Table 4.

Realities and challenges of voluntary community cardiac arrest response; key themes and sub-themes (cont.).

Theme/sub-theme	Description	Illustrative quote(s)
The GP role in OHCA response is multifaceted	GPs described a spectrum of different clinical roles when responding to OHCA.	GP10: you’ll confer with whosoever is there you know, and it could be the ambulance service, it could be the guards (police). You know I've been involved where it's been more a forensic exercise with the guards and so you establish what needs to be done. Your role as a GP would cover from first on scene to providing support as part of a resuscitation team to, it's still the legal role of the doctor to pronounce a patient dead even though resuscitation may have been ceased before you arrived and then the conferring with the coroner, conferring with the guards, providing emotional support to the family, so all those roles.
Filling a gap	Providing early basic life support treatment was identified as a key component of care and was considered especially important where ambulance response might be delayed.	GP12: Average (ambulance) response time is probably close to 40 (min) and it’s not infrequently that it’s over an hour. So in that first period of time, whatever we can do for them is as much as is gonna be done. GP5: And so my idea of turning up would only be to fill in until they (paramedics) arrive and then I would stand back.
Rowing in with paramedics but at times providing a 'broader' perspective	GPs considered paramedics to be very skilled in OHCA resuscitation and were generally happy to 'fit in' with their care plan. GPs did recognize that occasionally the 'broader perspective' brought by the GP could be useful. In particular, GPs identified decision-making around resuscitation termination to be a key aspect of GP care.	GP11: Paramedics and advanced paramedics are so used to doing this sort of thing as well that often you find that you sort of fall into a role depending on what is happening and what is going on. GP12: They have a narrow skill set but they’re very, very good with that narrow skill set. They’re much better at doing it than we are because they’re doing it much more often. The only difference is that we’re looking at a problem from first principles whereas they’re looking at a problem in terms of the protocol that they want to apply. That’s the only difference. And occasionally there are situations where you’re going to use something or a technique which just isn’t in the CPGs (clinical practice guidelines) GP13: It’s a difficult decision for anyone to make (ceasing resuscitation). They’re following a CPG guideline. I suppose I’m looking at it slightly more holistically as a GP, do you know ‘Is it worth giving this another shot or is this, look, we’ve gone to the notes, he’s got a history…’ and perhaps it’s, it’s still very clinical, but it’s taking maybe a slightly different approach to it.
Caring for bystanders and families	GPs described a specific and significant aspect of their role in OHCA care as ‘caring for families’.	GP14: But you are a GP and you have to pick up the pieces to make things easier for a family. If I didn’t respond what would happen? They’d move the person and that would be it. There’s nobody left with the family. So I do think there is an important role there. GP13: I do an aftercare visit, you know, down the line, maybe a month after, if the whole family are my patients. If they’re not, in my practice we send a mass card and if they’re somebody I’ve looked after for a long time we would try and attend the funeral.