Improving Response to Sudden Cardiac Arrest
The Illinois Heart Rescue Project coordinates, trains and promotes best practices in the EMS community
Dispatcher Aided CPR
Emergency Medical Dispatch (EMD) is a vital component of any Emergency Medical Services System. An EMD program should provide written, medically approved guidelines or protocols that emergency medical dispatchers use to effectively deliver pre-arrival emergency telephone instructions, including CPR. The assistance to provide CPR instructions and walk the caller through the delivery of CPR for the patient is known as Dispatcher Assisted CPR.
Time from collapse to initiation of CPR is a critical factor in determining survival from out-of- hospital cardiac arrest. Providing CPR instructions over the telephone immediately after someone calls 911 is a critical element that decreases time from collapse to initiation of CPR. An assertive and well trained dispatcher can recognize cardiac arrest and have the bystander performing CPR in less than 1 minute from the time the call was received. Studies have shown that DA CPR can improve the percentage of cardiac arrest cases that receive bystander CPR and overall survival.
High Performance CPR
EMS systems should train to provide high-performance resuscitation. This includes a well-planned, well-rehearsed, often choreographed and flawlessly executed approach to caring for the victim of SCA at the scene. The goals of high performance resuscitation include the provision of continuous, high-quality CPR, minimal off-chest time, rapid defibrillation, non-aggressive airway placement, and the use of end tidal CO2 waveform to both confirm tube placement and monitor the quality of the resuscitation efforts. Systems should have clear termination of resuscitation protocols, which allow the patient to receive the most complete care possible at the scene prior to termination of efforts.
Following the resuscitation, a post-event review should occur as soon as possible using all available quality improvement tools available. A review of system dispatch times allow crews to determine if quicker response is possible. Review should also include a determination of whether or not bystander CPR was provided by dispatch evaluation of CPR fraction and quality of compressions if possible, evaluation of ventilation rate and end tidal CO2 waveforms and appropriateness of all treatments provided in the field. Having crews and medical directors implement adjustments and improvements to these system components following review of the event constitutes a high performance resuscitation program.
Establishing OHCA (Outside Hospital Cardiac Arrest) Systems of Care
This includes linking with community AED programs, coordinating with receiving hospitals to optimize post-cardiac arrest care, and measuring survival to hospital discharge.
Fundamental to this is improving the collection and quality of data from EMS organizations. Illinois Heart Rescue supports the widespread adoption the CARES (Cardiac Arrest Registry to Enhance Survival) database. It is a simple but powerful database initiated in 2004 by the Center for Disease Control (CDC) that allows cities to collect a small set of performance measures from 9-1-1, first responders, fire departments, and Emergency Medical Services, and link it with outcome data from hospitals. This data enables cities to perform internal benchmarking and improve their response to cardiac arrest by strengthening the chain of survival in their community. Because most EMS systems don’t measure their response effectively, they are unable to implement change in an effective manner. Since the program’s inception, survival from cardiac arrest in the city of Atlanta has increased from 3% to 15%.