Out of hospital cardiac arrest: strategy 2021 to 2026

7. Aftercare

We will ensure support for people in Scotland after their experience with out-of-hospital cardiac arrest.

Aims:

1. All individuals who experience an OHCA are well supported afterwards.

2. There is support available for bystanders who witness an OHCA.

3. The wellbeing of emergency service and volunteer community responders is supported.

It is important to ensure that care and support is available for all people who have been affected by OHCA. This includes survivors, their families, bystanders and other responders.

In order to support the aftercare needs of people who have been affected by OHCA, it is vital that we listen to the lived experience to shape our actions and develop our support resources.

Survivors and their families

For many survivors, the cause of their cardiac arrest will have been a blockage in one of the blood vessels supplying the heart muscle. This causes a heart attack which can sometimes lead to cardiac arrest.

People who have this underlying cause for their cardiac arrest will be eligible to access cardiac rehabilitation. Cardiac rehabilitation services provide vital support to help people get back to everyday life as much as possible after developing heart disease.

However, for people who experience cardiac arrest with a different cause – for example Spontaneous Coronary Artery Dissection (SCAD), or an inherited heart condition, may not be eligible for referral into these services.

Wider work on improving timely and equitable access to rehabilitation for people with heart disease is covered within the Scottish Government's Heart Disease Action Plan. We will work collaboratively to improve this kind of support for people who experience cardiac arrest.

We must also recognise that OHCA can have a significant impact on people's emotional and psychological wellbeing, and explore how best to support people in coping with these impacts.

Many OHCA survivors can benefit from accessing information and support. This can take the form of peer support such as online forums from Sudden Cardiac Arrest UK (https://www.suddencardiacarrestuk.org/get-support), or in some cases, specialist help, such as the "Life After Cardiac Arrest" (www.lifeaftercardiacarrest.org) resource for survivors and families experiencing loss after OHCA.

Many of the SALFS partner organisations have information available about cardiac arrest. This includes support groups for survivors and specialist psychological services in some cases.

We will continue to signpost to these as part of our public awareness campaign. We will also seek to identify and amplify examples of best practice in order to increase the availability of help to those who need it.

Bystanders

The increasing bystander CPR rate in Scotland means that more people are intervening in an OHCA than ever before.

Several studies have explored the effect of witnessing a cardiac arrest on the well-being of bystanders, who are often family members of the person in cardiac arrest. Fear, anxiety, anger, confusion, and even signs of post-traumatic stress have been reported^{[49] [50] [51] [52] [53] [54] [55]}.

Research looking at the experience of bystanders has also shown wide variation in individual preference for the support they require from clinical staff. Clinicians involved in those cases had a huge impact on individuals' experience after the cardiac arrest and are therefore in a key position to make a difference to individuals after OHCA^[56].

Responding to this need for support, SALFS partners have created online educational resources aimed at emergency services clinicians and First Responders to provide a space of further learning to understand OHCA post-event. We will signpost to these resources as part of our ongoing public awareness work.

We will continue to explore and learn from national and international initiatives to increase the availability of support to OHCA bystanders.

Innovations such as the Bystander Support Network in Canada have been created to provide an opportunity for bystanders to find further information and support.

Support for Community Responders and Emergency Services

In addition to the needs of members of the public who are bystanders to OHCA, we also need to consider the mental wellbeing of responders (including community First Responders and those working in emergency services).

The Rivers Centre (www.lifelines.scot) is a specialist service for First Responders affected by psychological trauma. We will work closely with community responder groups, the Scottish Ambulance Service, Police Scotland, and Scottish Fire and Rescue Service to raise awareness of this resource and support responders to access the support they require.

Case Study: Bystander Support in Canada

In Canada, an online Bystander Support Network has been created to provide resources alongside an online forum for bystanders affected by Cardiac Arrest^[57]. Members are able to research, ask questions, share stories, and network with others from around the world who have been affected by OHCA. It is a resource for members of the public seeking support after an OHCA but also an evolving piece of research to help clinicians and researchers learn more about the bystander experience and what types of support is needed. http://www.bystandernetwork.org/

Actions:

1. We will provide a range of aftercare support, including online, telephone and face-to-face resources.

2. We will improve signposting to existing aftercare support.

3. We will develop a referral pathway for First Responders to access aftercare support.

4. We will include aftercare in our public awareness campaign to ensure that people are aware of the routes through which they can access support.

5. We will listen to those with lived experience of OHCA to better understand their aftercare needs.