Emergency Medical Services Response Time Research Articles

Abstract 18330: Direct Transport to a PCI Center Following Out-of-Hospital Cardiac Arrest is Associated With Improved Survival in North Carolina

Introduction: Guidelines recommend implementation of regional systems of care for out-of-hospital cardiac arrest (OHCA) patients. Whether direct transport of OHCA patients to a PCI center over a non-PCI center improves outcomes is unknown. Hypothesis: Direct transport to a PCI center is associated with better outcomes. Methods: Using the Cardiac Arrest Registry to Enhance Survival, we identified OHCA patients with pre-hospital return of spontaneous circulation (ROSC) from 16 counties (population 3,143,809) in North Carolina between 2012-2014. Destination hospital was classified by PCI center status. We performed logistic regression analyses using propensity score inverse probability weights including drive time to nearest PCI center, initial rhythm and prehospital ECG information. Results: Of 1508 patients with ROSC, 1360 (90.2%) were transported to a PCI center and 148 (9.8%) to a non-PCI center (Table). The unadjusted survival rate was higher among those directly transported to a PCI center (33.5% versus 14.6%), OR 2.95 (95% CI 1.84-4.76). After accounting for potential confounding using inverse probability weights as well as adjusting for age, sex, EMS response time and clustering of county, direct transport to PCI center remained significantly associated with better survival, OR 2.47 (95% CI 2.08-2.92). Significant differences in survival remained when including patients without ST-elevation myocardial infarction only, adjusted OR 1.74 (95% CI 1.05-2.91). For patients bypassing the nearest hospital and taken directly to a PCI center with >10 min of difference in drive time between nearest hospital and PCI center, adjusted OR was 2.54 (95% CI 2.01-3.23) compared to patients taken to non-PCI hospitals. Conclusions: Direct transport to a PCI center appears to be associated with improved survival in OHCA patients. This suggests that implementation of protocols to transport patients with OHCA directly to PCI centers, when feasible, may improve outcomes.

Abstract 18724: Coronary Angiography After Out-of-hospital Cardiac Arrest is Associated With Improved Neurologically Intact Survival

Introduction: Evidence for the effectiveness of coronary angiography after out-of-hospital cardiac arrest (OHCA) is conflicting. Our objective was to evaluate the association between receiving coronary angiography within 72 hours of hospital arrival and survival with favorable neurologic outcome. Methods: This was a population-based retrospective cohort study of consecutive cases of adult OHCA transported to and treated at 28 hospitals in Southern Ontario between March 1, 2010 and December 31, 2014. We included patients with atraumatic OHCA, who achieved return of spontaneous circulation, and were alive 6 hours after hospital arrival. Multi-level logistic regression was used to measure the association between early coronary angiography and neurologically intact survival (Modified Rankin Score 0-2), while controlling for potential confounders and clustered data. We controlled for age, sex, initial cardiac rhythm, witness status, bystander resuscitation, EMS response time, prehospital return of spontaneous circulation, location of arrest, daytime presentation, neurologic status at hospital arrival, STEMI status, cardiac history, initiation of therapeutic hypothermia, hospital size and type, and hospital annual cardiac arrest volume. Results: During the period of study, 2678 consecutive OHCA patients met the inclusion criteria. The mean age was 66(±16), 31.7% were female, 54.1% had a bystander witnessed arrest, 35.2% received bystander CPR, 45.9% had a shockable initial rhythm, 30.1% had ST elevation on the first post arrest ECG, and 32.4% received coronary angiography. Receiving coronary angiography was strongly associated with neurologically intact survival (OR 2.30, CI95 1.69-3.15) and survival (OR 2.08, CI95 1.53-2.82). A similar association was observed in the subgroup of patients without STEMI (OR 3.24, CI95 2.16-4.87 and OR 2.66, CI95 1.78-3.99, respectively). Conclusions: Neurologically intact survival among post cardiac arrest patients may be improved with coronary angiography, particularly for patients without STEMI. This observation should be confirmed with future randomized controlled studies.

Abstract 18070: Therapies Optimizing Organ Perfusion and Protection After Out-of-hospital Cardiac Arrest Improves Survival With Favorable Neurologic Outcome

Introduction: Survival rates with favorable neurologic function after out-of-hospital cardiac arrest (OHCA) have remained low for decades. Hypothesis: Use of therapies focused on better perfusion during CPR using mechanical adjuncts and protective post-resuscitation care would improve survival and neurologic outcomes after OHCA compared to conventional CPR and care. Methods: OHCA outcomes in Alameda County, CA, USA, population 1.5 million, from December 2009-2011 when there was incomplete availability and use of impedance threshold device [ITD], mechanical CPR [MCPR], and hospital therapeutic hypothermia [HTH], were compared to 2012 when all were available and more widely used. Return of Spontaneous Circulation (ROSC), survival and Cerebral Performance Category (CPC) scores were compared using univariate and multivariable analyses. Results: Of the 3008 non-traumatic OHCAs who received CPR during the study period, >95% of survival outcome data were available. From 2009-11 to 2012, there was an increase in ROSC from 28.6% to 34.1% (p=0.002; OR=1.28; CI=1.09, 1.51) and a non-significant increase in hospital discharge from 10.5% to 12.3% (p=0.14; OR=1.17; CI=0.92, 1.49). There was, however, an 80% increase in survival with favorable neurological function between the two periods, as determined by CPC≤2, from 4.4% to 7.9% (p<0.001; unadjusted OR=1.85; CI=1.35, 2.54). After adjusting for witnessed arrest, bystander CPR, initial rhythm (VT/VF vs. others), placement of an advanced airway, EMS response time, and age, the adjusted OR was 1.60 (1.11, 2.31; p=0.012). Using a stepwise regression model, the most important independent positive predictors of CPC≤2 were 2012 (p=0.019), witnessed (p<0.001), initial rhythm VT/VF (p<0.001), and advanced airway (inverse association p<0.001). Additional analyses of the three therapies, separately and in combination, demonstrated that for all patients admitted to the hospital, ITD use with HTH had the most impact on survival to discharge with CPC≤2 of 24%. Conclusions: Therapies (ITD, MCPR, HTH) developed to enhance circulation during CPR and cerebral recovery after ROSC, significantly improved survival with favorable neurological function by 80% following OHCA.

Abstract 12258: Out-of-hospital Cardiac Arrest With Initially Shockable Rhythm: What Are the Outcomes if No Shock is Given?

Background: Prompt defibrillation is critical for termination of ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) in out-of-hospital cardiac arrest (OHCA). For ethical reasons, the real impact of not shocking OHCA patients with a shockable rhythm is unlikely to be investigated in clinical trials and thus remains unknown. Objectives: To describe demographics, pre-hospital characteristics, interventions, and outcomes in OHCA patients with an initially shockable rhythm who did and did not get shocked in the field in DFW ROC site. Methods: We included all non-traumatic OHCA cases ≥18 years old with VF or VT as first known rhythms, who were treated and transported to a hospital within the DFW ROC site between 2006 - 2011. We report return of spontaneous circulation (ROSC) in the field and survival to hospital discharge for victims with and without shock delivered in the field. Multiple variable regression analysis assessed the association between shock delivery and ROSC in the field as well as survival. Results: Included were 882 adult non-traumatic OHCA cases with VF or VT as first known rhythms; mean (±SD) age was 60 ± 15 years, 71% male, bystander witnessed 56%, bystander resuscitation attempt 43%, public arrest location 26%, EMS response time 4.7 ± 2.3 min, 26.9% (237) had ROSC in the field, 14.9% (131) survived to hospital discharge; 93.4% (824) of all patients were shocked, while 6.6% (58) were not shocked. Of the 6.6% (58) who were not shocked, 12.1% (7) achieved ROSC in the field and 8.6% (5) survived to hospital discharge. For those not shocked in the field, the unadjusted and adjusted odds ratios for ROSC were 0.354 (95% CI 0.158-0.791, p=0.011) and 0.189 (95% CI 0.039-0.911, p=0.038), respectively; and for survival to hospital discharge they were 0.522 (95% CI 0.205-1.331, p=0.173) and 0.498 (95% CI 0.088-2.810, p=0.430), respectively. Conclusions: In the DFW ROC site, 6.6% of OHCA victims with an initially shockable rhythm did not receive a shock, which was significantly associated with decreased ROSC in the field. More patients survived who were shocked in the field, but this difference was not significant after adjustment for Utstein variables.

Abstract 19131: The Advanced Life Support Termination of Resuscitation Rule: A Local Evaluation of the Impact on Termination Rates

Introduction: Termination of Resuscitation (TOR) rules have been designed to guide in-field termination decisions and reduce futile hospital transportations. The impact of such a rule may depend on regional infrastructure, arrest characteristics and pre-existent termination rates. Our region is characterized by high rates of bystander cardiopulmonary resuscitation (CPR), and Advanced Life Support (ALS) trained rescuers authorized to make termination decisions. We aim to investigate the actual in-field termination rates and the termination rates as recommended by the ALS-TOR rule. Furthermore, we studied factors associated with the actual termination decisions. Methods: Cohort of out-of-hospital cardiac arrest patients who were resuscitated in the Nijmegen area, the Netherlands (2008-2011). The ALS-TOR rule recommends termination in case all following criteria are met: unwitnessed arrest, no bystander CPR, no shock delivery, no return of spontaneous circulation (ROSC). Results: The observed percentage of in-field termination was 46% (275/598), while the ALS-TOR rule recommended termination in only 6% (35/588), owing to high percentages of witnessed arrests (73%) and bystander CPR (54%) in our region. Factors independently associated with the actual decisions to terminate resuscitation were absence of ROSC [aOR 35.6 (95% CI 18.3-69.3)], non-shockable initial rhythm [aOR 6.0 (95% CI 3.2-11.0)], unwitnessed arrest [aOR 2.7 (95% CI 1.4-5.2)], non-public arrest [aOR 2.5 (95% CI 1.2-5.0)] and longer EMS-response times [aOR 1.1 per minute increase (95% CI 1.0-1.2)]. Conclusions: Contrary to previous studies, implementation of the ALS-TOR rule in our region would have decreased termination rates from almost half to less than 10% due to the favourable arrest characteristics. In light of the prognosis after OHCA, this finding suggests that adherence to this set of criteria does not contribute to efficient triage in our population. Therefore it seems prudent to locally evaluate the utility of the ALS-TOR rule prior to implementation.

Prevalence of emergency medical service utilisation in patients with out-of-hospital cardiac arrest in Thailand

BackgroundMost patients with out-of-hospital cardiac arrest (OHCA) have grave outcomes. The efficacy of emergency medical services (EMS) may affect outcomes. However, no data exists in Thailand.ObjectivesTo ascertain the prevalence of...

The impact of increasing emergency medical services response time over a 10 year period on survival from out-of-hospital cardiac arrest in Victoria, Australia

The impact of increasing emergency medical services response time over a 10 year period on survival from out-of-hospital cardiac arrest in Victoria, Australia

Early cardiopulmonary resuscitation in out-of-hospital cardiac arrest

BackgroundThree million people in Sweden are trained in cardiopulmonary resuscitation (CPR). Whether this training increases the frequency of bystander CPR or the survival rate among persons who have out-of-hospital cardiac arrests has been questioned. MethodsWe analyzed a total of 30,381 out-of-hospital cardiac arrests witnessed in Sweden from January 1, 1990, through December 31, 2011, to determine whether CPR was performed before the arrival of emergency medical services (EMS) and whether early CPR was correlated with survival. ResultsCPR was performed before the arrival of EMS in 15,512 cases (51.1%) and was not performed before the arrival of EMS in 14,869 cases (48.9%). The 30-day survival rate was 10.5% when CPR was performed before EMS arrival versus 4.0% when CPR was not performed before EMS arrival (P<0.001). When adjustment was made for a propensity score (which included the variables of age, sex, location of cardiac arrest, cause of cardiac arrest, initial cardiac rhythm, EMS response time, ti...

Location of collapse in out-of-hospital cardiac arrest as a proxy for disease and medication use

s / Resuscitation 96S (2015) 5–42 27 sex, location of cardiac arrest, cause of cardiac arrest, initial cardiac rhythm, EMS response time, time from collapse to call for EMS, and year of event), CPR before the arrival of EMS was associated with an increased 30-day survival rate (odds ratio, 2.15; 95% confidence interval, 1.88 to 2.45). When the time to defibrillation in patients who were found to be in ventricular fibrillation was included in the propensity score, the results were similar. The positive correlation between early CPR and survival rate remained stable over the course of the study period. An association was also observed between the time from collapse to the start of CPR and the 30-day survival rate. Conclusions: CPR performed before EMS arrival was associated with a 30-day survival rate after an out-of-hospital cardiac arrest that was more than twice as high as that associated with no CPR before EMS arrival. http://dx.doi.org/10.1016/j.resuscitation.2015.09.062

Improving Survival and Neurologic Function for Younger Age Groups After Out-of-Hospital Cardiac Arrest in Sweden: A 20-Year Comparison.

To describe changes in the epidemiology of out-of-hospital cardiac arrest in Sweden with the emphasis on the younger age groups. Prospective observational study. Sweden. Patients were recruited from the Swedish Registry of Cardiopulmonary Resuscitation from 1990 to 2012. Only non-crew-witnessed cases were included. Cardiopulmonary resuscitation. The endpoint was 30-day survival. Cerebral function among survivors was estimated according to the cerebral performance category scores. In all, 50,879 patients in the survey had an out-of-hospital cardiac arrest, of which 1,321 (2.6%) were 21 years old or younger and 1,543 (3.0%) were 22-35 years old. On the basis of results from 2011 and 2012, we estimated that there are 4.9 cases per 100,000 person-years in the age group 0-21 years. The highest survival was found in the 13- to 21-year age group (12.6%). Among patients 21 years old or younger, the following were associated with an increased chance of survival: increasing age, male gender, witnessed out-of-hospital cardiac arrest, ventricular fibrillation, and a short emergency medical service response time. Among patients 21 years old or younger , there was an increase in survival from 6.2% in 1992-1998 to 14.0% in 2007-2012. Among 30-day survivors, 91% had a cerebral performance category score of 1 or 2 (good cerebral performance or moderate cerebral disability) at hospital discharge. In Sweden, among patients 21 years old or younger, five out-of-hospital cardiac arrests per 100,000 person-years occur and survival in this patient group has more than doubled during the past two decades. The majority of survivors have good or relatively good cerebral function.

Emergency dispatch process and patient outcome in bystander-witnessed out-of-hospital cardiac arrest with a shockable rhythm.

ObjectiveTo describe the dispatch process for out-of-hospital cardiac arrest (OHCA) in bystander-witnessed patients with initial shockable rhythm, and to evaluate whether recognition of OHCA by the emergency medical dispatcher (EMD) has an effect on the outcome.MethodsThis study was part of the FINNRESUSCI study focusing on the epidemiology and outcome of OHCA in Finland. Witnessed [not by Emergency Medical Service (EMS)] OHCA patients with initial shockable rhythm in the southern and the eastern parts of Finland during a 6-month period from March 1 to August 31 2010, were electronically collected from eight dispatch centres and from paper case reports filled out by EMS crews.ResultsOf the 164 patients, 82.3% (n=135) were correctly recognized by the EMD as cardiac arrests. The majority of all calls (90.7%) were dispatched within 2 min. Patients were more likely to survive and be discharged from the hospital if the EMS response time was within 8 min (P<0.001). Telephone-guided cardiopulmonary resuscitation (T-CPR) was given in 53 cases (32.3%). Overall survival to hospital discharge was 43.4% (n=71). Survival to hospital discharge was 44.4% (n=60) when the EMD recognized OHCA and 37.9% (n=11) when OHCA was not recognized. The difference was not statistically significant (P=0.521).ConclusionThe rate of recognition of cardiac arrest by EMD was high, but EMD recognition did not affect the outcome. The survival rate was high in both groups. Recognized cardiac arrest patients received bystander CPR more frequently than those for whom OHCA remained unrecognized.

The relationship between survival after out-of-hospital cardiac arrest and process measures for emergency medical service ambulance team performance.

International institutes have developed their own clinical performance indicators for ambulance services. It is unknown whether these process measures are related to survival of patients after out-of-hospital cardiac arrest (OHCA). We aimed to determine whether Emergency Medical Service (EMS)-related ambulance team process measures correlate with patient survival. Four years of observational data were collected from an urban EMS OHCA registry. The two process measures were achieving an EMS response time ≤4 min and prehospital ROSC (return of spontaneous circulation). The outcome measure was survival to discharge. We used the GLMM (generalised linear mixed model) with stepwise selection to examine this process-outcome link at the patient and EMS team levels, respectively. We analyzed 3856 OHCA patients distributed across forty-three EMS ambulance teams. Survival to discharge was observed in 193 (5%) patients. The two EMS team process measures were positively associated with an improvement in survival at the patient level after case-mix adjustment. However, they were not associated with improvement in the risk-adjusted survival rate. The EMS team-level process measures proposed by international institutes may not predict the risk-adjusted survival rate. Using these measures to motivate EMS teams to improve their quality performance would be questionable. Increased efforts should be devoted to constructing more pivotal EMS team-level process measures that are tightly linked to survival.

Early Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest

BackgroundThree million people in Sweden are trained in cardiopulmonary resuscitation (CPR). Whether this training increases the frequency of bystander CPR or the survival rate among persons who have out-of-hospital cardiac arrests has been questioned.MethodsWe analyzed a total of 30,381 out-of-hospital cardiac arrests witnessed in Sweden from January 1, 1990, through December 31, 2011, to determine whether CPR was performed before the arrival of emergency medical services (EMS) and whether early CPR was correlated with survival.ResultsCPR was performed before the arrival of EMS in 15,512 cases (51.1%) and was not performed before the arrival of EMS in 14,869 cases (48.9%). The 30-day survival rate was 10.5% when CPR was performed before EMS arrival versus 4.0% when CPR was not performed before EMS arrival (P<0.001). When adjustment was made for a propensity score (which included the variables of age, sex, location of cardiac arrest, cause of cardiac arrest, initial cardiac rhythm, EMS response time, time from collapse to call for EMS, and year of event), CPR before the arrival of EMS was associated with an increased 30-day survival rate (odds ratio, 2.15; 95% confidence interval, 1.88 to 2.45). When the time to defibrillation in patients who were found to be in ventricular fibrillation was included in the propensity score, the results were similar. The positive correlation between early CPR and survival rate remained stable over the course of the study period. An association was also observed between the time from collapse to the start of CPR and the 30-day survival rate.ConclusionsCPR performed before EMS arrival was associated with a 30-day survival rate after an out-of-hospital cardiac arrest that was more than twice as high as that associated with no CPR before EMS arrival. (Funded by the Laerdal Foundation for Acute Medicine and others.)

Acceptability of Alternatives to Traditional Emergency Care: Patient Characteristics, Alternate Transport Modes, and Alternate Destinations

To determine the acceptability of alternatives to traditional emergency care, we assessed the proportion of subjects willing to consider alternative modes of transportation and alternative destinations. We further identified patient characteristics associated with willingness to consider these alternatives. We conducted a cross-sectional survey study in the emergency department (ED) of an academic medical center. Research assistants screened all non-critically ill ED patients for eligibility and willingness to participate and administered an interview-based survey that included questions on demographic and clinical characteristics, perceived illness severity, and acceptability of alternatives to traditional emergency care for acute illness and injuries. We calculated the proportions and 95% confidence intervals for subjects who found alternative transport modes and destinations acceptable and developed a log-binomial regression model to identify patient characteristics associated with acceptability of alternative modes of transport and alternative destinations. Complete data were available on 1,058 subjects. Forty-two percent of the study sample arrived to the ED via emergency medical services (EMS). Over two-thirds of the study sample (68.2%) was willing to consider transport via either taxi or medical transport van and 69.0% was willing to consider either transportation to an urgent care center or their primary care physician's office. Other alternatives, including delayed EMS response time, were less frequently endorsed as acceptable alternatives. Subject characteristics associated with willingness to accept alternative modes of transportation included younger age, chief complaint, previous ED use, and place of residence (p < 0.05). Subject characteristics associated with willingness to accept alternative destinations included younger age, non-white race, lower patient acuity, and lower self-perceived illness severity (p < 0.05). In our ED, some patients found alternative transport modes and alternative destinations acceptable. We identified patient-level characteristics associated with willingness to accept alternatives; however, the predictive ability and clinical utility of these factors is limited. Future research should further explore the acceptability and effectiveness of these alternative care delivery options.

Analyzing the continuum of fatal crashes: A generalized ordered approach

In the United States, safety researchers have focused on examining fatal crashes (involving at least one fatally injured vehicle occupant) by using Fatality Analysis Reporting System (FARS) dataset. FARS database compiles crashes if at least one person involved in the crash dies within 30 consecutive days from the time of crash along with the exact timeline of the fatal occurrence. Previous studies using FARS dataset offer many useful insights on what factors affect crash related fatality, particularly in the context of fatal vs. non-fatal injury categorization. However, there is one aspect of fatal crashes that has received scarce attention in the traditional safety analysis. The studies that dichotomize crashes into fatal vs. non-fatal groups assume that all fatal crashes in the FARS dataset are similar. Keeping all else same, a fatal crash that results in an immediate fatality is clearly much more severe than another crash that leads to fatality after several days. Our study contributes to continuing research on fatal crashes. Specifically, rather than homogenizing all fatal crashes as the same, our study analyzes the fatal injury from a new perspective by examining fatality as a continuous spectrum based on survival time ranging from dying within 30 days of crash to dying instantly (as reported in the FARS data). The fatality continuum is represented as a discrete ordered dependent variable and analyzed using the mixed generalized ordered logit (MGOL) model. By doing so, we expect to provide a more accurate estimation of critical crash attributes that contribute to death. In modeling the discretized fatality timeline, the Emergency Medical Service (EMS) response time variable is an important determinant. However, it is possible that the EMS response time and fatality timeline are influenced by the same set of observed and unobserved factors, generating endogeneity in the outcome variable of interest. Hence, we propose to estimate a two equation model that comprises of a regression equation for EMS response time and MGOL for fatality continuum with residuals from the EMS model to correct for endogeneity bias on the effect of exogenous factors on the timeline of death. Such research attempts are useful in determining what factors affect the time between crash occurrence and time of death so that safety measures can be implemented to prolong survival. The model estimates are augmented by conducting elasticity analysis to highlight the important factors affecting time-to-death process.

Probability of Return of Spontaneous Circulation as a Function of Timing of Vasopressor Administration in Out-of-Hospital Cardiac Arrest

Introduction. Vasopressors (epinephrine and vasopressin) are associated with return of spontaneous circulation (ROSC). Recent retrospective studies reported a greater likelihood of ROSC when vasopressors were administered within the first 10 minutes of arrest. However, it is unlikely that the relationship between ROSC and the timing of vasopressor administration is a binary function (i.e., ≤10 vs. >10 minutes). More likely, this relationship is a function of time measured on a continuum, with diminishing effectiveness even within the first 10 minutes of arrest, and potentially, some lingering benefit beyond 10 minutes. However, this relationship remains undefined. Objective. To develop a model describing the likelihood of ROSC as a function of the call receipt to vasopressor interval (CRTVI) measured on a continuum. Methods. We conducted a retrospective study of cardiac arrest using the North Carolina Prehospital Care Reporting System (PREMIS). Inclusionary criteria were all adult patients suffering a witnessed, nontraumatic arrest during January–June 2012. Chi-square and t-tests were used to analyze the relationships between ROSC and CRTVI; patient age, race, and gender; endotracheal intubation (ETI); automated external defibrillator (AED) use; presenting cardiac rhythm; and bystander cardiopulmonary resuscitation (CPR). A multivariate logistic regression model calculated the odds ratio (OR) of ROSC as a function of CRTVI while controlling for potential confounding variables. Results. Of the 1,122 patients meeting inclusion criteria, 542 (48.3%) experienced ROSC. ROSC was less likely with increasing CRTVI (OR = 0.96, p < 0.01). Compared to patients with shockable rhythms, patients with asystole (OR = 0.42, p < 0.01) and pulseless electrical activity (OR = 0.52, p < 0.01) were less likely to achieve ROSC. Males (OR = 0.64, p = 0.02) and patients receiving bystander CPR (OR = 0.42, p < 0.01) were less likely to attain ROSC, although emergency medical services response times were significantly longer among patients receiving bystander CPR. Race, age, ETI, and AED were not predictors of ROSC. Conclusions. We found that time to vasopressor administration is significantly associated with ROSC, and the odds of ROSC declines by 4% for every 1-minute delay between call receipt and vasopressor administration. These results support the notion of a time-dependent function of vasopressor effectiveness across the entire range of administration delays rather than just the first 10 minutes. Large, prospective studies are needed to determine the relationship between the timing of vasopressor administration and long-term outcomes. Keywords: Epinephrine, cardiac arrest, emergency medical services, paramedic, resuscitation, CPR

Helicopter Emergency Medical Services Response Times in Norway: Do They Matter?

ObjectiveThe main objective of the Norwegian air ambulance service is to provide advanced emergency medicine to critically ill or severely injured patients. The government has defined a time frame of 45 minutes as the goal within which 90% of the population should be reached. The aims of this study were to document accurate flying times for rotor wing units to the scene and to determine the rates of acute primary missions in Norway. MethodsWe analyzed operational data from every acute primary mission from all air ambulance bases in Norway in 2011, focusing on the flying time taken to reach scene, the municipality requesting the flight, and the severity score data. ResultsA total of 5,805 acute primary missions were completed in Norway in 2011. The median flying time was 19 minutes (25%-75% percentiles: 13-28). The mean mission rate for the 17 bases was 7.5 (95% confidence interval, 7.4-7.8 per 10,000 inhabitants). The overall mean (standard deviation) National Committee on Aeronautics score for all missions was 4.07 (1.30). ConclusionThe government's expectation of serving the entire population via HEMS within 45 minutes appears to be achieved on a national level. However, vast differences remain in the flying times and rates between bases.

Ein städtischer Rettungsdienstbereich am Beginn eines sektorenübergreifenden Qualitätsmanagementsystems: Eine priorisierte Umsetzung der ERC Empfehlungen von 2010 und das Langzeitüberleben nach Herzkreislaufstillstand

Due to limited resources, the 2010 European Resuscitation Council (ERC) guidelines could not be fully implemented in the Emergency Medical Services (EMS) of Brunswick, Germany. This is why implementation was prioritized according to local conditions. Thus, prehospital therapeutic hypothermia, mechanical chest compression and feedback systems were not established. Clinical data and long-term results were assessed by a QM system and room for improvement was identified. All attempted resuscitations from 2011 until 2014 were recorded and compared against the German Resuscitation Registry. Outcomes of adult patients following non-traumatic cardiac arrest were analyzed by year. 812 resuscitations were attempted (incidence 81.2/100,000 inhabitants/year). In the two years following full implementation since 2013 the discharge rate from hospital was 16.4%, the discharge rate with a favorable neurologic outcome was 14.1%, the 1-year survival rate was 14.4% in 2013. A significant improvement of risk-adjusted ROSC rate during the investigation period was demonstrated. The discharge rates remained unchanged; the increase in the discharge rates paralleled the increase in CPR incidence. EMS response times were remarkably shorter. The implementation of the ERC guidelines chosen appears to be generally safe. Fast EMS response contributed to superior results. All links of the chain of survival showed room for improvement, especially the proportion of lay rescuer CPR and telephone-assisted CPR. The high CPR incidence might indicate room for improvement in prevention. Access to resuscitation care can hardly be evaluated. Age-related access to pre-hospital resuscitation seems to be appropriate.

Improving the Response Time of Ambulances Using Global Positioning Satellite System (GPS) in Gaza City in the Gaza Strip

Improving the Response Time of Ambulances Using Global Positioning Satellite System (GPS) in Gaza City in the Gaza Strip Dr. Abed Schokry Abstract An Emergency Medical Service (EMS) has significant impact on health service provision. Its importance refers to that failure of ambulances to respond to emergency calls within set times may result in loss of life. The purpose of this study is to assess the effect of using a Global Positioning System (GPS) on EMS response time in a district of Gaza City. A digital routable map, as an equivalent system to GPS, was placed in an ambulance of an EMS provider. The system was programmed to select the fastest route to the scene. Over a one-week period, data were collected using one ambulance with the same driver and same navigation team. The ambulance driver was asked to drive to a randomly selected address once without using the GPS equivalent system and another with using it, the response time was recorded every time using a stopwatch. The results confirm that the mean response time of the ambulance with GPS was significantly shorter, 4.7 min. +/-1.5 min (mean +/- SD) compared to the response time without GPS which was 6.05+/- 3.04 min (mean +/- SD). GPS technology can significantly improve EMS response time to the scene of emergencies by as much as 20%. Full Text: PDF DOI: 10.15640/jea.v3n2a7

Epidemiology and outcome of adult out-of-hospital cardiac arrest of non-cardiac origin in Osaka: a population-based study

ObjectivesTo evaluate epidemiological characteristics of out-of-hospital cardiac arrests (OHCAs) by detailed non-cardiac cause and factors associated with the outcomes after OHCAs of non-cardiac origin.DesignA prospective, population-based observational study.SettingThe Utstein Osaka...