiencing loneliness as clinicians focus on the affected person. Actions of the clinicians affect SO feelings. SO feel acknowledged when listened to & comforted when care is provided to the patient

1, 2

Jabre et al.,

(2013) [36]

France

The principal aim of this trial was to determine whether offering a relative the choice of observing CPR might reduce the likelihood of PTSD-related symptoms. We also assessed the effect of family presence on medical efforts at resuscitation & the well-being of the healthcare team

570 relatives of adult patients who were in cardiac arrest & were given CPR by 15 prehospital emergency medical service units

Randomised controlled trial

Family presence during CPR was associated with positive results on psychological variables & did not interfere with medical efforts, increase stress in the health care team, or result in medicolegal conflicts

4

Jarneid et al.,

(2020) [37]

Norway

To investigate fathers’ experiences of being present at an unplanned birth outside a maternity facility

12 fathers

Qualitative, semi-structured interviews

Fathers’ experiences included stress, worry & anxiety but also pride & joy of stronger attachment to their partner & the baby they had helped to deliver. The support they received from the emergency services gave them increased reassurance & control, especially in cases where a midwife was present. Fathers sometimes did not feel confident in the care ambulance personnel could provide

1, 5

Jepsen et al.,

(2019) [38]

Sweden

To explore the experiences of the caring encounter in the ambulance service among parents to children aged 0–14 years

14 parents of children aged 0–14 years old who were cared for by EMS

Qualitative, interviews

The parents described the importance of giving the family enough time in the situation, creating a safe environment & involving the parents in the care. In cases where the parents felt insecure, there had been lack of communication & lack of sensitivity, & the ambulance team did not invite the parents to participate in the care

1, 2

Jurhmann et al.,

(2022) [6]

Australia

To review & synthesise the empirical evidence regarding paramedics delivering palliative & end-of-life care in community-based settings

23 articles. Articles which included ambulance staff (n = 20), patients (n = 4), family (n = 2)

Systematic integrative review

Paramedics can play an important role in facilitating home-based death & reducing avoidable hospital admissions. There is a strong desire amongst ambulance staff, family members & patients for paramedics to refocus their attention on holistic home-based management of palliative symptoms instead of hospital conveyance

1, 2, 4

Larsen et al.,

(2022) [39]

Denmark

To explore relatives’ experience of out-of-hospital cardiac arrest during & post-event

12 relatives of adult OHCA survivors

Qualitative, semi-structured interviews

Relatives were challenged with witnessing OHCA & the trajectory after it, experiencing a high level of distress & anxiety. The development of support networks & education programs for patients & relatives is a critical element in supporting relatives of cardiac arrest survivors after discharge

1, 2, 5

Mathiesen et al., (2016) [40]

Norway

To explore reactions & coping strategies in lay rescuers who have provided CPR to OHCA victims

20 lay rescuers who performed CPR

Qualitative, semi-structured interviews

Reactions after providing CPR to OHCA victims may cause serious & persistent concerns in lay rescuers. A common coping strategy was confiding in close relations. Some lay rescuers required professional help to cope with the OHCA incident

2, 5

Mausz et al.,

(2018) [41]

Canada

To qualitatively explore bystander CPR to identify contextual influences on performance that might be relevant for CPR training & to describe the emotional & psychological impact of providing CPR

15 lay rescuers who were involved in an adult OHCA

Qualitative, semi-structured focus groups

Bystanders move through three key stages when encountering OHCA: being called to act; taking action & making sense of the experience. The long-term psychological consequences of bystander intervention in OHCA remain poorly understood & warrant further study

1, 2, 5

Merlevede et al., (2004) [42]

Belgium

To determine the perceptions, needs & mourning reactions of their bereaved relatives confronted with sudden unexpected death & to assess the relationship with the cause of death

74 relatives of 53 deceased individuals who passed away suddenly out-of-hospital (n = 45) or in ED (n = 5)

Mixed methods, semi-structured interviews & standardised surveys

Common needs identified by the bereaved family were: lack of information/long waits for information; wanting an opportunity to view resuscitation or deceased; lack of family involvement in cases where the deceased is left in the home; & lack of follow up care

3, 4, 5

Moller et al.,

(2014) [43]

Denmark

To explore the concept of debriefing bystanders after participating in an out-of-hospital cardiac arrest resuscitation attempt

15 bystanders who received telephone debriefing post-OHCA participation

Qualitative design, telephone interviews

Post-event debriefing when provided by healthcare professionals stimulates reflection, positively influencing the ability to cope with the emotional reactions & the cognitive perception of own performance; enhances motivation to perform CPR & motivates improvement of skills

4, 5

Myall et al.,

(2020) [5]

United Kingdom

To identify the factors that shape & characterise experiences of prehospital practitioners, families & bystanders in the context of death & dying outside of the hospital environment where pre-hospital practitioners respond

51 papers included which reported on death & dying in the prehospital setting

Scoping review

Few papers focused on family & significant others’ experiences. Generally, relatives reported positive interactions with prehospital practitioners, & while some families reported more negative encounters, it suggests there may be a disconnect between prehospital practitioners’ perceptions of the care they provide & families’ experience of that care

1, 2, 4

Nordby & Nohr

(2008) [44]

Norway

To understand how relevant communicative challenges in cases of sudden infant death syndrome were perceived by both parents & paramedics

Six pairs of parents & six paramedics who had been involved in sudden unexpected death in infant

Qualitative, semi-structured interviews

Many of the parents interviewed were not satisfied with the paramedics' communication, empathy & ability to take care of the practical aspects of the situation

3, 4, 5

Nord-Ljungquist et al., (2020) [45]

Sweden

To describe the emergency situation involving a while waiting for an ambulance assignment in a rural environment from the caller's perspective

Eight callers who alerted emergency services for another person in need of emergency help

Qualitative, individual interviews

Participants describe a double ambivalence between feeling alone in the situation & having full control, & trust handing over the responsibility yet losing control. Actions of emergency services can affect the experience of the caller

1, 2, 5

Peculo-Carrasco et al., (2020) [46]

Spain

To determine the feelings of safety among patients & carers based on their experiences & those of their emergency care professionals

29 adult patients & 20 carers who requested emergency medical care, & 16 emergency care professionals

Qualitative,

focus groups of patients, carers, & emergency professionals

The factors, elements or situations with the greatest influence on the perception of feeling safe in this study are related to information & communication, person-centred care & professional competency,

1, 2, 3

Peters et al.,

(2016) [47]

Australia

To elucidate the experiences of family members after the loss of a loved one as a result of suicide

10 participants who were bereaved relatives of suicide

Qualitative, individual interviews

Interactions between those bereaved by suicide & first responders following a suicide can favourably or adversely influence the course of bereavement for loved ones. Participants identified that practical, emotional & financial support was needed to assist them with grieving & functional restoration

3, 5

Schmidt & Harrahill (1995) [48]

USA

To better understand the perceptions, needs, & responses of family members after an out-of-hospital death

31 surviving family members of urban out-of-hospital deaths which were attended by paramedics

Mixed methods, surveys & interviews

Paramedics were found to be professional & supportive. All participants were satisfied with death determination in the home rather than transportation to a hospital. This pilot study suggests that paramedics are able to meet the needs of survivors at the time of an out-of-hospital death

3, 4, 5

Soontorn et al.,

(2020) [49]

Thail&

To describe the experience of rural Thai family caregivers helping dependent elders during medical emergencies

15 family caregivers of elderly dependents experiencing medical emergencies

Qualitative, interviews

The setting of rural Thailand resulted in many challenges for family members in receiving emergency medical care. Barriers to emergency care were lack of home monitoring equipment, inexperienced caregivers in assessing warning signs, lack of information & understanding of emergency health services, & delayed arrival of EMS

2, 3

Swetenham et al., (2014) [50]

Australia

To explore the introduction of an extended care paramedics rapid response palliative care team

24 carers of palliative care patients

Mixed methods, interviews with service users & surveys of paramedics

Extended care paramedics are able to meet the needs of patients & family members undergoing palliative care treatment

1, 3

Thoren et al.,

(2010) [51]

Sweden

To describe spouses' experiences of witnessing their partners' cardiac arrest at home, including the time before the event & when it happened

15 spouses of deceased adult OHCA patients

Qualitative methodology,

individual Interviews

Major domains were identified of ‘time before the cardiac arrest’ & ‘the cardiac arrest event’. Emergency call services are able to influence family members’ actions & experiences during these times

1, 2

Wisten et al., (2007) [52]

Sweden

To elucidate the perceived support & the needs of bereaved parents confronted with sudden cardiac death of a child

Twenty-eight parents who experienced sudden cardiac death of a child

Qualitative, parent interviews

Positive factors were: perceived emotional support, being given time with the deceased, & a reconstruction of the circumstances at death by someone who could answer their questions. However, this study showed that a considerable proportion of the suddenly bereaved perceived a lack of support & information in the acute situation

1, 4, 5

Weslien et al.,

(2005) [53]

Sweden

To provide insight into family members’ experiences of cardiac arrest

17 family members who witnessed cardiac arrest

Qualitative,

semi-structured interviews

Three major phases occur for a family member witnessing cardiac arrest realisation of event, the arrival of EMS & takeover of care at the hospital. All of which impact the experiences of the family

1 – 5