2019-2020 UROP: Hannah Yoon EPOC Project Poster Presentation

Abstract

There are about 350,000 out-of-hospital cardiac arrest (OHCA) cases per year in the US, with a very low survival rate of approximately 11%. Research shows that the early links in the chain of survival (i.e. cardiac arrest recognition, call of help, bystander CPR, and bystander AED use) for OHCA have the greatest impact on survival. Previous studies have not used the chain of survival as a framework to qualitatively analyze what goes well or to identify challenges at each level of care. Enhancing Pre-hospital Outcomes for Cardiac Arrest (EPOC) aims to identify the system of care “best practices” for OHCA response across the chain. Using a sequential, mixed-methods approach, we began the project by analyzing the data from the Michigan Cardiac Arrest Registry to Enhance Survival (CARES) from 2014 to 2017 to define variation in OHCA survival outcomes across Michigan emergency medical service (EMS) agencies. We then sampled nine EMS systems (i.e. dispatch, fire, police, EMS, emergency department) according to variation in survival rates, urbanicity, and population density. At each site, we conducted key informant interview and focus groups because we wanted to hear from people who were active in the response and to find barriers and potential solutions to existing problems. After collecting data, we analyzed the responses individually using combined rapid and rigorous analysis, with a focus on the framework of the system of care. We also discussed findings in groups to reach a consensus about data after the individual analysis. The analysis is still underway, and we expect to complete it by the end of May. As of now, preliminary results indicate that the first three links of the chain of survival are crucial for improving response across the system of care (Table: Primary Preliminary Results). The final qualitative analysis will provide possible barriers or advances that could be used to improve OHCA outcomes. The final qualitative results will be validated using surveys administered to EMS agency and Medical Control Authority directors across Michigan. We plan on developing a best practice toolkit for OHCA response across the system of care and distribute it to all Emergency Medical Service systems across Michigan and nationally.

Personal Reflections From My Research Experience

Overall, I really enjoyed the first year of my research experience. I was able to learn how to conduct a thorough literature review, work with qualitative data, and create a poster to present findings. The research environment was different from the traditional wet-lab I was used to, but my mentor and other researchers made it a very comfortable environment to work. Meeting people at various stages of their profession was also exciting because it was an experience that I would not be exposed to if I had not been involved in research. It was interesting to see how people presented their findings and discussed their analysis in the qualitative analysis meetings I participated to reach the most effective conclusion and move forward with the project; it gave me a better understanding of how collaboration worked in the research setting. For the most part, I met the goals I was interested in achieving at the beginning of the year – I learned how to analyze and learn unfamiliar content effectively, and I learned much more about public health than what I used to know. The experience let me know that I could pursue the medical track while continuing my engagement with public health in the future, and I plan on doing so this summer. I hope to work more on the goal I was not able to accomplish throughout the year – working for a publication or, now more specifically, to learn how a manuscript is written – and develop my analysis skills with qualitative data.

Challenges and Victories in My Experience

One of the biggest challenges during my first year of research experience was finding a specific focus. At first, we were focused on researching about burnout among first responders, but we had trouble finding quantitative data about the field. Initially, we were trying to branch off the main EPOC project, but we decided to join the main project later to focus on different aspects of the research field. After joining, I was able to learn more about research collaboration by participating in meetings and got started with practicing qualitative analysis. This process had a challenge of its own as well, as it was sometimes difficult to understand how certain sentences should to be categorized. However, with some practice, I was able to get better at this process, and I plan on learning more about this technique and developing the skill in the future by continuing this project!