S64 Poster Presentations / Resuscitation 84S (2013) S8–S98

subject of enforcing do not attempt resuscitation in situation ofcirculatory and respiratory arrest.

Methods: The research was conducted by means of the diagnos-tic survey method applying a self-constructed questionnaire. Thestudy was carried out among 111 (100%) doctors and nurses, fromJanuary to May 2013. Obtained information were analyzed statis-tically, Chi-square of independence with assumed p ≤ 0.05. level ofsignificance was used for statistical analysis.

Results: The study of the respondents’ opinion shows that72.07% healthcare employees think that DNAR declaration shouldbe obligatory in Poland. Contrary opinion has 8.11% of respondents.In their opinion the decision to refrain from resuscitating should bemade by attending physician – 48.65% and medical board – 32.43%.Information enclosed within DNAR declaration, in most of respon-dents’ opinion – 70.27%, should be only passed on in written form.

Conclusions: Majority of doctors and nurses agree that patientshave a right to refrain from cardiopulmonary resuscitation as a self-determination act. Respondents concur the introduction of DNARdeclaration in Polish Healthcare system. In respondents’ opinionthat decision should be required in written form and an attendingphysician should decide about its implementation, what violatesthe existing rule. The execution of living will declaration raises ethi-cal issues. Additionally, it also appears as public/social problem. Thelast stage of incurable disease is given as justifiable circumstancesof DNAR.

http://dx.doi.org/10.1016/j.resuscitation.2013.08.164

AP140

Breaking bad news—How to improvecommunication?

Jakub Lickiewicz 1,∗, Wojciech Serednicki 1, EwaZasada 2

1 University Hospital, Krakow, Poland2 The Christie, Manchester, UK

Breaking bad news, decisions regarding end of life care anddiscussions regarding appropriateness of cardiopulmonary resus-citation (CPR) are very stressful and difficult for patients, familiesand doctors. One of the reasons CPR may by inappropriatelycommenced, despite predictable futility is lack of adequate com-munication. Hospitals can adopt different methods or protocolshelping to ease the distress felt by all involved.

Different algorithms were establishes to enable successful com-munication for example SPIKES (Setting, Perception, Knowledge,Empathy, Summarize). At the beginning of 2013 we designedour own algorithm adjusted to local needs. This algorithm wasintroduced on our Neurocritical Care Unit to improve doctors’ com-petence and confidence while breaking bad news. This is a pilotstudy. Protocol contains 17 points and describes consecutive stepsduring difficult discussion. We addressed still very unusual or evenunpopular problem in Poland – involvement of nurse or psycholo-gist. Introduction of algorithm was supported by psychologist whotook part in series of meetings with consultants and trainees inCritical Care and provided both psychological and methodologicalhelp.

Doctors have been declaring significant improvement in confi-dence while talking to families since protocol introduction. We arecurrently in progress of collecting questionnaire data. Preliminaryresults indicate reduction in stress level among healthcare profes-sionals and better team work. Very encouraging is fact that numberof complaints lodged by families decreased as well, most likelydue to reassurance provided by doctors and nurses with improvedcommunication skills.

Critical Care staff is constantly exposed on stressful situationsincluding frequent discussions regarding end of life care and notfor CPR decisions. Psychological support and introduction of for-mal algorithm was very helpful and well perceived by healthcareprofessionals.

http://dx.doi.org/10.1016/j.resuscitation.2013.08.165

Implementation

AP141

Danish AED network with linkage to emergencymedical services covered more than half ofpublic cardiac arrests in high-incidence areas

Carolina Malta Hansen 1,∗, Mads Wissenberg 1,Peter Weeke 1, Line Zinckernagel 2, Martin H.Ruwald 1, Lena Karlsson 1, Freddy Lippert 3,Gunnar H. Gislason 1, Søren L. Nielsen 3, LarsKøber 4, Christian Torp-Pedersen 5, Fredrik Folke 1

1 Department of Cardiology, Copenhagen UniversityHospital Gentofte, Copenhagen, Denmark2 National Institute of Public Health, University ofSouthern Denmark, Copenhagen, Denmark3 Emergency Medicine and EMS, Head Office, CapitalRegion of Denmark, Copenhagen, Denmark4 The Heart Centre, Copenhagen University HospitalRigshospitalet, Copenhagen, Denmark5 Institute of Health, Science and Technology,Aalborg University, Aalborg, Denmark

Purpose: Although increased AED dissemination has been asso-ciated with higher AED use, the trade-off between the numberof deployed AEDs and coverage of out-of-hospital cardiac arrests(OHCAs) in real life settings remains unclear. We investigated howincreased dissemination of registered AEDs available for publicaccess defibrillation affected coverage of public OHCAs in high andlow-incidence areas in a city center.

Methods and results: All public OHCA locations (1994–2011)and locations of all AEDs registered with the Danish AEDnetwork (2007–2011), in Copenhagen, Denmark, were plotted geo-graphically. Based on all cardiac arrest locations (1994–2011),

Table 1Distribution of registered AEDs and coverage of historical out-of-hospital cardiacarrests in public locations in Copenhagen (2007–2011).

Year 2007 2008 2009 2010 2011

AEDs, total, n 36 148 214 398 552AEDs in high-incidence areasa, n 1 8 11 20 30

AEDs in low-incidence areasb, n 21 99 128 233 318AEDs in areas with no OHCAc, n 14 41 75 145 204AEDs per sq km

Total city aread 0.37 1.53 2.20 4.11 5.72In high-incidence areas 1 8 11 20 30In low-incidence areas 0.6 3 3.9 7.1 9.6In all areas with OHCA 1.1 4.4 6.3 11.7 16.2Per 100,000 inhabitants 6.0 24.7 35.7 66.3 92.0Coverage of historical OHCAse

Total, % (n) 2.7 (51) 13.5 (252) 16.8 (313) 25.2 (470) 32.6 (608)In high-incidence areas, % (n) 5.7 (19) 24.5 (82) 26.0 (87) 38.5 (129) 51.3 (172)In low-incidence areas, % (n) 2.1 (32) 9.1 (170) 14.8 (226) 22.3 (341) 28.5 (436)

Abbreviations: AED, automated external defibrillator; OHCA, out-of-hospital cardiacarrest; sq km, square kilometer.

a High-incidence areas were defined as areas with ≥1 cardiac arrest every 2 yearsfrom 1994 to 2011.

b Low-incidence areas were defined as areas with ≥1 cardiac arrest that did notfulfill criteria for high-incidence areas from 1994–2011.

c Areas with no OHCA were defined as areas with no cardiac arrests from 1994 to2011.

d The city of Copenhagen comprises 97 sq km.e AED coverage of OHCAs was defined as the number of historical cardiac arrests

occurring ≤100 m of an AED.