Police Involvement in Out-of-Hospital Cardiac Arrest: A Qualitative Exploration of Law Enforcement Roles and Contributing Organizational Factors.

OBJECTIVES: Many American police organizations respond to out-of-hospital cardiac arrest (OHCA). This study sought to: 1) explore variation in the role of police in OHCA across emergency medical systems and 2) identify factors influencing this variation. METHODS: We conducted a qualitative multisite case study analysis using data collected through semi-structured key informant interviews and multidisciplinary focus groups with telecommunicators, fire, police, emergency medical services, and hospital personnel across nine Michigan emergency systems of care. Sites were sampled based on return of spontaneous circulation rates, trauma region, geography, rurality, and population density. Data were analyzed to examine police role in OHCA and the organizational factors that contribute to these roles. Transcripts and coded data were explored using iterative thematic analysis and matrices. RESULTS: Interviews included approximately 160 public safety informants of varying administrative levels (i.e., field staff, mid-level managers, and leadership). Across systems, police played four on-scene roles in OHCA response: 1) early responder, 2) resuscitation team member, 3) security, and 4) information gathering. Less consistently, police performed supplementary roles as telecommunicators and cardiac arrest educators. We found that factors including administrative structure of the police agency, resources (e.g., human and material), organizational culture, medical training, deployment and response policies, nature of response environment, and relationships with other prehospital stakeholders contributed to the degree certain roles were present. CONCLUSIONS: Police serve numerous on-scene and supplementary roles in OHCA response across jurisdictions. Their roles were influenced by multiple factors at each site. Future studies may help to better understand the value of and how to optimize police engagement in OHCA response.

Persistence and Change in Marriage Practices among Syrian Refugees in Jordan.

Early marriage, which is associated with a wide range of negative health and socioeconomic outcomes, may be a response to conflict and displacement. Since the onset of the Syrian conflict in 2011, there has been considerable attention to reports of high and potentially increasing rates of early marriage among Syrian refugee women. Using nationally representative survey data from Jordan in 2016 and Syria in 2009, as well as qualitative interviews with Syrian refugee youth in Jordan, we examine changes in age at marriage and drivers of early marriage. We find no evidence of an increase in early marriage rates after refugees' arrival to Jordan. Rates of early marriage among the Syrians now in Jordan were higher than preconflict national rates and have remained similar postdisplacement, although poverty and security concerns have created new drivers for accelerating marriage for young women. Other dynamics of the Syrian marriage market in displacement may act to decelerate marriage rates, including declining rates of consanguinity and inability to meet marriage costs. Analysis of early marriage in displacement must be placed within the context of change in marriage practices among refugees more broadly.

Key Factors in Designing the Health System-Community Pathways Program for African American/Black Children and Young Adults.

Many of the ethnic and racial workforce inequities in the United States are present in health care systems. Low representation of African American/Black individuals in the health care system workforce can be traced to a history of exclusionary practices that leave such individuals less likely to pursue health careers. Past research found that low representation is driven by inequities in health, education, and employment that are a result of structural racism. Pathways programs have been identified as one of the methods to increase recruitment, retention, and promotion in health-related career fields for African American/Black individuals. As prior research has shown, these programs recruit and support the graduation of students from underrepresented communities at all educational stages to increase their representation in specific fields. This article describes the development of key factors in framework design for the Health System-Community Pathways Program (HCPP), which aims to increase representation of African American/Black communities in the health care system workforce and improve the quality of their experience in pursuing careers in these fields. The HCPP framework of key factors is informed by an environmental scan, interviews and focus groups, and an expert discussion panel session. The article's authors come from diverse backgrounds; the team included African American/Black physicians and members of other historically marginalized communities. The qualitative research drew insights from diverse African American/Black community stakeholders; the study was reviewed by many stakeholders to ensure that the design of the research and the end product maximally benefits the community on which it focuses.

Strategies for Enhancing Prehospital Outcomes for Cardiac Arrest (EPOC).

Out-of-hospital cardiac arrest (OHCA) is a common, life-threatening event that is a leading cause of death in the United States. However, it is unclear how to design strategies that can be successfully implemented in emergency medical services (EMS) agencies and broader emergency response systems (such as fire, police, dispatch, and bystanders to OHCA events) in different communities to help improve daily care processes and outcomes in OHCA. The National Heart, Lung, and Blood Institute-funded Enhancing Prehospital Outcomes for Cardiac Arrest (EPOC) study lays the foundation for future quality improvement efforts in OHCA by identifying, understanding, and validating the best practices adopted within emergency response systems to address these life-threatening events and by addressing potential barriers to implementation of these practices. RAND researchers developed recommendations covering all levels of the prehospital OHCA incident response and the principles of change management necessary to implement those recommendations.

Identifying Strategies to Boost COVID-19 Vaccine Acceptance in the United States.

This study presents the results of an evaluation of the root causes of COVID-19 vaccine hesitancy to inform strategies to boost vaccine acceptance among vaccine-hesitant populations in the United States. The authors conducted a literature review of the causes of vaccine hesitancy and vaccine acceptance; focus groups with patients, pre-hospital first responders, and hospital-based health care providers; a social media platform sentiment analysis to review attitudes regarding the COVID-19 vaccine; and a roundtable discussion with experts on vaccine hesitancy. Drawing on this mixed-methods analysis, the authors recommend strategies to help boost COVID-19 vaccine acceptance in the United States, grouping them according to three overall goals: boosting confidence in the safety and effectiveness of the COVID-19 vaccines, combating complacency about the pandemic, and increasing the convenience of getting vaccinated. The authors emphasize that combating misinformation about the COVID-19 vaccine is key to achieving these goals. These recommendations can inform the development of a toolkit of strategies to reach herd immunity and end the pandemic.