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Krychtiuk KA, Starks MA, Al-Khalidi HR, Mark DB, Monk L, Yow E, Kaltenbach L, Jollis JG, Al-Khatib SM, Bosworth HB, Ward K, Brady S, Tyson C, Vandeventer S, Baloch K, Oakes M, Blewer AL, Lewinski AA, Hansen CM, Sharpe E, Rea TD, Nelson RD, Sasson C, McNally B, Granger CB. RAndomized Cluster Evaluation of Cardiac ARrest Systems (RACE-CARS) trial: Study Rationale and Design. Am Heart J 2024:S0002-8703(24)00179-0. [PMID: 39084483 DOI: 10.1016/j.ahj.2024.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 07/15/2024] [Accepted: 07/25/2024] [Indexed: 08/02/2024]
Abstract
Out-of-hospital cardiac arrest (OHCA) occurs in nearly 350,000 people each year in the United States (US). Despite advances in pre- and in-hospital care, OHCA survival remains low and is highly variable across systems and regions. The critical barrier to improving cardiac arrest outcomes is not a lack of knowledge about effective interventions, but rather the widespread lack of systems of care to deliver interventions known to be successful. The RAndomized Cluster Evaluation of Cardiac ARrest Systems (RACE-CARS) trial is a 7-year pragmatic, cluster-randomized trial of 60 counties (57 clusters) in North Carolina using an established registry and is testing whether implementation of a customized set of strategically targeted community-based interventions improves survival to hospital discharge with good neurologic function in OHCA relative to control/standard care. The multi-faceted intervention comprises rapid cardiac arrest recognition and systematic bystander CPR instructions by 9-1-1 telecommunicators, comprehensive community CPR training and enhanced early automated external defibrillator (AED) use prior to emergency medical systems (EMS) arrival. Approximately 20,000 patients are expected to be enrolled in the RACE CARS Trial over 4 years of the assessment period. The primary endpoint is survival to hospital discharge with good neurologic outcome defined as a cerebral performance category (CPC) of 1 or 2. Secondary outcomes include the rate of bystander CPR, defibrillation prior to arrival of EMS, and quality of life. We aim to identify successful community- and systems-based strategies to improve outcomes of OHCA using a cluster randomized-controlled trial design that aims to provide a high level of evidence for future application.
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Affiliation(s)
| | | | | | | | - Lisa Monk
- Duke Clinical Research Institute, Durham, NC, USA
| | - Eric Yow
- Duke Clinical Research Institute, Durham, NC, USA
| | | | | | | | - Hayden B Bosworth
- Duke Clinical Research Institute, Durham, NC, USA; Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA; Departments of Population Health Sciences, Medicine, Psychiatry, Nursing, Duke University Medical Center, Durham, NC, USA
| | | | - Sarah Brady
- Duke Clinical Research Institute, Durham, NC, USA
| | - Clark Tyson
- Duke Clinical Research Institute, Durham, NC, USA
| | | | | | - Megan Oakes
- Duke Clinical Research Institute, Durham, NC, USA
| | - Audrey L Blewer
- Departments of Population Health Sciences, Medicine, Psychiatry, Nursing, Duke University Medical Center, Durham, NC, USA; Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
| | - Allison A Lewinski
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA; Departments of Population Health Sciences, Medicine, Psychiatry, Nursing, Duke University Medical Center, Durham, NC, USA
| | - Carolina Malta Hansen
- Herlev and Gentofte Hospital, University of Copenhagen, Denmark; Rigshospitalet, University of Copenhagen, Denmark; Copenhagen Emergency Medical Services, University of Copenhagen, Denmark and Department of Clinical Medicine, Denmark
| | | | - Thomas D Rea
- Department of Medicine, University of Washington, School of Medicine, WA, USA
| | - R Darrell Nelson
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Comilla Sasson
- Department of Psychiatry, University of Colorado School of Medicine, and the Department of Community and Behavioral Health, Colorado School of Public Health, Aurora and the American Heart Association, Dallas, TX, USA
| | - Bryan McNally
- Emory University Rollins School of Public Health and Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Schnaubelt S, Veigl C, Snijders E, Abelairas Gómez C, Neymayer M, Anderson N, Nabecker S, Greif R. Tailored Basic Life Support Training for Specific Layperson Populations-A Scoping Review. J Clin Med 2024; 13:4032. [PMID: 39064072 PMCID: PMC11277549 DOI: 10.3390/jcm13144032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 07/05/2024] [Accepted: 07/07/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Basic life support (BLS) is a life-saving link in the out-of-hospital cardiac arrest chain of survival. Most members of the public are capable of providing BLS but are more likely to do so confidently and effectively if they undertake BLS training. Lay members of the public comprise diverse and specific populations and may benefit from tailored BLS training. Data on this topic are scarce, and it is completely unknown if there are any benefits arising from tailored courses or for whom course adaptations should be developed. Methods: The primary objective of this scoping review was to identify and describe differences in patient, clinical, and educational outcomes when comparing tailored versus standard BLS courses for specific layperson populations. This review was undertaken as part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation. Results: A primary search identified 1307 studies and after title, abstract, and full-text screening, we included eight publications reporting on tailored courses for specific populations. There were no studies reporting direct comparisons between tailored and standardized training. Seven (88%) studies investigated courses tailored for individuals with a disability, and only one study covered another specific population group (refugees). Overall, the quality of evidence was low as the studies did not compare tailored vs. non-tailored approaches or consisted of observational or pre-post-designed investigations. Conclusions: Tailored BLS education for specific populations is likely feasible and can include such groups into the pool of potential bystander resuscitation providers. Research into comparing tailored vs. standard courses, their cost-to-benefit ratio, how to best adapt courses, and how to involve members of the respective communities should be conducted. Additionally, tailored courses for first responders with and without a duty to respond could be explored.
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Affiliation(s)
- Sebastian Schnaubelt
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
- PULS—Austrian Cardiac Arrest Awareness Association, 1090 Vienna, Austria
- Department of Emergency Medicine, Antwerp University Hospital, 2650 Edegem, Belgium
- Emergency Medical Service Vienna, 1030 Vienna, Austria
| | - Christoph Veigl
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
- PULS—Austrian Cardiac Arrest Awareness Association, 1090 Vienna, Austria
| | - Erwin Snijders
- Department of Emergency Medicine, Antwerp University Hospital, 2650 Edegem, Belgium
| | - Cristian Abelairas Gómez
- Faculty of Education Sciences and CLINURSID Research Group, Universidade de Santiago de Compostela, 15705 Santiago de Compostela, Spain
- Simulation and Intensive Care Unit of Santiago (SICRUS) Research Group, Health Research Institute of Santiago, University Hospital of Santiago de Compostela—CHUS, 15706 Santiago de Compostela, Spain
| | - Marco Neymayer
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
- PULS—Austrian Cardiac Arrest Awareness Association, 1090 Vienna, Austria
| | - Natalie Anderson
- Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand
| | - Sabine Nabecker
- Department of Anesthesiology and Pain Management, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Robert Greif
- Faculty of Medicine, University of Bern, 3012 Bern, Switzerland
- School of Medicine, Sigmund Freud University Vienna, 1020 Vienna, Austria
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Starks MA, Chu J, Leung KB, Blewer AL, Simmons D, Hansen CM, Joiner A, Cabañas JG, Harmody MR, Nelson RD, McNally BF, Ornato JP, Granger CB, Chan TC, Mark DB. Combinations of First Responder and Drone Delivery to Achieve 5-Minute AED Deployment in OHCA. JACC. ADVANCES 2024; 3:101033. [PMID: 39130039 PMCID: PMC11313029 DOI: 10.1016/j.jacadv.2024.101033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 04/05/2024] [Accepted: 05/01/2024] [Indexed: 08/13/2024]
Abstract
Background Defibrillation in the critical first minutes of out-of-hospital cardiac arrest (OHCA) can significantly improve survival. However, timely access to automated external defibrillators (AEDs) remains a barrier. Objectives The authors estimated the impact of a statewide program for drone-delivered AEDs in North Carolina integrated into emergency medical service and first responder (FR) response for OHCA. Methods Using Cardiac Arrest Registry to Enhance Survival registry data, we included 28,292 OHCA patients ≥18 years of age between 1 January 2013 and 31 December 2019 in 48 North Carolina counties. We estimated the improvement in response times (time from 9-1-1 call to AED arrival) achieved by 2 sequential interventions: 1) AEDs for all FRs; and 2) optimized placement of drones to maximize 5-minute AED arrival within each county. Interventions were evaluated with logistic regression models to estimate changes in initial shockable rhythm and survival. Results Historical county-level median response times were 8.0 minutes (IQR: 7.0-9.0 minutes) with 16.5% of OHCAs having AED arrival times of <5 minutes (IQR: 11.2%-24.3%). Providing all FRs with AEDs improved median response to 7.0 minutes (IQR: 6.2-7.8 minutes) and increased OHCAs with <5-minute AED arrival to 22.3% (IQR: 16.4%-30.9%). Further incorporating optimized drone networks (326 drones across all 48 counties) improved median response to 4.8 minutes (IQR: 4.3-5.2 minutes) and OHCAs with <5-minute AED arrival to 56.3% (IQR: 46.9%-64.2%). Survival rates were estimated to increase by 34% for witnessed OHCAs with estimated drone arrival <5 minutes and ahead of FR and emergency medical service. Conclusions Deployment of AEDs by FRs and optimized drone delivery can improve AED arrival times which may lead to improved clinical outcomes. Implementation studies are needed.
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Affiliation(s)
- Monique A. Starks
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jamal Chu
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - K.H. Benjamin Leung
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
- Scottish Ambulance Service, Edinburgh, Scotland, United Kingdom
| | - Audrey L. Blewer
- Department of Community and Family Medicine and Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Denise Simmons
- Duke Office of Clinical Research, Duke University School of Medicine, Durham, North Carolina, USA
| | - Carolina Malta Hansen
- Division of Cardiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
- Division of Cardiology, Herlev and Gentofte Hospital, Copenhagen University, Copenhagen, Denmark
- Copenhagen Emergency Medical Services, Copenhagen University, Copenhagen, Denmark
| | - Anjni Joiner
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Durham County Emergency Medical Services, Durham, North Carolina, USA
| | - José G. Cabañas
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Wake County EMS, Raleigh, North Carolina, USA
| | - Matthew R. Harmody
- Emergency Medical Services, First Health of the Carolinas, Pinehurst, North Carolina, USA
| | - R. Darrell Nelson
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Bryan F. McNally
- Department of Emergency Medicine, Emory University, Atlanta, Georgia, USA
| | - Joseph P. Ornato
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Christopher B. Granger
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Timothy C.Y. Chan
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Daniel B. Mark
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
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4
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Lupton JR, Johnson E, Prigmore B, Daya MR, Jui J, Thompson K, Nuttall J, Neth MR, Sahni R, Newgard CD. Out-of-hospital cardiac arrest outcomes when law enforcement arrives before emergency medical services. Resuscitation 2024; 194:110044. [PMID: 37952574 PMCID: PMC10842836 DOI: 10.1016/j.resuscitation.2023.110044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Law enforcement (LE) professionals are often dispatched to out-of-hospital cardiac arrests (OHCA) to provide early cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) application with mixed evidence of a survival benefit. Our objective was to comprehensively evaluate LE care in OHCA. METHODS This is a secondary analysis of adults with non-traumatic OHCA not witnessed by EMS and without bystander AED use from 2018-2021. Our primary outcome was survival with Cerebral Perfusion Category score ≤ 2 (functional survival). Our exposures included: LE On-scene Only (without providing care); LE CPR Only (without applying an AED); LE Ideal Care (ensuring CPR and AED application). Our control group had no LE arrival before EMS. We performed multivariable logistic regression analyses adjusting for confounders and stratified our analyses by patients with and without bystander CPR. RESULTS There were 2569 adult, non-traumatic OHCAs from 2018-2021 meeting inclusion criteria. There were no differences in the odds of functional survival for LE On-scene Only (adjusted odds ratio [95% CI]: 1.28 [0.47-3.45]), LE CPR Only (1.26 [0.80-1.99]), or LE Ideal Care (1.36 [0.79-2.33]). In patients without bystander CPR, LE Ideal Care had significantly higher odds of functional survival (2.01 [1.06-3.81]) compared to no LE on-scene, with no significant associations for LE On-scene Only or LE CPR Only. There were no significant differences by LE care in patients already receiving bystander CPR. CONCLUSIONS LE arrival before EMS and ensuring both CPR and AED application is associated with significantly improved functional survival in OHCA patients not already receiving bystander CPR.
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Affiliation(s)
- Joshua R Lupton
- Department of Emergency Medicine, Oregon Health & Science University, USA.
| | - Erika Johnson
- Department of Emergency Medicine, Oregon Health & Science University, USA
| | - Brian Prigmore
- Department of Emergency Medicine, Oregon Health & Science University, USA
| | - Mohamud R Daya
- Department of Emergency Medicine, Oregon Health & Science University, USA
| | - Jonathan Jui
- Department of Emergency Medicine, Oregon Health & Science University, USA
| | - Kathryn Thompson
- Department of Emergency Medicine, Oregon Health & Science University, USA
| | | | - Matthew R Neth
- Department of Emergency Medicine, Oregon Health & Science University, USA
| | - Ritu Sahni
- Department of Emergency Medicine, Oregon Health & Science University, USA
| | - Craig D Newgard
- Department of Emergency Medicine, Oregon Health & Science University, USA
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Pérez-Regueiro I, Carcedo-Argüelles L, Menéndez-Angulo P, Guinea-Rivera R, Lana A. Time trend, willingness and knowledge of law enforcement agencies officers to act as first responders in out-of-hospital cardiac arrests. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:826-828. [PMID: 37543190 DOI: 10.1016/j.rec.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/13/2023] [Indexed: 08/07/2023]
Affiliation(s)
- Irene Pérez-Regueiro
- Servicio de Atención Médica de Urgencias de Asturias (SAMU-Asturias), Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Asturias, Spain
| | - Lucía Carcedo-Argüelles
- Unidad de Cuidados Intensivos, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Departamento de Medicina, Área de Medicina Preventiva y Salud Pública, Universidad de Oviedo, Oviedo, Asturias, Spain
| | - Paula Menéndez-Angulo
- Departamento de Medicina, Área de Medicina Preventiva y Salud Pública, Universidad de Oviedo, Oviedo, Asturias, Spain
| | - Rocío Guinea-Rivera
- Servicio de Atención Médica de Urgencias de Asturias (SAMU-Asturias), Oviedo, Asturias, Spain
| | - Alberto Lana
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Asturias, Spain; Departamento de Medicina, Área de Medicina Preventiva y Salud Pública, Universidad de Oviedo, Oviedo, Asturias, Spain.
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6
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Jean Louis C, Cildoz M, Echarri A, Beaumont C, Mallor F, Greif R, Baigorri M, Reyero D. Police as first reponders improve out-of-hospital cardiac arrest survival. BMC Emerg Med 2023; 23:102. [PMID: 37670267 PMCID: PMC10481462 DOI: 10.1186/s12873-023-00876-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 08/25/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Police forces are abundant circulating and might arrive before the emergency services to Out-of-Hospital-Cardiac-Arrest victims. If properly trained, they can provide basic life support and early defibrillation within minutes, probably increasing the survival of the victims. We evaluated the impact of local police as first responders on the survival rates of out-of-hospital cardiac arrest victims in Navarra, Spain, over 7 years. METHODS A retrospective analysis of an ongoing Out-of-Hospital Cardiac registry to compare the characteristics and survival of Out-of-Hospital-Cardiac-Arrest victims attended to in first place by local police, other first responders, and emergency ambulance services between 2014 and 2020. RESULTS Of 628 cases, 73.7% were men (aged 68.9 ± 15.8), and 26.3% were women (aged 65,0 ± 14,7 years, p < 0.01). Overall survival of patients attended to by police in the first place was 17.8%, other first responders 17.4% and emergency services 13.5% with no significant differences (p > 0.1). Time to initiating cardiopulmonary resuscitation is significant for survival. When police arrived first and started CPR before the emergency services, they arrived at a mean of 5.4 ± 3 min earlier (SD = 3.10). This early police intervention showed an increase in the probability of survival by 10.1%. CONCLUSIONS The privileged location and the sole amount of personnel of local police forces trained in life support and their fast delivery of defibrillators as first responders can improve the survival of out-of-hospital cardiac arrest victims.
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Affiliation(s)
- Clint Jean Louis
- Emergency Advanced Ambulance Physician, Prehospital Emergency Services, Navarra Health Services, Avenida Pamplona No.2. 4ª, Barañain, Navarra España, 31010, Spain.
- Regional Coordinator Cardiac-Arrest Code, Citizen Empowerment Program, Navarra Health Services, Pamplona, Navarra, Spain.
- European Resuscitation Council (ERC) Research NET, Brussels, Belgium.
| | - Marta Cildoz
- Department of Statistics and Operational Research, Public University of Navarra, Pamplona, Navarra, Spain
| | - Alfredo Echarri
- Emergency Advanced Ambulance Physician, Prehospital Emergency Services, Navarra Health Services, Avenida Pamplona No.2. 4ª, Barañain, Navarra España, 31010, Spain
- Head of Emergency Transportation Services, Prehospital Emergency Services, Navarra Health Services, Pamplona, Navarra, Spain
| | - Carlos Beaumont
- Emergency Physician, Emergency Department, University Hospital of Navarra, Pamplona, Navarra, Spain
| | - Fermin Mallor
- Department of Statistics and Operational Research, Public University of Navarra, Pamplona, Navarra, Spain
| | - Robert Greif
- European Resuscitation Council (ERC) Research NET, Brussels, Belgium
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
- School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - Miguel Baigorri
- Department of Statistics and Operational Research, Public University of Navarra, Pamplona, Navarra, Spain
| | - Diego Reyero
- Emergency Advanced Ambulance Physician, Prehospital Emergency Services, Navarra Health Services, Avenida Pamplona No.2. 4ª, Barañain, Navarra España, 31010, Spain
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Gaisendrees C, Jaeger D, Kalra R, Kosmopoulos M, Harkins K, Marquez A, Hodgson L, Kollmar L, Bartos J, Yannopoulos D. The Minnesota first-responder AED project: Aiming to increase survival in out-of-hospital cardiac arrest. Resusc Plus 2023; 15:100437. [PMID: 37576444 PMCID: PMC10416018 DOI: 10.1016/j.resplu.2023.100437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
There are 350,000 out-of-hospital cardiac arrest (OHCA) cases annually in the United States of America. Using automated external defibrillators (AEDs) has increased survival in cardiac arrests (CA) with an initial shockable rhythm. Thus, guidelines recommend complete geographical coverage with AEDs. To fill in the gaps in Minnesota, the Center for Resuscitation Medicine at the University of Minnesota raised an $18.8 million grant from the Helmsley Charitable Trust to supply law enforcement first responders with AEDs and, thus, increase survival rates after OHCA by reducing the time to first shock. This report elaborates on the decision-making, fundraising, and logistic strategy required to reach statewide AED coverage. Methods The baseline need for AEDs was analyzed using a questionnaire sent out to state law enforcement agencies, state patrols, city and county agencies, and tribal agencies in 2021. Furthermore, OHCA cases of 2021 were reviewed. The combination of this information led to an action plan to equip and train all agencies throughout the state's eight regions with AEDs. Results The electronic survey was initially sent out to 358 agencies. The initial response rate was 77% (n = 276). This resulted in a total need of 8300 AEDs to be deployed over three years (2022-2025). As of 2023, over 4769 AEDs have been distributed, covering 237 sites. Conclusion By equipping first responders with AED systems, the Center for Resuscitation Medicine aims to shorten the gap in statewide AED coverage, thus increasing the chances of survival after OHCA.
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Affiliation(s)
- Christopher Gaisendrees
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
- Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Germany
| | - Deborah Jaeger
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
- Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States
- INSERM U 1116, University of Lorraine, Vandœuvre-lès-Nancy, France
| | - Rajat Kalra
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
- Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States
| | - Marinos Kosmopoulos
- Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States
| | - Kimberly Harkins
- Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States
| | - Alexandra Marquez
- Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States
| | - Lucinda Hodgson
- Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States
| | - Loren Kollmar
- Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States
| | - Jason Bartos
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
- Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States
| | - Demetris Yannopoulos
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
- Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States
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Krammel M, Eichelter J, Gatterer C, Lobmeyr E, Neymayer M, Grassmann D, Holzer M, Sulzgruber P, Schnaubelt S. Differences in Automated External Defibrillator Types in Out-of-Hospital Cardiac Arrest Treated by Police First Responders. J Cardiovasc Dev Dis 2023; 10:jcdd10050196. [PMID: 37233163 DOI: 10.3390/jcdd10050196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/22/2023] [Accepted: 04/26/2023] [Indexed: 05/27/2023] Open
Abstract
Background: Police first responder systems also including automated external defibrillation (AED) has in the past shown considerable impact on favourable outcomes after out-of-hospital cardiac arrest (OHCA). While short hands-off times in chest compressions are known to be beneficial, various AED models use different algorithms, inducing longer or shorter durations of crucial timeframes along basic life support (BLS). Yet, data on details of these differences, and also of their potential impact on clinical outcomes are scarce. Methods: For this retrospective observational study, patients with OHCA of presumed cardiac origin and initially shockable rhythm treated by police first responders in Vienna, Austria, between 01/2013 and 12/2021 were included. Data from the Viennese Cardiac Arrest Registry and AED files were extracted, and exact timeframes were analyzed. Results: There were no significant differences in the 350 eligible cases in demographics, return of spontaneous circulation, 30-day survival, or favourable neurological outcome between the used AED types. However, the Philips HS1 and -FrX AEDs showed immediate rhythm analysis after electrode placement (0 [0-1] s) and almost no shock loading time (0 [0-1] s), as opposed to the LP CR Plus (3 [0-4] and 6 [6-6] s, respectively) and LP 1000 (3 [2-10] and 6 [5-7] s, respectively). On the other hand, the HS1 and -FrX had longer analysis times of 12 [12-16] and 12 [11-18] s than the LP CR Plus (5 [5-6] s) and LP 1000 (6 [5-8] s). The duration from when the AED was turned on until the first defibrillation were 45 [28-61] s (Philips FrX), 59 [28-81] s (LP 1000), 59 [50-97] s (HS1), and 69 [55-85] s (LP CR Plus). Conclusion: In a retrospective analysis of OHCA-cases treated by police first responders, we could not find significant differences in clinical patient outcomes concerning the respective used AED model. However, various differences in time durations (e.g., electrode placement to rhythm analysis, analysis duration, or AED turned on until first defibrillation) along the BLS algorithm were seen. This opens up the question of AED-adaptations and tailored training methods for professional first responders.
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Affiliation(s)
- Mario Krammel
- PULS-Austrian Cardiac Arrest Awareness Association, 1090 Vienna, Austria
- Emergency Medical Service (MA70), 1030 Vienna, Austria
| | - Jakob Eichelter
- PULS-Austrian Cardiac Arrest Awareness Association, 1090 Vienna, Austria
- Department of Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Constantin Gatterer
- PULS-Austrian Cardiac Arrest Awareness Association, 1090 Vienna, Austria
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria
| | - Elisabeth Lobmeyr
- Department of Internal Medicine I, Medical University of Vienna, 1090 Vienna, Austria
| | - Marco Neymayer
- PULS-Austrian Cardiac Arrest Awareness Association, 1090 Vienna, Austria
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | | | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Patrick Sulzgruber
- PULS-Austrian Cardiac Arrest Awareness Association, 1090 Vienna, Austria
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria
| | - Sebastian Schnaubelt
- PULS-Austrian Cardiac Arrest Awareness Association, 1090 Vienna, Austria
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
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9
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Tzenetidis N, Kourlaba G, Triantafyllou C, Tzenetidis V, Koulouvaris P, Myrianthefs P. Practices and educational needs of Hellenic Police Officers in providing first aid/cardiopulmonary resuscitation: A cross-sectional survey. Work 2023:WOR220150. [PMID: 36683479 DOI: 10.3233/wor-220150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND It is well known that police officers (POs) are expected to be the first responders in emergency cases requiring First Aid (FA) such as cardiac arrest. OBJECTIVE Description of practices and educational needs of Hellenic POs in providing FA/Cardiopulmonary Resuscitation (CPR) in case of medical emergencies and description of the equipment of professional FA kit. METHODS An anonymous cross-sectional survey was conducted from January 1, 2016, to December 31, 2017, using a self-administered questionnaire designed to serve the purposes of this particular survey. The instrument consisted of 53 questions (multiple choice and open-ended questions) administered in a convenience sample of 700 POs of the Attica prefecture. RESULTS A sample of 520 POs (constables and lieutenants) completed the questionnaire (response rate = 74.28%). Among the participants, 248 (47.7 %) declared that they had provided FA/CPR in the past, while among those declaring that they had never provided FA/PCR (n = 248), 153 (61.7%) said that they had experienced FA/CPR needs, but did not know what they had to do. Moreover, only 18.1% (94/520) of the POs answered that they have FA equipment in their professional equipment, which mainly includes bandages (54/94, 57.4%), while 29.7% of POs provided answers about their educational needs (313 in total) declared that they would like to be educated in bleeding control. CONCLUSION There is a need to educate and train Greek POs in first aid and CPR in an organized and mandatory way in order to meet emergency needs.
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Affiliation(s)
- Nikolaos Tzenetidis
- Department of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Kourlaba
- Department of Nursing, Faculty of Health Sciences, University of Peloponnese, Tripoli Greece
| | - Christos Triantafyllou
- Department of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Panagiotis Koulouvaris
- First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Pavlos Myrianthefs
- Department of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
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10
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Berglund E, Byrsell F, Forsberg S, Nord A, Jonsson M. Are first responders first? The rally to the suspected out-of-hospital cardiac arrest. Resuscitation 2022; 180:70-77. [PMID: 36162614 DOI: 10.1016/j.resuscitation.2022.09.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/15/2022] [Accepted: 09/17/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Time is the crucial factor in the "chain of survival" treatment concept for out-of-hospital cardiac arrest (OHCA). We aimed to measure different response time intervals by comparing emergency medical system (EMS), fire fighters and smartphone aided volunteer responders. METHODS In two large Swedish regions, volunteer responders were timed from the alert until they arrived at the scene of the suspected OHCA. The first arriving volunteer responders who tried to fetch an automated external defibrillator (AED-responder) and who ran to perform bystander cardiopulmonary resuscitation (CPR-responder) were compared to both the first arriving EMS and fire fighters. Three-time intervals were measured, from call to dispatch, the unit response time (from dispatch to arrival) and the total response time. RESULTS During 22 months, 2631 suspected OHCAs were included. The median time from call to dispatch was in minutes 1.8 (95% CI = 1.7-1.8) for EMS, 2.9 (95% CI = 2.8-3.0) for fire-fighters and 3.0 (95% CI = 2.9-3.1) for volunteer responders. The median unit response time was 8.3 (95% CI = 8.1-8.5) for EMS, 6.8 (95% CI = 6.7-6.9) for fire fighters and 6.0 (95% CI = 5.7-6.2) for AED-responders and 4.6 (95% CI = 4.5-4.8) for CPR-responders. The total response time was 10.4 (95% CI = 10.1-10.6) for EMS, 10.2 (95% CI = 9.9-10.4) for fire fighters, 9.6 (95% CI = 9.1-9.8) for AED-responders and 8.2 (95% CI = 8.0-8.3) for CPR-responders. CONCLUSION First arriving volunteer responders had the shortest unit response time when compared to both fire fighters and EMS, however this advantage was reduced by delays introduced at the dispatch center. Earlier automatic dispatch should be considered in further studies.
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Affiliation(s)
- E Berglund
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sweden.
| | - F Byrsell
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sweden
| | - S Forsberg
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sweden
| | - A Nord
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sweden
| | - M Jonsson
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sweden
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11
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Pourtaher E, Payne ER, Fera N, Rowe K, Leung SYJ, Stancliff S, Hammer M, Vinehout J, Dailey MW. Naloxone administration by law enforcement officers in New York State (2015-2020). Harm Reduct J 2022; 19:102. [PMID: 36123614 PMCID: PMC9483860 DOI: 10.1186/s12954-022-00682-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has amplified the need for wide deployment of effective harm reduction strategies in preventing opioid overdose mortality. Placing naloxone in the hands of key responders, including law enforcement officers who are often first on the scene of a suspected overdose, is one such strategy. New York State (NYS) was one of the first states to implement a statewide law enforcement naloxone administration program. This article provides an overview of the law enforcement administration of naloxone in NYS between 2015 and 2020 and highlights key characteristics of over 9000 opioid overdose reversal events. METHODS Data in naloxone usage report forms completed by police officers were compiled and analyzed. Data included 9133 naloxone administration reports by 5835 unique officers located in 60 counties across NYS. Descriptive statistics were used to examine attributes of the aided individuals, including differences between fatal and non-fatal incidents. Additional descriptive analyses were conducted for incidents in which law enforcement officers arrived first at the scene of suspected overdose. Comparisons were made to examine year-over-year trends in administration as naloxone formulations were changed. Quantitative analysis was supplemented by content analysis of officers' notes (n = 2192). RESULTS In 85.9% of cases, law enforcement officers arrived at the scene of a suspected overdose prior to emergency medical services (EMS) personnel. These officers assessed the likelihood of an opioid overdose having occurred based on the aided person's breathing status and other information obtained on the scene. They administered an average of 2 doses of naloxone to aided individuals. In 36.8% of cases, they reported additional administration of naloxone by other responders including EMS, fire departments, and laypersons. Data indicated the aided survived the suspected overdose in 87.4% of cases. CONCLUSIONS With appropriate training, law enforcement personnel were able to recognize opioid overdoses and prevent fatalities by administering naloxone and carrying out time-sensitive medical interventions. These officers provided life-saving services to aided individuals alongside other responders including EMS, fire departments, and bystanders. Further expansion of law enforcement naloxone administration nationally and internationally could help decrease opioid overdose mortality.
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Affiliation(s)
- Elham Pourtaher
- New York State Department of Health, AIDS Institute, New York, USA.
| | - Emily R Payne
- New York State Department of Health, AIDS Institute, New York, USA
| | - Nicole Fera
- New York State Department of Health, AIDS Institute, New York, USA
| | - Kirsten Rowe
- New York State Department of Health, AIDS Institute, New York, USA
| | | | - Sharon Stancliff
- New York State Department of Health, AIDS Institute, New York, USA
| | - Mark Hammer
- New York State Department of Health, AIDS Institute, New York, USA
| | - Joshua Vinehout
- New York State Division of Criminal Justice Services, Albany, USA
| | - Michael W Dailey
- Department of Emergency Medicine, Albany Medical College, Albany, USA
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12
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Salhi RA, Hammond S, Lehrich JL, O'leary M, Kamdar N, Brent C, Mendes de Leon CF, Mendel P, Nelson C, Forbush B, Neumar R, Nallamothu BK, Abir M. The Association of Fire or Police First Responder Initiated Interventions with Out of Hospital Cardiac Arrest Survival. Resuscitation 2022; 174:9-15. [PMID: 35257834 PMCID: PMC9050861 DOI: 10.1016/j.resuscitation.2022.02.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/12/2022] [Accepted: 02/27/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Fire and police first responders are often the first to arrive in medical emergencies and provide basic life support services until specialized personnel arrive. This study aims to evaluate rates of fire or police first responder-initiated cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use, as well as their associated impact on out-of-hospital cardiac arrest (OHCA) outcomes. METHODS We completed a secondary data analysis of the MI-CARES registry from 2014 to 2019. We reported rates of CPR initiation and AED use by fire or police first responders. Multilevel modeling was utilized to evaluate the relationship between fire/police first responder-initiated interventions and outcomes of interest: ROSC upon emergency department arrival, survival to hospital discharge, and good neurologic outcome. RESULTS Our cohort included 25,067 OHCA incidents. We found fire or police first responders initiated CPR in 31.8% of OHCA events and AED use in 6.1% of OHCA events. Likelihood of sustained ROSC on ED arrival after CPR initiated by a fire/police first responder was not statistically different as compared to EMS initiated CPR (aOR 1.01, CI 0.93-1.11). However, fire/police first responder interventions were associated with significantly higher odds of survival to hospital discharge and survival with good neurologic outcome (aOR 1.25, 95% CI 1.08-1.45 and aOR 1.40, 95% CI 1.18-1.65, respectively). Similar associations were see when examining fire or police initiated AED use. CONCLUSIONS Fire or police first responders may be an underutilized, potentially powerful mechanism for improving OHCA survival. Future studies should investigate barriers and opportunities for increasing first responder interventions by these groups in OHCA.
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13
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Matinrad N, Reuter-Oppermann M. A review on initiatives for the management of daily medical emergencies prior to the arrival of emergency medical services. CENTRAL EUROPEAN JOURNAL OF OPERATIONS RESEARCH 2021; 30:251-302. [PMID: 34566490 PMCID: PMC8449697 DOI: 10.1007/s10100-021-00769-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 05/31/2023]
Abstract
Emergency services worldwide face increasing cost pressure that potentially limits their existing resources. In many countries, emergency services also face the issues of staff shortage-creating extra challenges and constraints, especially during crisis times such as the COVID-19 pandemic-as well as long distances to sparsely populated areas resulting in longer response times. To overcome these issues and potentially reduce consequences of daily (medical) emergencies, several countries, such as Sweden, Germany, and the Netherlands, have started initiatives using new types of human resources as well as equipment, which have not been part of the existing emergency systems before. These resources are employed in response to medical emergency cases if they can arrive earlier than emergency medical services (EMS). A good number of studies have investigated the use of these new types of resources in EMS systems, from medical, technical, and logistical perspectives as their study domains. Several review papers in the literature exist that focus on one or several of these new types of resources. However, to the best of our knowledge, no review paper that comprehensively considers all new types of resources in emergency medical response systems exists. We try to fill this gap by presenting a broad literature review of the studies focused on the different new types of resources, which are used prior to the arrival of EMS. Our objective is to present an application-based and methodological overview of these papers, to provide insights to this important field and to bring it to the attention of researchers as well as emergency managers and administrators.
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Affiliation(s)
- Niki Matinrad
- Department of Science and Technology, Linköping University, Norrköping, 60174 Sweden
| | - Melanie Reuter-Oppermann
- Information Systems - Software and Digital Business Group, Technical University of Darmstadt, 64289 Darmstadt, Germany
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14
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Karam N, Jost D, Jouven X, Marijon E. Automated external defibrillator delivery by drones: are we ready for prime time? Eur Heart J 2021; 43:1488-1490. [PMID: 34438447 DOI: 10.1093/eurheartj/ehab565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nicole Karam
- Paris-Sudden Death Expertise Center (SDEC), Paris, France.,University of Paris, PARCC, INSERM, F-75015 Paris, France.,European Georges Pompidou Hospital, Cardiology Department, Paris, France
| | - Daniel Jost
- Paris-Sudden Death Expertise Center (SDEC), Paris, France.,Brigade Sapeurs-Pompiers de Paris, Paris, France
| | - Xavier Jouven
- Paris-Sudden Death Expertise Center (SDEC), Paris, France.,University of Paris, PARCC, INSERM, F-75015 Paris, France.,European Georges Pompidou Hospital, Cardiology Department, Paris, France
| | - Eloi Marijon
- Paris-Sudden Death Expertise Center (SDEC), Paris, France.,University of Paris, PARCC, INSERM, F-75015 Paris, France.,European Georges Pompidou Hospital, Cardiology Department, Paris, France
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15
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Hirayama I, Doi K, Yamamoto M, Toida C, Morimura N. Evaluation of Autonomous Actions on Bystander-Initiated Cardiopulmonary Resuscitation and Public Access Defibrillation in Tokyo. Int Heart J 2021; 62:879-884. [PMID: 34276018 DOI: 10.1536/ihj.21-016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The frequencies of autonomous bystander-initiated cardiopulmonary resuscitation (CPR) and public access defibrillation have not yet been clarified. We aimed to evaluate the frequency of autonomous actions by citizens not having a duty to act.This retrospective observational study included patients who suffered an out-of-hospital cardiac arrest (OHCA) in Tokyo between January 1, 2013 and December 31, 2017. The Delphi method with a panel of 11 experts classified the locations of OHCA resuscitations into 3 categories as follows; autonomous, non autonomous, and undetermined. The locations determined as autonomous were further divided into 2 groups; home and other locations. Bystander-initiated CPR and application of an automated external defibrillator (AED) pad were evaluated in 43,460 patients with OHCA.Group A (non autonomous), group B (autonomous, not home), and group C (home), consisted of 7,352, 3,193, and 32,915 patients, respectively. Compared with group A, group B and group C had significantly lower rates of bystander-initiated CPR (group A, B, C; 68.3% versus 38.6% versus 23.9%) and AED pad application (groups A, B, C; 26.8% versus 15.1% versus 0.6%). In addition, multivariate analysis demonstrated that an autonomous location of resuscitation was independently associated with the frequencies of bystander-initiated CPR and AED pad application, even after adjusting for age, sex, and witness status.Autonomous actions by citizens were unacceptably infrequent. Therefore, the education and training of citizens is necessary to further enhance autonomous CPR.
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Affiliation(s)
- Ichiro Hirayama
- Department of Acute Medicine, Graduate School of Medicine, The University of Tokyo
| | - Kent Doi
- Department of Acute Medicine, Graduate School of Medicine, The University of Tokyo
| | - Miyuki Yamamoto
- Department of Acute Medicine, Graduate School of Medicine, The University of Tokyo
| | - Chiaki Toida
- Department of Acute Medicine, Graduate School of Medicine, The University of Tokyo
| | - Naoto Morimura
- Department of Acute Medicine, Graduate School of Medicine, The University of Tokyo
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16
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Association between Mode of Transportation and Survival in Adult Trauma Patients with Blunt Injuries: Matched Cohort Study between Police and Ground Ambulance Transport. Prehosp Disaster Med 2021; 36:431-439. [PMID: 34078515 DOI: 10.1017/s1049023x21000510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Early police transport (PT) of penetrating trauma patients has the potential to improve survival rates for trauma patients. There are no well-established guidelines for the transport of blunt trauma patients by PT currently. STUDY OBJECTIVE This study examines the association between the survival rate of blunt trauma patients and the transport modality (police versus ground ambulance). METHODS A retrospective, matched cohort study was conducted using the National Trauma Data Bank (NTDB). All blunt trauma patients transported by police to trauma centers were identified and matched (one-to-four) to patients transported by ground Emergency Medical Services (EMS) for analysis. Descriptive analysis was carried out. This was followed by comparing all patients' characteristics and their survival rates in terms of the mode of transportation. RESULTS Out of the 2,469 patients with blunt injuries, EMS transported 1,846 patients and police transported 623 patients. Most patients were 16-64 years of age (86.2%) with a male predominance (82.5%). Fall (38.4%) was the most common mechanism of injury with majority of injuries involving the head and neck body part (64.8%). Fractures were the most common nature of injury (62.1%). The overall survival rate of adult blunt trauma patients was similar for both methods of transportation (99.2%; P = 1.000). CONCLUSION In this study, adult blunt trauma patients transported by police had similar outcomes to those transported by EMS. As such, PT in trauma should be encouraged and protocolized to improve resource utilization and outcomes further.
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17
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Andelius L, Oving I, Folke F, de Graaf C, Stieglis R, Kjoelbye JS, Hansen CM, Koster RW, L Tan H, Blom MT. Management of first responder programmes for out-of-hospital cardiac arrest during the COVID-19 pandemic in Europe. Resusc Plus 2021; 5:100075. [PMID: 33426536 PMCID: PMC7778367 DOI: 10.1016/j.resplu.2020.100075] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/20/2020] [Accepted: 12/20/2020] [Indexed: 12/14/2022] Open
Abstract
AIM First responder (FR) programmes dispatch professional FRs (police and/or firefighters) or citizen responders to perform cardiopulmonary resuscitation (CPR) and use automated external defibrillators (AED) in out-of-hospital cardiac arrest (OHCA). We aimed to describe management of FR-programmes across Europe in response to the Coronavirus Disease 2019 (COVID-19) pandemic. METHODS In June 2020, we conducted a cross-sectional survey sent to OHCA registry representatives in 18 European countries with active FR-programmes. The survey was administered by e-mail and included questions regarding management of both citizen responder and FR-programmes. A follow-up question was conducted in October 2020 assessing management during a potential "second wave" of COVID-19. RESULTS All representatives responded (response rate = 100%). Fourteen regions dispatched citizen responders and 17 regions dispatched professional FRs (9 regions dispatched both). Responses were post-hoc divided into three categories: FR activation continued unchanged, FR activation continued with restrictions, or FR activation temporarily paused. For citizen responders, regions either temporarily paused activation (n = 7, 50.0%) or continued activation with restrictions (n = 7, 50.0%). The most common restriction was to omit rescue breaths and perform compression-only CPR. For professional FRs, nine regions continued activation with restrictions (52.9%) and five regions (29.4%) continued activation unchanged, but with personal protective equipment available for the professional FRs. In three regions (17.6%), activation of professional FRs temporarily paused. CONCLUSION Most regions changed management of FR-programmes in response to the COVID-19 pandemic. Studies are needed to investigate the consequences of pausing or restricting FR-programmes for bystander CPR and AED use, and how this may impact patient outcome.
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Affiliation(s)
- Linn Andelius
- Copenhagen Emergency Medical Services, University of Copenhagen, Denmark
| | - Iris Oving
- Department of Cardiology, Heart Center, Amsterdam University Medical Centres, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Fredrik Folke
- Copenhagen Emergency Medical Services, University of Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital Herlev Gentofte, Denmark
| | - Corina de Graaf
- Department of Cardiology, Heart Center, Amsterdam University Medical Centres, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Remy Stieglis
- Department of Cardiology, Heart Center, Amsterdam University Medical Centres, Academic Medical Center, University of Amsterdam, The Netherlands
| | | | - Carolina Malta Hansen
- Copenhagen Emergency Medical Services, University of Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital Herlev Gentofte, Denmark
| | - Rudolph W. Koster
- Department of Cardiology, Heart Center, Amsterdam University Medical Centres, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Hanno L Tan
- Department of Cardiology, Heart Center, Amsterdam University Medical Centres, Academic Medical Center, University of Amsterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Marieke T. Blom
- Department of Cardiology, Heart Center, Amsterdam University Medical Centres, Academic Medical Center, University of Amsterdam, The Netherlands
| | - for the ESCAPE-NET investigators
- Copenhagen Emergency Medical Services, University of Copenhagen, Denmark
- Department of Cardiology, Heart Center, Amsterdam University Medical Centres, Academic Medical Center, University of Amsterdam, The Netherlands
- Department of Cardiology, Copenhagen University Hospital Herlev Gentofte, Denmark
- Netherlands Heart Institute, Utrecht, The Netherlands
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18
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Metelmann C, Metelmann B, Kohnen D, Brinkrolf P, Andelius L, Böttiger BW, Burkart R, Hahnenkamp K, Krammel M, Marks T, Müller MP, Prasse S, Stieglis R, Strickmann B, Thies KC. Smartphone-based dispatch of community first responders to out-of-hospital cardiac arrest - statements from an international consensus conference. Scand J Trauma Resusc Emerg Med 2021; 29:29. [PMID: 33526058 PMCID: PMC7852085 DOI: 10.1186/s13049-021-00841-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 01/19/2021] [Indexed: 12/11/2022] Open
Abstract
Background Over the past decade Smartphone-based activation (SBA) of Community First Responders (CFR) to out-of-hospital cardiac arrests (OHCA) has gained much attention and popularity throughout Europe. Various programmes have been established, and interestingly there are considerable differences in technology, responder spectrum and the degree of integration into the prehospital emergency services. It is unclear whether these dissimilarities affect outcome. This paper reviews the current state in five European countries, reveals similarities and controversies, and presents consensus statements generated in an international conference with the intention to support public decision making on future strategies for SBA of CFR. Methods In a consensus conference a three-step approach was used: (i) presentation of current research from five European countries; (ii) workshops discussing evidence amongst the audience to generate consensus statements; (iii) anonymous real-time voting applying the modified RAND-UCLA Appropriateness method to adopt or reject the statements. The consensus panel aimed to represent all stakeholders involved in this topic. Results While 21 of 25 generated statements gained approval, consensus was only found for 5 of them. One statement was rejected but without consensus. Members of the consensus conference confirmed that CFR save lives. They further acknowledged the crucial role of emergency medical control centres and called for nationwide strategies. Conclusions Members of the consensus conference acknowledged that smartphone-based activation of CFR to OHCA saves lives. The statements generated by the consensus conference may assist the public, healthcare services and governments to utilise these systems to their full potential, and direct the research community towards fields that still need to be addressed. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00841-1.
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Affiliation(s)
- Camilla Metelmann
- Department of Anaesthesiology, University Medicine Greifswald, Ferdinand-Sauerbruch Straße 1, 17489, Greifswald, Germany.
| | - Bibiana Metelmann
- Department of Anaesthesiology, University Medicine Greifswald, Ferdinand-Sauerbruch Straße 1, 17489, Greifswald, Germany
| | - Dorothea Kohnen
- zeb.business school, Steinbeis University Berlin, Münster, Germany
| | - Peter Brinkrolf
- Department of Anaesthesiology, University Medicine Greifswald, Ferdinand-Sauerbruch Straße 1, 17489, Greifswald, Germany
| | - Linn Andelius
- Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark
| | - Bernd W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | | | - Klaus Hahnenkamp
- Department of Anaesthesiology, University Medicine Greifswald, Ferdinand-Sauerbruch Straße 1, 17489, Greifswald, Germany
| | - Mario Krammel
- Emergency Medical Service Vienna, Vienna, Austria.,PULS Austrian Cardiac Arrest Awareness Association, Vienna, Austria
| | - Tore Marks
- Department of Anaesthesiology, University Medicine Greifswald, Ferdinand-Sauerbruch Straße 1, 17489, Greifswald, Germany
| | - Michael P Müller
- Department of Anaesthesiology, Intensive Care and Emergency Medicine, St. Josefskrankenhaus, Freiburg im Breisgau, Germany
| | | | - Remy Stieglis
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bernd Strickmann
- Emergency Medical Service, City and District of Gütersloh, Gütersloh, Germany
| | - Karl Christian Thies
- Department of Anaesthesiology, University Medicine Greifswald, Ferdinand-Sauerbruch Straße 1, 17489, Greifswald, Germany.,Klinik für Anaesthesiologie, EvKB, Universitätsklinikum OWL der Universitaet Bielefeld, Campus Bielefeld-Bethel, Burgsteig 13, 33617, Bielefeld, Germany
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19
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Okubo M. Importance of first responder systems in out-of-hospital cardiac arrest raises more questions. THE LANCET REGIONAL HEALTH. EUROPE 2021; 1:100009. [PMID: 35104304 PMCID: PMC8454875 DOI: 10.1016/j.lanepe.2020.100009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Masashi Okubo
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, 3600 Forbes Avenue, Iroquois Building 400A, Pittsburgh, 15260 PA, USA
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20
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Salhi RA, Fouche S, Mendel P, Nelson C, Fetters MD, Guetterman T, Forman J, Nham W, Goldstick JE, Lehrich J, Forbush B, Iovan S, Hsu A, Shields TA, Domeier R, Setodji CM, Neumar RW, Nallamothu BK, Abir M. Enhancing Prehospital Outcomes for Cardiac Arrest (EPOC) study: sequential mixed-methods study protocol in Michigan, USA. BMJ Open 2020; 10:e041277. [PMID: 33247025 PMCID: PMC7703417 DOI: 10.1136/bmjopen-2020-041277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Out-of-hospital cardiac arrest (OHCA) is a common, life-threatening event encountered routinely by first responders, including police, fire and emergency medical services (EMS). Current literature suggests that there is significant regional variation in outcomes, some of which may be related to modifiable factors. Yet, there is a persistent knowledge gap regarding strategies to guide quality improvement efforts in OHCA care and, by extension, survival. The Enhancing Prehospital Outcomes for Cardiac Arrest (EPOC) study aims to fill these gaps and to improve outcomes. METHODS AND ANALYSIS This mixed-methods study includes three aims. In aim I, we will define variation in OHCA survival to the emergency department (ED) among EMS agencies that participate in the Michigan Cardiac Arrest Registry to Enhance Survival (CARES) in order to sample EMS agencies with high-survival and low-survival outcomes. In aim II, we will conduct site visits to emergency medical systems-including 911/dispatch, police, non-transport fire, and EMS agencies-in approximately eight high-survival and low-survival communities identified in aim I. At each site, key informant interviews and a multidisciplinary focus group will identify themes associated with high OHCA survival. Transcripts will be coded using a structured codebook and analysed through thematic analysis. Results from aims I and II will inform the development of a survey instrument in aim III that will be administered to all EMS agencies in Michigan. This survey will test the generalisability of factors associated with increased OHCA survival in the qualitative work to ultimately build an EPOC Toolkit which will be distributed to a broad range of stakeholders as a practical 'how-to' guide to improve outcomes. ETHICS AND DISSEMINATION The EPOC study was deemed exempt by the University of Michigan Institutional Review Board. Findings will be compiled in an 'EPOC Toolkit' and disseminated in the USA through partnerships including, but not limited to, policymakers, EMS leadership and health departments.
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Affiliation(s)
- Rama A Salhi
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Sydney Fouche
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | - Michael D Fetters
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Timothy Guetterman
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jane Forman
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
- Center for Clinical Management Research, Veterans Affairs Health System, Ann Arbor, Michigan, USA
| | - Wilson Nham
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Jason E Goldstick
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Jessica Lehrich
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Bill Forbush
- City of Alpena Fire Department, Alpena County EMS, City of Alpena, Alpena, Michigan, USA
| | - Samantha Iovan
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Antony Hsu
- Department of Emergency Medicine, Saint Joseph Mercy Health System, Ann Arbor, Michigan, USA
| | - Theresa A Shields
- Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Robert Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Health System, Ann Arbor, Michigan, USA
| | | | - Robert W Neumar
- Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Brahmajee K Nallamothu
- Division of Cardiovascular Diseases and the Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Mahshid Abir
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
- Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
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Svensson A, Elmqvist C, Fridlund B, Rask M, Andersson R, Stening K. Using firefighters as medical first responders to shorten response time in rural areas in Sweden. Aust J Rural Health 2020; 28:6-14. [PMID: 32105393 DOI: 10.1111/ajr.12599] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 12/20/2019] [Accepted: 12/22/2019] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To map out and describe an earlier response by using firefighters as medical first responders on while waiting for the ambulance and first incident person assignments focusing on frequency, event time and survival >30 days after performed cardiopulmonary resuscitation. DESIGN Retrospective descriptive design. SETTING Ambulance service in a county of southern Sweden with a population of 200 000 inhabitants (23/km2 ). PARTICIPANTS Data were collected from four data systems within different organizations; emergency medical communication centre, fire deparment, ambulance services and conty hospital analysis unit. MAIN OUTCOME MEASURE(S) Data from 600 while waiting for the ambulance assignments, whereof 120 with first incident person present, collected between 1 January 2012 and 31 December 2016. Between 1 June 2014 and 1 October 2015, the two fire departments were dually dispatched on out-of-hospital cardiac arrests. RESULTS Three main findings were made: there was a prolonged process time for dispatching fire fighters on while waiting for the ambulance assignments. Dual dispatches did not shorten the process time for dispatching full-time firefighters, and, in a majority of while waiting for the ambulance assignments where cardiopulmonary resuscitation was performed, firefighters or first incident persons arrived first on the scene. CONCLUSION Minimising every minute that delays the performance of life-saving actions is crucial. By dispatching firefighters on while waiting for the ambulance assignments in rural areas, the response time in a majority of assignments was shortened. However, there was substantial delay in dispatching firefighters due to prolonged process time at the emergency medical communication centre. The emergency medical communication centre operator's ability to quickly assess the need for while waiting for the ambulance assignments plays a crucial role in the chain of survival.
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Affiliation(s)
- Anders Svensson
- Centre of Interprofessional Collaboration within Emergency care (CICE), Växjö, Sweden.,Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Carina Elmqvist
- Centre of Interprofessional Collaboration within Emergency care (CICE), Växjö, Sweden.,Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Bengt Fridlund
- Centre of Interprofessional Collaboration within Emergency care (CICE), Växjö, Sweden.,Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Mikael Rask
- Centre of Interprofessional Collaboration within Emergency care (CICE), Växjö, Sweden.,Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Richard Andersson
- Centre of Interprofessional Collaboration within Emergency care (CICE), Växjö, Sweden.,Ambulance Services at Region Kronoberg, Växjö, Sweden
| | - Kent Stening
- Centre of Interprofessional Collaboration within Emergency care (CICE), Växjö, Sweden.,Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
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Krammel M, Lobmeyr E, Sulzgruber P, Winnisch M, Weidenauer D, Poppe M, Datler P, Zeiner S, Keferboeck M, Eichelter J, Hamp T, Uray T, Schnaubelt S, Nuernberger A. The impact of a high-quality basic life support police-based first responder system on outcome after out-of-hospital cardiac arrest. PLoS One 2020; 15:e0233966. [PMID: 32484818 PMCID: PMC7266310 DOI: 10.1371/journal.pone.0233966] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 05/15/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Laypersons' efforts to initiate basic life support (BLS) in witnessed Out-of-Hospital Cardiac Arrest (OHCA) remain comparably low within western society. Therefore, in order to shorten no-flow times in cardiac arrest, several police-based first responder systems equipped with automated external defibrillators (Pol-AED) were established in urban areas, which subsequently allow early BLS and AED administration by police officers. However, data on the quality of BLS and AED use in such a system and its impact on patient outcome remain scarce and inconclusive. METHODS A total of 85 Pol-AED cases were randomly assigned to a gender, age and first rhythm matched non-Pol-AED control group (n = 170) in a 1:2 ratio. Data on quality of BLS were extracted via trans-thoracic impedance tracings of used AED devices. RESULTS Comparing Pol-AED cases and the control group, we observed a similar compression rate per minute (p = 0.677) and compression ratio (p = 0.651), mirroring an overall high quality of BLS administered by police officers. Time to the first shock was significantly shorter in Pol-AED cases (6 minutes [IQR: 2-10] vs. 12 minutes [IQR: 8-17]; p<0.001). While Pol-AED was not associated with increased sustained return of spontaneous circulation (p = 0.564), a strong and independent impact on survival until hospital discharge (adj. OR: 1.85 [95%CI: 1.06-3.23; p = 0.030]) and a borderline significance for the association with favorable neurological outcome (adj. OR: 1.58 [95%CI: 0.96-2.89; p = 0.052) were observed. CONCLUSION We were able to demonstrate an early start and a high quality of BLS and AED use in Pol-AED assessed OHCA cases. Moreover, the presence of Pol-AED care was associated with better patient survival and borderline significance for favorable neurological outcome.
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Affiliation(s)
- Mario Krammel
- Department of Anesthesiology, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria.,PULS-Austrian Cardiac Arrest Awareness Association, Vienna, Austria.,Emergency Medical Service, Vienna, Austria
| | - Elisabeth Lobmeyr
- PULS-Austrian Cardiac Arrest Awareness Association, Vienna, Austria.,Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Patrick Sulzgruber
- PULS-Austrian Cardiac Arrest Awareness Association, Vienna, Austria.,Division of Cardiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Markus Winnisch
- PULS-Austrian Cardiac Arrest Awareness Association, Vienna, Austria.,Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - David Weidenauer
- PULS-Austrian Cardiac Arrest Awareness Association, Vienna, Austria.,Division of Cardiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Michael Poppe
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Philip Datler
- Department of Anesthesiology, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Sebastian Zeiner
- Department of Anesthesiology, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Markus Keferboeck
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Jakob Eichelter
- PULS-Austrian Cardiac Arrest Awareness Association, Vienna, Austria.,Emergency Medical Service, Vienna, Austria
| | - Thomas Hamp
- Department of Anesthesiology, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria.,PULS-Austrian Cardiac Arrest Awareness Association, Vienna, Austria
| | - Thomas Uray
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Sebastian Schnaubelt
- PULS-Austrian Cardiac Arrest Awareness Association, Vienna, Austria.,Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
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Dispatcher Identification of Out-of-Hospital Cardiac Arrest and Neurologically Intact Survival: A Retrospective Cohort Study. Prehosp Disaster Med 2019; 35:17-23. [DOI: 10.1017/s1049023x19005077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIntroduction:To date, there are no published data on the association of patient-centered outcomes and accurate public-safety answering point (PSAP) dispatch in an American population. The goal of this study is to determine if PSAP dispatcher recognition of out-of-hospital cardiac arrest (OHCA) is associated with neurologically intact survival to hospital discharge.Methods:This retrospective cohort study is an analysis of prospectively collected Quality Assurance/Quality Improvement (QA/QI) data from the San Antonio Fire Department (SAFD; San Antonio, Texas USA) OHCA registry from January 2013 through December 2015. Exclusion criteria were: Emergency Medical Services (EMS)-witnessed arrest, traumatic arrest, age <18 years old, no dispatch type recorded, and missing outcome data. The primary exposure was dispatcher recognition of cardiac arrest. The primary outcome was neurologically intact survival (defined as Cerebral Performance Category [CPC] 1 or 2) to hospital discharge. The secondary outcomes were: bystander cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) use, and prehospital return of spontaneous return of circulation (ROSC).Results:Of 3,469 consecutive OHCA cases, 2,569 cases were included in this analysis. The PSAP dispatched 1,964/2,569 (76.4%) of confirmed OHCA cases correctly. The PSAP dispatched 605/2,569 (23.6%) of confirmed OHCA cases as another chief complaint. Neurologically intact survival to hospital discharge occurred in 99/1,964 (5.0%) of the recognized cardiac arrest group and 28/605 (4.6%) of the unrecognized cardiac arrest group (OR = 1.09; 95% CI, 0.71–1.70). Bystander CPR occurred in 975/1,964 (49.6%) of the recognized cardiac arrest group versus 138/605 (22.8%) of the unrecognized cardiac arrest group (OR = 3.34; 95% CI, 2.70–4.11).Conclusion:This study found no association between PSAP dispatcher identification of OHCA and neurologically intact survival to hospital discharge. Dispatcher identification of OHCA remains an important, but not singularly decisive link in the OHCA chain of survival.
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Maurer H, Masterson S, Tjelmeland I, Gräsner J, Lefering R, Böttiger B, Bossaert L, Herlitz J, Koster R, Rosell-Ortiz F, Perkins G, Wnent J. When is a bystander not a bystander any more? A European survey. Resuscitation 2019; 136:78-84. [DOI: 10.1016/j.resuscitation.2018.12.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 11/09/2018] [Accepted: 12/10/2018] [Indexed: 02/07/2023]
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Hansen SM, Hansen CM, Fordyce CB, Dupre ME, Monk L, Tyson C, Torp-Pedersen C, McNally B, Vellano K, Jollis J, Granger CB. Association Between Driving Distance From Nearest Fire Station and Survival of Out-of-Hospital Cardiac Arrest. J Am Heart Assoc 2018; 7:e008771. [PMID: 30571383 PMCID: PMC6404193 DOI: 10.1161/jaha.118.008771] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Firefighter first responders dispatched in parallel with emergency medical services (EMS) personnel for out‐of‐hospital cardiac arrests (OHCA) can provide early defibrillation to improve survival. We examined whether survival following first responder defibrillation differed according to driving distance from nearest fire station to OHCA site. Methods and Results From the CARES (Cardiac Arrest Registry to Enhance Survival) registry, we identified non‐EMS witnessed OHCAs of presumed cardiac cause from 2010 to 2014 in Durham, Mecklenburg, and Wake counties, North Carolina. We used logistic regression to estimate the association between calculated driving distances (≤1, 1–1.5, 1.5–2, and >2 miles) and survival to hospital discharge following first responder defibrillation compared with defibrillation by EMS personnel. In total, 5020 OHCAs were included in the study. First responders more often applied the first automated external defibrillators at the shortest distances (≤1 mile) versus longest distances (>2 miles) (53.4% versus 46.6%, respectively, P<0.001). When compared with EMS defibrillation, first responder defibrillation within 1 mile and 1 to 1.5 miles of the nearest fire station was associated with increased survival to hospital discharge (odds ratio 2.01 [95% confidence interval 1.46–2.78] and odds ratio 1.61 [95% confidence interval 1.10–2.35], respectively). However, at the longest distances (1.5–2.0 and >2.0 miles), survival following first responder defibrillation did not differ from EMS defibrillation (odds ratio 0.77 [95% confidence interval 0.48–1.21] and odds ratio 0.97 [95% confidence interval 0.67–1.41], respectively). Conclusions Shorter driving distance from nearest fire station to OHCA location was associated with improved survival following defibrillation by first responders. These results suggest that the location of first responder units should be considered when organizing prehospital systems of OHCA care.
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Affiliation(s)
- Steen M Hansen
- 1 Duke Clinical Research Institute Duke University Durham NC.,3 Department of Clinical Epidemiology Aalborg University Hospital Aalborg Denmark
| | | | - Christopher B Fordyce
- 4 Division of Cardiology University of British Columbia Vancouver British Columbia Canada
| | - Matthew E Dupre
- 1 Duke Clinical Research Institute Duke University Durham NC.,2 Department of Population Health Sciences Duke University Durham NC
| | - Lisa Monk
- 1 Duke Clinical Research Institute Duke University Durham NC
| | - Clark Tyson
- 1 Duke Clinical Research Institute Duke University Durham NC
| | | | - Bryan McNally
- 5 Emory University School of Medicine Atlanta GA.,6 Rollins School of Public Health Emory University Atlanta GA
| | | | - James Jollis
- 1 Duke Clinical Research Institute Duke University Durham NC
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Hofmeijer J, Hemels MEW. Recovery after cardiac arrest: the brain is the heart of the matter. Neth Heart J 2018; 26:484-485. [PMID: 30191536 PMCID: PMC6150872 DOI: 10.1007/s12471-018-1156-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- J Hofmeijer
- Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands. .,Clinical Neurophysiology, Technical Medical Center, University of Twente, Enschede, The Netherlands.
| | - M E W Hemels
- Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands.,Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
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Abstract
OBJECTIVES Many police officers receive medical training for limited assessments and interventions. In most situations where medical issues arise, however, emergency medical services (EMS) are called for evaluation, treatment, and transport. Given the limited amount of information about such encounters we examined officer calls for EMS help in a single system to better describe these encounters. METHODS Requests for medical help from a fire-based EMS system by police in a moderate-sized city in 2014 and 2015 were identified. In this system, fire department resources are requested for initial evaluations of any medical complaint. Data were extracted from fire records including disposition, transportation from scene, type of injury or illness, and vital signs. Data analysis used descriptive statistics. RESULTS 4,792 calls were made, representing 2.2% of all police-citizen interactions and 4.2% of all EMS calls. A total of 61.2% of calls resulted in transport to hospital. Of those, 5.6% required fire-based advanced life support; the remainder were transported by private basic life support ambulance or non-medical means. Most requests were for trauma (51.4%), followed by medical (24.7%), drug/alcohol use (17.1%), and psychiatric (6.7%). Vital signs tended to be within normal limits including 72.7% of pulses, 65.1% of systolic blood pressures, and 90.5% of respiratory rates. CONCLUSION Requests for EMS assistance from police were common. Most calls involved patients with normal vital signs who did not require advanced life support transport. Further research is needed to identify situations where increased officer training and change in protocols could potentially change EMS response models and improve efficiency of the system.
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Danielis M, Chittaro M, De Monte A, Trillò G, Durì D. A five-year retrospective study of out-of-hospital cardiac arrest in a north-east Italian urban area. Eur J Cardiovasc Nurs 2018; 18:67-74. [PMID: 29932346 DOI: 10.1177/1474515118786677] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND The reporting and analysing of data of out-of-hospital cardiac arrests encourages the quality improvement of the emergency medical services. For this reason, the establishment of a sufficiently large patient database is intended to allow analysis of resuscitation treatments for out-of-hospital cardiac arrests and performances of different emergency medical services. AIMS The aim of this study was to describe the demographics, characteristics, outcomes and determinant factors of survival for patients who suffered an out-of-hospital cardiac arrest. METHODS this was a retrospective study including all out-of-hospital cardiac arrest cases treated by the emergency medical service in the district of Udine (Italy) from 1 January 2010-31 December 2014. RESULTS A total of 1105 out-of-hospital cardiac arrest patients were attended by the emergency medical service. Of these, 489 (44.2%) underwent cardiopulmonary resuscitation, and return of spontaneous circulation was achieved in 142 patients (29%). There was a male predominance overall, and the main age was 72.6 years (standard deviation 17.9). Cardiopulmonary resuscitation before emergency medical service arrival was performed on 62 cases (44%) in the return of spontaneous circulation group, and on 115 cases (33%) in the no return of spontaneous circulation group ( p<0.024). Among the 142 cases of return of spontaneous circulation, 29 (5.9%) survived to hospital discharge. There was a smaller likelihood of return of spontaneous circulation when patients were female (odds ratio 0.61, 0.40-0.93). Patients who had an out-of-hospital cardiac arrest with an initial shockable rhythm (odds ratio 6.33, 3.86-10.39) or an age <60 years (odds ratio 2.91, 1.86-4.57) had a greater likelihood of return of spontaneous circulation. In addition, bystander cardiopulmonary resuscitation (odds ratio 1.56, 1.04-2.33) was associated with an increased chance of return of spontaneous circulation. CONCLUSION The incidence of out-of-hospital cardiac arrest and survival rate lies within the known range. A wider database is necessary to achieve a better knowledge of out-of-hospital cardiac arrest and to drive future investments in the healthcare system.
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Affiliation(s)
- Matteo Danielis
- 1 Department of Anaesthesia and Intensive Care, Azienda Sanitaria Universitaria Integrata di Udine, Italy
| | - Martina Chittaro
- 2 Pneumology and Respiratory Physiopathology, Azienda Sanitaria Universitaria Integrata di Udine, Italy
| | - Amato De Monte
- 1 Department of Anaesthesia and Intensive Care, Azienda Sanitaria Universitaria Integrata di Udine, Italy
| | - Giulio Trillò
- 1 Department of Anaesthesia and Intensive Care, Azienda Sanitaria Universitaria Integrata di Udine, Italy
| | - Davide Durì
- 1 Department of Anaesthesia and Intensive Care, Azienda Sanitaria Universitaria Integrata di Udine, Italy
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Sado J, Kiyohara K, Hayashida S, Matsuyama T, Katayama Y, Hirose T, Kiguchi T, Nishiyama C, Iwami T, Kitamura Y, Sobue T, Kitamura T. Characteristics and Outcomes of Out-of-Hospital Cardiac Arrest Occurring While in a Motor Vehicle. Am J Cardiol 2018; 121:1387-1392. [PMID: 29605079 DOI: 10.1016/j.amjcard.2018.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 02/01/2018] [Accepted: 02/08/2018] [Indexed: 11/28/2022]
Abstract
This study aimed to investigate the incidence, patient characteristics, and outcomes of out-of-hospital cardiac arrest (OHCA) occurring while in a motor vehicle in Osaka City, Japan (with a population of 2.6 million), from 2009 to 2015. The OHCA data used in this study were obtained from the population-based Utstein-style registry in Osaka City. Patients who had OHCA occurring while in a motor vehicle were included. The primary end point was 1-month survival with favorable neurologic outcome after OHCA. During the study period, 18,458 OHCAs were observed, and 264 of them (1.4%) occurred while on or in a motor vehicle (drivers, n = 179; nondrivers, n = 85). The overall incidence rate of OHCAs occurring while in a motor vehicle was 14.0 per million population per year (drivers, 9.5; nondrivers, 4.5). In the drivers with OHCAs, 78 (43.6%) and 101 (56.4%) cases were of medical origin and traffic injuries, respectively. Approximately half of OHCAs with a medical origin in drivers presumably occurred while driving (46.2%, 36 of 78). The overall proportion of 1-month survival with favorable neurologic outcome after OHCA was 6.4% (17 of 264). In the drivers, the proportion of OHCAs with a medical origin and because of traffic injuries were 11.5% (9 of 78) and 2.0% (2 of 101) (p = 0.008), respectively. In conclusion, although OHCAs occurring while in a motor vehicle represented a small subset of the overall OHCA burden, a relatively large number of cardiac arrests with a medical origin occurred in drivers.
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Affiliation(s)
- Junya Sado
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kosuke Kiyohara
- Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan; Emergency and Critical Medical Center, Osaka Police Hospital, Osaka, Japan
| | | | - Chika Nishiyama
- Department of Critical Care Nursing, Kyoto University Graduate School of Human Health Science, Kyoto, Japan
| | - Taku Iwami
- Kyoto University Health Service, Kyoto, Japan
| | - Yuri Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tomotaka Sobue
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan.
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Holmberg MJ, Vognsen M, Andersen MS, Donnino MW, Andersen LW. Bystander automated external defibrillator use and clinical outcomes after out-of-hospital cardiac arrest: A systematic review and meta-analysis. Resuscitation 2017; 120:77-87. [PMID: 28888810 DOI: 10.1016/j.resuscitation.2017.09.003] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/23/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
Abstract
AIM To systematically review studies comparing bystander automated external defibrillator (AED) use to no AED use in regard to clinical outcomes in out-of-hospital cardiac arrest (OHCA), and to provide a descriptive summary of studies on the cost-effectiveness of bystander AED use. METHODS We searched Medline, Embase, the Web of Science, and the Cochrane Library for randomized trials and observational studies published before June 1, 2017. Meta-analyses were performed for patients with all rhythms, shockable rhythms, and non-shockable rhythms. RESULTS Forty-four observational studies, 3 randomized trials, and 13 cost-effectiveness studies were included. Meta-analysis of 6 observational studies without critical risk of bias showed that bystander AED use was associated with survival to hospital discharge (all rhythms OR: 1.73 [95%CI: 1.36, 2.18], shockable rhythms OR: 1.66 [95%CI: 1.54, 1.79]) and favorable neurological outcome (all rhythms OR: 2.12 [95%CI: 1.36, 3.29], shockable rhythms OR: 2.37 [95%CI: 1.58, 3.57]). There was no association between bystander AED use and neurological outcome for non-shockable rhythms (OR: 0.76 [95%CI: 0.10, 5.87]). The Public-Access Defibrillation trial found higher survival rates when volunteers were equipped with AEDs. The other trials found no survival difference, although their study settings differed. The quality of evidence was low for randomized trials and very low for observational studies. AEDs were cost-effective in settings with high cardiac arrest incidence, with most studies reporting ratios < $100,000 per quality-adjusted life years. CONCLUSIONS The evidence supports the association between bystander AED use and improved clinical outcomes, although the quality of evidence was low to very low.
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Affiliation(s)
- Mathias J Holmberg
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, 8000 Aarhus C, Denmark; Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, 02215 MA, USA
| | - Mikael Vognsen
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, 8000 Aarhus C, Denmark
| | - Mikkel S Andersen
- Department of Emergency Medicine, Odense University Hospital, 5000 Odense C, Denmark
| | - Michael W Donnino
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, 02215 MA, USA; Department of Internal Medicine, Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Boston, 02215 MA, USA
| | - Lars W Andersen
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, 8000 Aarhus C, Denmark; Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, 02215 MA, USA.
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Impact of city police layperson education and equipment with automatic external defibrillators on patient outcome after out of hospital cardiac arrest. Resuscitation 2017; 118:27-34. [DOI: 10.1016/j.resuscitation.2017.06.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 06/08/2017] [Accepted: 06/16/2017] [Indexed: 01/09/2023]
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Steeps RJ, Wilfong DA, Hubble MW, Bercher DL. Emergency Medical Services Professionals' Attitudes About Community Paramedic Programs. West J Emerg Med 2017; 18:630-639. [PMID: 28611884 PMCID: PMC5468069 DOI: 10.5811/westjem.2017.3.32591] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/21/2016] [Accepted: 03/02/2017] [Indexed: 11/11/2022] Open
Abstract
Introduction The number of community paramedic (CP) programs has expanded to mitigate the impact of increased patient usage on emergency services. However, it has not been determined to what extent emergency medical services (EMS) professionals would be willing to participate in this model of care. With this project, we sought to evaluate the perceptions of EMS professionals toward the concept of a CP program. Methods We used a cross-sectional study method to evaluate the perceptions of participating EMS professionals with regard to their understanding of and willingness to participate in a CP program. Approximately 350 licensed EMS professionals currently working for an EMS service that provides coverage to four states (Missouri, Arkansas, Kansas, and Oklahoma) were invited to participate in an electronic survey regarding their perceptions toward a CP program. We analyzed interval data using the Mann-Whitney U test, Kruskal-Wallis one-way analysis of variance, and Pearson correlation as appropriate. Multivariate logistic regression was performed to examine the impact of participant characteristics on their willingness to perform CP duties. Statistical significance was established at p ≤ 0.05. Results Of the 350 EMS professionals receiving an invitation, 283 (81%) participated. Of those participants, 165 (70%) indicated that they understood what a CP program entails. One hundred thirty-five (58%) stated they were likely to attend additional education in order to become a CP, 152 (66%) were willing to perform CP duties, and 175 (75%) felt that their respective communities would be in favor of a local CP program. Using logistic regression with regard to willingness to perform CP duties, we found that females were more willing than males (OR = 4.65; p = 0.03) and that those participants without any perceived time on shift to commit to CP duties were less willing than those who believed their work shifts could accommodate additional duties (OR = 0.20; p < 0.001). Conclusion The majority of EMS professionals in this study believe they understand CP programs and perceive that their communities want them to provide CP-level care. While fewer in number, most are willing to attend additional CP education and/or are willing to perform CP duties.
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Affiliation(s)
- Robert J Steeps
- Northwest Arkansas Community College, Division of Health Professions, Emergency Medical Sciences Program, Bentonville, Arkansas
| | - Denise A Wilfong
- Western Carolina University, School of Health Sciences, Emergency Medical Care Program, Cullowhee, North Carolina
| | - Michael W Hubble
- Western Carolina University, School of Health Sciences, Emergency Medical Care Program, Cullowhee, North Carolina
| | - Daniel L Bercher
- University of Arkansas for Medical Sciences, College of Health Related Professions, Department of Emergency Medical Services, Little Rock, Arkansas
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Milan M, Perman SM. Out of Hospital Cardiac Arrest: A Current Review of the Literature that Informed the 2015 American Heart Association Guidelines Update. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2016; 4:164-171. [PMID: 30271683 PMCID: PMC6159945 DOI: 10.1007/s40138-016-0118-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Out-of-Hospital cardiac arrest affects over 300,000 individuals in the US per year and is the third leading cause of death for Americans. Given the extent of this public health problem, investigations are ongoing to improve upon outcomes for patients who suffer cardiac arrest. In 2015, the American Heart Association issued an update to the 2010 Cardiopulmonary and Emergency Cardiovascular Care Guidelines.1 In this manuscript, we reviewed the literature that informed the major changes to the guidelines and present a concise review of the current literature that informs how patients who suffer a cardiac arrest are cared for in the pre-hospital, emergency department and in-hospital environment. Additionally, the new AHA guideline on Maternal Resuscitation will also be described.
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Affiliation(s)
- Melissa Milan
- Department of Pediatric Surgery, Department of Emergency Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave, Aurora, CO 80045, USA
| | - Sarah M Perman
- Department of Emergency Medicine, University of Colorado School of Medicine, 12401 E.17 Ave., Aurora CO, 80045, USA, 720.848.5593 (o), 720.848.7374 (f),
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Bhoi S, Mishra PR, Soni KD, Baitha U, Sinha TP. Epidemiology of traumatic cardiac arrest in patients presenting to emergency department at a level 1 trauma center. Indian J Crit Care Med 2016; 20:469-72. [PMID: 27630459 PMCID: PMC4994127 DOI: 10.4103/0972-5229.188198] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: There is a paucity of literature on prehospital care and epidemiology of traumatic cardiac arrest (TCA) in India. This study highlights the profile and characteristics of TCA. Methods: A retrospective cohort study was conducted to study epidemiological profile of TCA patients ≥1 year presenting to a level 1 trauma center of India. Results: One thousand sixty-one patients were recruited in the study. The median age (interquartile range) was 32 (23–45) years (male:female ratio of 5.9:1). Asystole (253), pulseless electrical activity (11), ventricular fibrillation (six), and ventricular tachycardia (five) were initial arrest rhythm. Road traffic crash (RTC) (57.16%), fall from height (18.52%), and assault (10.51%) were modes of injury. Prehospital care was provided by police (36.59%), ambulance (10.54%), relatives (45.40%), and bystanders (7.47% cases). Return of spontaneous circulation was seen in 69 patients, of which only three survived to hospital discharge. Conclusion: RTC in young males was a major cause of TCA. Asystole was the most common arrest rhythm. Police personnel were major prehospital service provider. Prehospital care needs improvement including the development of robust TCA registry.
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Affiliation(s)
- Sanjeev Bhoi
- Department of Emergency Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Prakash Ranjan Mishra
- Department of Emergency Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Dev Soni
- Department of Anaesthesia and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Upendra Baitha
- Department of Emergency Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Tej Prakash Sinha
- Department of Emergency Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
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Svensson A, Fridlund B, Wångmar E, Elmqvist C. Home healthcare nurses’ experiences of being on stand by as a first responder in a ‘While Waiting For the Ambulance’ assignment. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/2057158516637236] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of the study is to describe experiences of the ‘While Waiting for the Ambulance’ (WWFA) assignment, as described by home healthcare nurses (HHCNs). Since the early 1990s, municipal resources in Sweden, preferably firefighters, have been dispatched on WWFA. In order to further assist the local residents on an island in the southwest of Sweden, HHCNs have recently begun accompanying firefighters on WWFA. A reflective lifeworld approach was used for data analysis including in-depth interviews with eight HHCNs. When WWFA was established, the HHCNs experienced lack of clarity in where their responsibilities start and end. A split role is described, and there is a paradox in that the responders are meant to collaborate toward saving lives, when the assignment itself has a lack of collaborative structure. Ethical dilemmas and inner emotional worries led to the nurses expressing a need for support before, during and after WWFA.
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Affiliation(s)
- Anders Svensson
- Centre for Acute and Critical Care, Linneaus University, Växjö, Sweden
| | - Bengt Fridlund
- School of Health and Welfare, Jönköping University, Sweden
| | - Erik Wångmar
- Department of Political Science, Linnaeus University, Växjö, Sweden
| | - Carina Elmqvist
- Centre for Acute and Critical Care, Linneaus University, Växjö, Sweden
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Pijls RW, Nelemans PJ, Rahel BM, Gorgels AP. A text message alert system for trained volunteers improves out-of-hospital cardiac arrest survival. Resuscitation 2016; 105:182-7. [DOI: 10.1016/j.resuscitation.2016.06.006] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 05/12/2016] [Accepted: 06/08/2016] [Indexed: 10/21/2022]
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Durand G, Tabarly J, Houze-Cerfon CH, Bounes V. Utilisation des défibrillateurs par le grand public dans les arrêts cardiaques survenant dans les lieux publics de Haute-Garonne. ANNALES FRANCAISES DE MEDECINE D URGENCE 2016. [DOI: 10.1007/s13341-016-0666-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bhoi S, Thakur N, Verma P, Sawhney C, Vankar S, Agrawal D, Sinha T. Does community emergency care initiative improve the knowledge and skill of healthcare workers and laypersons in basic emergency care in India? J Emerg Trauma Shock 2016; 9:10-6. [PMID: 26957820 PMCID: PMC4766757 DOI: 10.4103/0974-2700.173870] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Due to lack of training in emergency care, basic emergency care in India is still in its infancy. We designed All India Institute of Medical Sciences basic emergency care course (AIIMS BECC) to address the issue. Aim: To improve the knowledge and skill of healthcare workers and laypersons in basic emergency care and to identify impact of the course. Materials and Methods: Prospective study conducted over a period of 4 years. The target groups were medical and nonmedical personnel. Provider AIIMS BECC is of 1 day duration including lectures on cardio-pulmonary resuscitation, choking, and special scenarios. Course was disseminated via lectures, audio-visual aids, and mannequin training. For analysis, the participants were categorized on the basis of their education and profession. A pre- and a post-course evaluation were done and individual scores were given out of 20 and compared among all the groups and P value was calculated. Results: A total of 1283 subjects were trained. 99.81% became providers and 2.0% were trained as instructors. There was a significant improvement in knowledge among all the participants irrespective of their education level including medicos/nonmedicos. However, participants who had higher education (graduates and postgraduates) and/or belonged to medical field had better knowledge gain as compared to those who had low level of education (≤12th standard) and were nonmedicos. Conclusion: BECC is an excellent community initiative to improve knowledge and skill of healthcare and laypersons in providing basic emergency care.
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Affiliation(s)
- Sanjeev Bhoi
- Department of Emergency Medicine, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Nirmal Thakur
- JPN Apex Trauma Centre, All India Institute of Medical Sciences, Community Emergency Care Initiative, All India Institute of Medical Sciences, New Delhi, India
| | - Pankaj Verma
- Department of Emergency Medicine, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Chhavi Sawhney
- Department of Anaesthesia, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Vankar
- Department of Emergency Medicine, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Agrawal
- Department of Neurosurgery, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Tejprakash Sinha
- Department of Emergency Medicine, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
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Hansen SM, Brøndum S, Thomas G, Rasmussen SR, Kvist B, Christensen A, Lyng C, Lindberg J, Lauritsen TLB, Lippert FK, Torp-Pedersen C, Hansen PA. Home Care Providers to the Rescue: A Novel First-Responder Programme. PLoS One 2015; 10:e0141352. [PMID: 26509532 PMCID: PMC4625014 DOI: 10.1371/journal.pone.0141352] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 10/06/2015] [Indexed: 11/19/2022] Open
Abstract
AIM To describe the implementation of a novel first-responder programme in which home care providers equipped with automated external defibrillators (AEDs) were dispatched in parallel with existing emergency medical services in the event of a suspected out-of-hospital cardiac arrest (OHCA). METHODS We evaluated a one-year prospective study that trained home care providers in performing cardiopulmonary resuscitation (CPR) and using an AED in cases of suspected OHCA. Data were collected from cardiac arrest case files, case files from each provider dispatch and a survey among dispatched providers. The study was conducted in a rural district in Denmark. RESULTS Home care providers were dispatched to 28 of the 60 OHCAs that occurred in the study period. In ten cases the providers arrived before the ambulance service and subsequently performed CPR. AED analysis was executed in three cases and shock was delivered in one case. For 26 of the 28 cases, the cardiac arrest occurred in a private home. Ninety-five per cent of the providers who had been dispatched to a cardiac arrest reported feeling prepared for managing the initial resuscitation, including use of AED. CONCLUSION Home care providers are suited to act as first-responders in predominantly rural and residential districts. Future follow-up will allow further evaluation of home care provider arrivals and patient survival.
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Affiliation(s)
- Steen M. Hansen
- Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark
| | - Stig Brøndum
- Hjerteforeningen, Danish Heart Foundation, Copenhagen, Denmark
| | - Grethe Thomas
- The Danish Foundation TrygFonden, Copenhagen, Denmark
| | - Susanne R. Rasmussen
- KORA, Danish Institute for Local and Regional Government Research, Aarhus, Denmark
| | - Birgitte Kvist
- Department of Health and Nursing, Municipality of Frederikshavn, North Denmark Region, Frederikshavn, Denmark
| | | | - Charlotte Lyng
- Home Care Organization, Municipality of Frederikshavn, North Denmark Region, Frederikshavn, Denmark
| | - Jan Lindberg
- Prehospital Care Organization, North Denmark Region, Aalborg, Denmark
| | - Torsten L. B. Lauritsen
- Department of Anaesthesia, The Juliane Marie Centre, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | | | | | - Poul A. Hansen
- Prehospital Care Organization, North Denmark Region, Aalborg, Denmark
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Abstract
The modern treatment of cardiac arrest is an increasingly complex medical procedure with a rapidly changing array of therapeutic approaches designed to restore life to victims of sudden death. The 2 primary goals of providing artificial circulation and defibrillation to halt ventricular fibrillation remain of paramount importance for saving lives. They have undergone significant improvements in technology and dissemination into the community subsequent to their establishment 60 years ago. The evolution of artificial circulation includes efforts to optimize manual cardiopulmonary resuscitation, external mechanical cardiopulmonary resuscitation devices designed to augment circulation, and may soon advance further into the rapid deployment of specially designed internal emergency cardiopulmonary bypass devices. The development of defibrillation technologies has progressed from bulky internal defibrillators paddles applied directly to the heart, to manually controlled external defibrillators, to automatic external defibrillators that can now be obtained over-the-counter for widespread use in the community or home. But the modern treatment of cardiac arrest now involves more than merely providing circulation and defibrillation. As suggested by a 3-phase model of treatment, newer approaches targeting patients who have had a more prolonged cardiac arrest include treatment of the metabolic phase of cardiac arrest with therapeutic hypothermia, agents to treat or prevent reperfusion injury, new strategies specifically focused on pulseless electric activity, which is the presenting rhythm in at least one third of cardiac arrests, and aggressive post resuscitation care. There are discoveries at the cellular and molecular level about ischemia and reperfusion pathobiology that may be translated into future new therapies. On the near horizon is the combination of advanced cardiopulmonary bypass plus a cocktail of multiple agents targeted at restoration of normal metabolism and prevention of reperfusion injury, as this holds the promise of restoring life to many patients for whom our current therapies fail.
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Affiliation(s)
- Kaustubha D Patil
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (K.D.P., H.R.H.); Departments of Radiology and Biomedical Engineering, Johns Hopkins University, Baltimore, MD (H.R.H.); and Department of Emergency Medicine, University of Pennsylvania, Philadelphia (L.B.B.)
| | - Henry R Halperin
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (K.D.P., H.R.H.); Departments of Radiology and Biomedical Engineering, Johns Hopkins University, Baltimore, MD (H.R.H.); and Department of Emergency Medicine, University of Pennsylvania, Philadelphia (L.B.B.)
| | - Lance B Becker
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (K.D.P., H.R.H.); Departments of Radiology and Biomedical Engineering, Johns Hopkins University, Baltimore, MD (H.R.H.); and Department of Emergency Medicine, University of Pennsylvania, Philadelphia (L.B.B.).
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Bergman R, Hiemstra B, Nieuwland W, Lipsic E, Absalom A, van der Naalt J, Zijlstra F, van der Horst IC, Nijsten MW. Long-term outcome of patients after out-of-hospital cardiac arrest in relation to treatment: a single-centre study. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2015; 5:328-38. [PMID: 26068962 DOI: 10.1177/2048872615590144] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 05/15/2015] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Outcome after out-of-hospital cardiac arrest (OHCA) remains poor. With the introduction of automated external defibrillators, percutaneous coronary intervention (PCI) and mild therapeutic hypothermia (MTH) the prognosis of patients after OHCA appears to be improving. The aim of this study was to evaluate short and long-term outcome among a non-selected population of patients who experienced OHCA and were admitted to a hospital working within a ST elevation myocardial infarction network. METHODS All patients who achieved return of spontaneous circulation (ROSC) (n=456) admitted to one hospital after OHCA were included. Initial rhythm, reperfusion therapy with PCI, implementation of MTH and additional medical management were recorded. The primary outcome measure was survival (hospital and long term). Neurological status was measured as cerebral performance category. The inclusion period was January 2003 to August 2010. Follow-up was complete until April 2014. RESULTS The mean patient age was 63±14 years and 327 (72%) were men. The initial rhythm was ventricular fibrillation, pulseless electrical activity, asystole and pulseless ventricular tachycardia in 322 (71%), 58 (13%), 55 (12%) and 21 (5%) of the 456 patients, respectively. Treatment included PCI in 191 (42%) and MTH in 188 (41%). Overall in-hospital and long-term (5-year) survival was 53% (n=240) and 44% (n=202), respectively. In the 170 patients treated with primary PCI, in-hospital survival was 112/170 (66%). After hospital discharge these patients had a 5-year survival rate of 99% and cerebral performance category was good in 92%. CONCLUSIONS In this integrated ST elevation myocardial infarction network survival and neurological outcome of selected patients with ROSC after OHCA and treated with PCI was good. There is insufficient evidence about the outcome of this approach, which has a significant impact on utilisation of resources. Good quality randomised controlled trials are needed. In selected patients successfully resuscitated after OHCA of presumed cardiac aetiology, we believe that a more liberal application of primary PCI may be considered in experienced acute cardiac referral centres.
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Affiliation(s)
- Remco Bergman
- Department of Critical Care, University Medical Center Groningen, The Netherlands Department of Anaesthesiology, University Medical Center Groningen, The Netherlands
| | - Bart Hiemstra
- Department of Critical Care, University Medical Center Groningen, The Netherlands
| | - Wybe Nieuwland
- Department of Cardiology, University Medical Center Groningen, The Netherlands
| | - Eric Lipsic
- Department of Cardiology, University Medical Center Groningen, The Netherlands
| | - Anthony Absalom
- Department of Anaesthesiology, University Medical Center Groningen, The Netherlands
| | | | - Felix Zijlstra
- Department of Cardiology, Erasmus University Rotterdam, The Netherlands
| | | | - Maarten Wn Nijsten
- Department of Critical Care, University Medical Center Groningen, The Netherlands
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Ringh M, Jonsson M, Nordberg P, Fredman D, Hasselqvist-Ax I, Håkansson F, Claesson A, Riva G, Hollenberg J. Survival after Public Access Defibrillation in Stockholm, Sweden – A striking success. Resuscitation 2015; 91:1-7. [DOI: 10.1016/j.resuscitation.2015.02.032] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 02/10/2015] [Accepted: 02/25/2015] [Indexed: 10/23/2022]
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Moon S, Vadeboncoeur TF, Kortuem W, Kisakye M, Karamooz M, White B, Brazil P, Spaite DW, Bobrow BJ. Analysis of out-of-hospital cardiac arrest location and public access defibrillator placement in Metropolitan Phoenix, Arizona. Resuscitation 2015; 89:43-9. [PMID: 25617487 DOI: 10.1016/j.resuscitation.2014.10.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 09/05/2014] [Accepted: 10/28/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Automated external defibrillators (AEDs) improve outcomes from out-of-hospital cardiac arrest (OHCA) but are infrequently used. We sought to compare the locations of OHCAs and AEDs in metropolitan Phoenix, Arizona. METHODS Public location OHCAs and AEDs were geocoded utilizing a statewide OHCA database (1/2010-12/2012) and AED registry. OHCAs were mapped using kernel-density estimation and overlapped with AED placements. Spearman's rho was obtained to determine the correlation between OHCA incidents and AED locations. RESULTS A total of 654 consecutive public location OHCAs and all 1704 non-medical facility AEDs registered in the study area were included in the analysis. High OHCA incident areas lacking AEDs were identified in the kernel-density surface map. OHCA event/AED correlation analysis showed a weak correlation (Spearman's rho=0.283; p=0.002). Events occurred most frequently at locations categorized as "In Cars/Roads/Parking lots" (190/654, 29.1%) and there were no identified AEDs for these areas. AEDs were placed most frequently in "Public business/Office/Workplace" and cardiac arrests occurred with the second highest frequency in this location type. CONCLUSION There was a weak correlation between OHCA events and deployed AEDs. It was possible to identify areas where OHCAs occurred frequently but AEDs were lacking. The ability to correlate the sites of OHCAs and AED locations is a necessary step toward improving the effectiveness of public access defibrillation.
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Affiliation(s)
- Sungwoo Moon
- Arizona Department of Health Services Bureau of Emergency Medical Services and Trauma System, Phoenix, AZ, United States; Arizona Emergency Medicine Research Center, University of Arizona College of Medicine, Tucson, AZ, United States; Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Gyeonggido, South Korea.
| | | | - Wesley Kortuem
- Arizona Department of Health Services Bureau of Public Health Statistics, Phoenix, AZ, United States
| | - Marvis Kisakye
- Arizona Department of Health Services Bureau of Public Health Statistics, Phoenix, AZ, United States
| | - Madalyn Karamooz
- University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | - Bernadette White
- Arizona Department of Health Services Bureau of Emergency Medical Services and Trauma System, Phoenix, AZ, United States
| | - Paula Brazil
- Arizona Department of Health Services Bureau of Emergency Medical Services and Trauma System, Phoenix, AZ, United States
| | - Daniel W Spaite
- Arizona Emergency Medicine Research Center, University of Arizona College of Medicine, Tucson, AZ, United States
| | - Bentley J Bobrow
- Arizona Department of Health Services Bureau of Emergency Medical Services and Trauma System, Phoenix, AZ, United States; Arizona Emergency Medicine Research Center, University of Arizona College of Medicine, Tucson, AZ, United States; Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ, United States
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Blom MT, Beesems SG, Homma PC, Zijlstra JA, Hulleman M, van Hoeijen DA, Bardai A, Tijssen JG, Tan HL, Koster RW. Improved Survival After Out-of-Hospital Cardiac Arrest and Use of Automated External Defibrillators. Circulation 2014; 130:1868-75. [DOI: 10.1161/circulationaha.114.010905] [Citation(s) in RCA: 225] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marieke T. Blom
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (M.T.B., S.G.B., P.C.M.H., J.A.Z., M.H., D.A.v.H., A.B., J.G.P.T., H.L.T., R.W.K.); Interuniversity Cardiology Institute Netherlands, Utrecht, The Netherlands (A.B.)
| | - Stefanie G. Beesems
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (M.T.B., S.G.B., P.C.M.H., J.A.Z., M.H., D.A.v.H., A.B., J.G.P.T., H.L.T., R.W.K.); Interuniversity Cardiology Institute Netherlands, Utrecht, The Netherlands (A.B.)
| | - Petronella C.M. Homma
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (M.T.B., S.G.B., P.C.M.H., J.A.Z., M.H., D.A.v.H., A.B., J.G.P.T., H.L.T., R.W.K.); Interuniversity Cardiology Institute Netherlands, Utrecht, The Netherlands (A.B.)
| | - Jolande A. Zijlstra
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (M.T.B., S.G.B., P.C.M.H., J.A.Z., M.H., D.A.v.H., A.B., J.G.P.T., H.L.T., R.W.K.); Interuniversity Cardiology Institute Netherlands, Utrecht, The Netherlands (A.B.)
| | - Michiel Hulleman
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (M.T.B., S.G.B., P.C.M.H., J.A.Z., M.H., D.A.v.H., A.B., J.G.P.T., H.L.T., R.W.K.); Interuniversity Cardiology Institute Netherlands, Utrecht, The Netherlands (A.B.)
| | - Daniel A. van Hoeijen
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (M.T.B., S.G.B., P.C.M.H., J.A.Z., M.H., D.A.v.H., A.B., J.G.P.T., H.L.T., R.W.K.); Interuniversity Cardiology Institute Netherlands, Utrecht, The Netherlands (A.B.)
| | - Abdennasser Bardai
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (M.T.B., S.G.B., P.C.M.H., J.A.Z., M.H., D.A.v.H., A.B., J.G.P.T., H.L.T., R.W.K.); Interuniversity Cardiology Institute Netherlands, Utrecht, The Netherlands (A.B.)
| | - Jan G.P. Tijssen
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (M.T.B., S.G.B., P.C.M.H., J.A.Z., M.H., D.A.v.H., A.B., J.G.P.T., H.L.T., R.W.K.); Interuniversity Cardiology Institute Netherlands, Utrecht, The Netherlands (A.B.)
| | - Hanno L. Tan
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (M.T.B., S.G.B., P.C.M.H., J.A.Z., M.H., D.A.v.H., A.B., J.G.P.T., H.L.T., R.W.K.); Interuniversity Cardiology Institute Netherlands, Utrecht, The Netherlands (A.B.)
| | - Rudolph W. Koster
- From the Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (M.T.B., S.G.B., P.C.M.H., J.A.Z., M.H., D.A.v.H., A.B., J.G.P.T., H.L.T., R.W.K.); Interuniversity Cardiology Institute Netherlands, Utrecht, The Netherlands (A.B.)
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Callaway DW, Robertson J, Sztajnkrycer MD. Law enforcement-applied tourniquets: a case series of life-saving interventions. PREHOSP EMERG CARE 2014; 19:320-7. [PMID: 25350269 DOI: 10.3109/10903127.2014.964893] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Although the epidemiology of civilian trauma is distinct from that encountered in combat, in both settings, extremity hemorrhage remains a major preventable cause of potential mortality. The current paper describes the largest case series in the literature in which police officers arriving prior to emergency medical services applied commercially available field tourniquets to civilian victims of violent trauma. Although all 3 patients with vascular injury arrived at the receiving emergency department in extremis, they were successfully resuscitated and survived to discharge without major morbidity. While this outcome is likely multifactorial and highlights the exceptional care delivered by the modern trauma system, tourniquet application appears to have kept critically injured patients alive long enough to reach definitive trauma care. No patient had a tourniquet-related complication. This case series suggests that law enforcement officers can effectively identify indications for tourniquets and rapidly apply such life-saving interventions.
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Stratton SJ, Uner A. Speed Does Matter: Police “Scoop and Run” Transport of Critical Trauma Victims. Ann Emerg Med 2014; 64:417-22. [DOI: 10.1016/j.annemergmed.2014.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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