• Christopher James Groombridge, Amit Maini, Darshini Ayton, Sze-Ee Soh, Nicola Walsham, Yesul Kim, SmitDe VilliersVEmergency & Trauma Centre, Alfred Hospital, Melbourne, Victoria, Australia.Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia., and Mark Fitzgerald.
• National Trauma Research Institute, Alfred Health, Melbourne, Victoria, Australia cgroombridge@doctors.org.uk.
• Emerg Med J. 2022 Nov 1; 39 (11): 839-846.

ObjectiveThis study explored the perspectives and behaviours of emergency physicians (EPs), regularly involved in resuscitation, to identify the sources and effects of any stress experienced during a resuscitation as well as the strategies employed to deal with these stressors.MethodsThis was a two-centre sequential exploratory mixed-methods study of EPs consisting of a focus group, exploring the human factors related to resuscitation, and an anonymous survey. Between April and June 2020, the online survey was distributed to all EPs working at Australia's largest two major trauma centres, both in Melbourne, and investigated sources of stress during resuscitation, impact of stress on performance, mitigation strategies used, impact of the COVID-19 pandemic on stress and stress management training received. Associations with gender and years of clinical practice were also examined.Results7 EPs took part in the focus group and 82 responses to the online survey were received (81% response rate). The most common sources of stress reported were resuscitation of an 'unwell young paediatric patient' (81%, 95% CI 70.6 to 87.6) or 'unwell pregnant patient' (71%, 95% CI 60.1 to 79.5) and 'conflict with a team member' (71%, 95% CI 60.1 to 79.5). The most frequently reported strategies to mitigate stress were 'verbalising a plan to the team' (84%, 95% CI 74.7 to 90.5), 'implementing a standardised/structured approach' (73%, 95% CI 62.7 to 81.6) and 'asking for help' (57%, 95% CI 46.5 to 67.5). 79% (95% CI 69.3 to 86.6) of EPs reported that they would like additional training on stress management. Junior EPs more frequently reported the use of 'mental rehearsal' to mitigate stress during a resuscitation (62% vs 22%; p<0.01) while female EPs reported 'asking for help' as a mitigator of stress more frequently than male EPs (79% vs 47%; p=0.01).ConclusionsStress is commonly experienced by EPs during resuscitation and can impact decision-making and procedural performance. This study identifies the most common sources of stress during a resuscitation as well as the strategies that EPs use to mitigate the effects of stress on their performance. These findings may contribute to the development of tailored stress management training for critical care clinicians.© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.

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