Exploring Strategies to Improve Cardiac Arrest Survival Proceedings of a Workshop (2017) / Chapter Skim
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5 Enhancing the Emergency Medical Services Response to Cardiac Arrest
5 Enhancing the Emergency Medical Services Response to Cardiac Arrest
Pages 69-84
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From page 69... ...
Recommendations 3 and 5 from the Institute of Medicine's (IOM's) report describe opportunities for strengthening the capabilities and performance across EMS systems, while implementing continuous quality improvement programs (see Box 5-1)
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From page 70... ...
Recommendation 5. Adopt Continuous Quality Improvement Programs Emergency medical services (EMS)
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From page 71... ...
. SOURCE: Presented by Myron Weisfeldt, July 12, 2016, A Dissemination Workshop on the Report Strategies to Improve Cardiac Arrest Survival: A Time to Act.
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From page 72... ...
DISPATCHER-ASSISTED CPR1: CURRENT PROGRESS AND EMERGING TECHNOLOGIES Drew Dawson, National Highway Traffic Safety Administration (retired) Dispatcher-assisted CPR increases rates of bystander CPR, decreases the time between collapse and preliminary chest compression, and if done correctly, emphasized Drew Dawson, increases survival rates following cardiac arrest.
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From page 73... ...
Dawson called on these organizations and the American Heart Association to develop and endorse national dispatcher-assisted CPR standards. Stronger partnerships at the state level among state EMS offices, state health agencies, state 911 offices, and health care systems are also needed to bolster certification requirements, increase awareness, and expand implementation, he said.
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From page 74... ...
Although there are technological challenges associated with improving 911, most of the gaps are a result of communication and relationship barriers, Dawson said in response to a participant who noted a disconnect between some local law enforcement agencies and EMS medical directors and personnel regarding PSAPs. Both Dawson and Arthur Kellermann reiterated that strong partnerships at the local level are required to improve 911 systems and cardiac arrest care, regardless of who operates the PSAP (e.g., law enforcement, fire, EMS)
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From page 75... ...
identified four main factors that are associated with increased rates of survival, including whether • the collapse is witnessed by a bystander or EMS personnel; • the individual receives bystander CPR; • the rhythm can be shocked; or • return of spontaneous circulation is achieved at the scene. We know what needs to be done to improve survival rates for OHCA, said Kellermann.
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From page 76... ...
SOURCE: Presented by Arthur Kellermann, July 12, 2016, A Dissemination Workshop on the Report Strategies to Improve Cardiac Arrest Survival: A Time to Act (citing Kellermann, 2010)
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From page 77... ...
"We know we can do better," said Kellermann, as he called for action. PROMOTING QUALITY IMPROVEMENT PROCESSES IN EMS SYSTEMS Peter Taillac, National Association of State EMS Officials The United States has more than 21,000 licensed EMS agencies (NHTSA, 2011)
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From page 78... ...
• ealth Resources and Services Administration: Pediatric EMS H Standards • ational Association of State EMS Officials: National Model EMS Clini N cal Guidelines (NASEMSO Medical Directors Council, 2014) • ational Registry of Emergency Medical Technicians: National emer N gency medical technician (EMT)
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From page 79... ...
In the participant's health care system, outcomes related to STEMI are posted in the emergency departments within 24 hours to recognize the achievements of specific EMS teams, which also stokes competition to improve. The hospitals and EMS agencies within this system have moved regional EMS meetings into the hospitals, where EMS personnel and physicians review the data and discuss cases in terms of what went well and what could be done better next time.
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From page 80... ...
. Pepe noted that only about half of 911 PSAPs in the United States formally use emergency medical dispatchers, who can provide preEMS arrival instructions (PAIs)
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Too often the dispatcher answers a cardiac arrest call, provides dispatcher-assisted CPR, and then moves on to the next call without ever knowing the outcome of the guidance and instruction, said a participant. In addition to education and feedback, Pepe reported that some breakout group members suggested the development of external dispatcher accreditation processes as another opportunity to fortify dispatcher education and preparation as well as instilling local pride in emergency medical department functions.
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From page 82... ...
Communities should be encouraged to know their numbers in terms of survival rates, noted a 4 Breakout session presenters were asked to summarize the major ideas and opinions proposed by individual participants during their respective breakout sessions. Individual statements described below are not necessarily the position of the presenter and should not be interpreted as consensus statements from the breakout group as a whole or of the National Academies of Sciences, Engineering, and Medicine.
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From page 83... ...
The breakout group discussed building and expanding infrastructure for incentives and information exchange to promote continuous quality improvement programs across EMS systems. Sanders noted that there are several examples of demonstration projects with solid infrastructure (e.g., HeartRescue Project, the Resuscitation Academy, EMS Compass)
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From page 84... ...
Washington, DC: NRC. NREMT (National Registry of Emergency Medical Technicians)
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