Background National guidance suggests that adult survivors of medical out-of-hospital cardiac arrest (OHCA) should be considered for direct transport to a specialist centre. Much of the research that informs this recommendation originates from urban environments where patients achieve rapid access to hospital. Little evidence could be found describing the decision-making profile and experiences of paramedics caring for OHCA patients and how conveyance destinations are currently selected. Methods Qualitative inquiry was used to describe the experiences of paramedics caring for OHCA patients and to determine the factors which constrain or facilitate the direct conveyance to a specialist centre. Data was gathered from two socially distanced focus groups lead by a facilitator using a pre-determined topic guide. Nine paramedics took part in this service evaluation from a single regional UK ambulance service. Focus group conversations were recorded, transcribed, and coded using thematic analysis. Results Factors considered by participants could be broadly categorised under five primary themes; available guidance, hospital features, non-technical factors (e.g. dealing with conflict), patient condition and clinical skills. Factors including proximity to hospital, access to specialist services and the availability of pre-hospital enhanced care were identified which resonated with existing literature. Additional issues including managing resistance from other healthcare professionals, decision making based on experience and a reliance on local guidance emerged from the project and were felt to be unexpected. Conclusion Paramedics consider a range of factors when selecting a conveyance destination for survivors of medical OHCA, including the hospital’s distance from scene and access to specialist services. The patient’s stability and availability of enhanced care, in particular to manage agitation are also considered. Paramedics predominantly use local Trust guidance, rely on familiarity, or previous experience to help support their decision making and may need to overcome conflict from hospital colleagues to select an appropriate conveyance destination.

中文翻译：

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PP13 一项服务评估，探讨医护人员在为院外心脏骤停幸存者选择转运目的地时考虑的因素

背景 国家指导建议应考虑将院外心脏骤停 (OHCA) 的成年幸存者直接运送到专科中心。为这一建议提供信息的大部分研究都来自城市环境，在这些环境中，患者可以快速进入医院。几乎没有证据可以描述护理 OHCA 患者的护理人员的决策概况和经验，以及目前如何选择运送目的地。方法 定性调查用于描述护理人员照顾 OHCA 患者的经验，并确定限制或促进直接转送至专科中心的因素。数据是从两个社交距离较远的焦点小组中收集的，该小组由主持人使用预先确定的主题指南领导。九名护理人员从英国单一地区的救护车服务中参与了这项服务评估。使用主题分析记录、转录和编码焦点小组对话。结果 参与者考虑的因素可大致分为五个主要主题；可用的指导、医院特点、非技术因素（例如处理冲突）、患者状况和临床技能。确定了与现有文献产生共鸣的因素，包括靠近医院、获得专科服务和院前强化护理的可用性。其他问题，包括管理来自其他医疗保健专业人员的阻力、基于经验的决策以及对当地指导的依赖，这些问题都出现在项目中，并且被认为是出乎意料的。结论 医护人员在为医疗 OHCA 幸存者选择转运目的地时会考虑一系列因素，包括医院与现场的距离以及能否获得专科服务。还考虑了患者的稳定性和加强护理的可用性，特别是管理躁动。护理人员主要使用当地的信任指导，依靠熟悉程度或以前的经验来帮助支持他们的决策，并且可能需要克服医院同事的冲突来选择合适的运送目的地。