It Takes a System to Make a Save
In the HeartRescue Project’s approach to improving SCA survival, everyone plays a role
Ed Racht will be the keynote speaker at the 2012 EMS World Expo, scheduled for October 29–November 2 in New Orleans, LA.
Ed’s presentation, “What Does the Data Tell Us? Rethinking Our Approach to Sudden Cardiac Arrest,” will discuss the HeartRescue Project and show how cardiac arrest is an area where EMS can make a profound difference. Improving survival rates takes commitment, resources and a willingness to work together toward a common goal. Attend this inspiring and informative session at 10 a.m. on October 31 to find out how your community can save more lives. For more information, visit EMSWorldExpo.com.
No clinical condition has had more impact on defining the role and culture of modern EMS systems than cardiac arrest. More important, there’s no clinical condition that gives us such a tremendous opportunity to dramatically improve outcomes. Today we understand so much more about the pathophysiology of cardiac arrest and the principles that maximize the patient’s opportunity for a good outcome, but we haven’t truly realized the potential.
Yet.
At an industry level, the approach to managing cardiac arrest has had a profound influence on EMS system design, educational program development, and staffing and deployment decisions. Recognized early and managed effectively, SCA patients have significant potential to return to normal lives. When they’re not, death (or, worse, survival in a persistent neurologically vegetative state) is almost guaranteed. To the general public, cardiac arrest has always been perceived (appropriately) as “the big one.” They expect us (again, appropriately) to be ready, trained, equipped and competent to care for this condition whenever and wherever it occurs. In the eyes of our communities, cardiac arrest is one of the main reasons we exist.
At home, in each of our agencies, we’re regularly tasked with evaluating and implementing evolving guidelines as well as local changes in our communities. When the science of resuscitation changes, treatment protocols change, new equipment or medication may be introduced, and educational efforts that include not only didactic information but some form of practical, hands-on experience are rolled out.
While every system acknowledges the urgency of implementing new guidelines, we still collectively struggle to make significant changes in relatively short periods of time. For example, in a survey of 174 EMS agencies regarding the implementation of the 2005 AHA guidelines, the average time from release to guideline implementation was 416 days.1
On an individual level, any practitioner involved in resuscitation efforts for any period of time has witnessed the tremendous changes in our approach to treating cardiac arrest. Remember the good old days of the “ABCs”? How about sodium bicarbonate, Isuprel, lidocaine or procainamide? In the more “advanced” systems, remember connecting patients to telemetry monitors, establishing connections with base hospitals and transmitting ventricular fibrillation tracings just to get orders to shock? Remember when automated defibrillators were first placed in the hands of lay rescuers? How about the perception of worsening care because we removed sacred mouth-to-mouth prearrival instructions? Who would have imagined our cardiology colleagues taking unconscious survivors of cardiac arrest to cath labs still comatose?
We’ve learned some important lessons in our quest to provide more effective care for these patients. As with most acute clinical conditions, we now understand there’s both an art and a science to resuscitation. But perhaps the most important lesson we’ve learned in our journey to provide better care for these patients is one that’s not so apparent.
The Problem
Sudden cardiac arrest remains one of the leading killers of Americans, affecting more than 350,000 people each year.2 More than 90% of people who experience it don’t survive. In communities that don’t measure their cardiac arrest survival rates, it’s believed survival is much lower. Unfortunately our national survival rate hasn’t significantly changed in more than 30 years.
