Hospital trips a waste - @ JEMS.com


Hospital trips a waste


 
 

Suzanne Hoholik | | Monday, October 6, 2008


COLUMBUS, Ohio -- Cardiac-arrest patients who have no pulse despite paramedics' efforts to revive them shouldn't be taken to a hospital, according to a new study.

Instead, paramedics should be able to determine whether resuscitation efforts should be stopped at the scene and patients pronounced dead.

Dr. Comilla Sasson, an emergency-medicine lecturer at the University of Michigan and lead author of a study published last week in the Journal of the American Medical Association, said transporting patients who have no chance of survival is a poor use of medical staff members and hospital resources.

She said she saw many patients who were "obviously dead" when she worked in an emergency department in Chicago.

"I would try to save this person who I already knew was a futile resuscitation and leave 15 to 17 patients who needed care," she said.

Her study found that paramedics who use rules about when to stop resuscitation were better equipped to decide when a trip to a hospital was futile.

The no-transport rules apply after a patient has no heart activity when paramedics arrive and spend 20 to 30 minutes on resuscitation with no results. Criteria include paramedics not witnessing the cardiac arrest, defibrillators not being used and bystanders not giving CPR.

The study examined 5,505 cardiac-arrest cases from Oct. 1, 2005, to April 30, 2008, in eight cities, including Columbus.

"This is not a do-not-treat or do-not-resuscitate rule," Sasson said.

Americans suffer about 166,200 cardiac arrests outside hospitals each year, and paramedics respond to about 60 percent of them. The national survival rate of cardiac arrest is 6.4 percent. In Columbus, the survival rate is 12 percent.

Columbus paramedics will work for about 20 minutes on patients who have no heart activity, said Dr. David Keseg, medical director for the Columbus Division of Fire.

If there's no change, paramedics can pronounce patients dead at the scene.

"When they (families) see an honest effort being spent, they're pretty accepting of that," Keseg said. "Our guys are really good with dealing with grieving and trying to be sensitive."

Dr. John Drstvensek, medical director for Grant Medical Center, and Riverside and Dublin Methodist hospitals, said he understands why family or bystanders might want paramedics to transport every patient.

However, "The public needs to understand that people who have sudden cardiac arrest, despite the efforts of EMS, do not survive," he said. "The public has to realize that it's not in anyone's best interest to spend money on care that will not provide anyone a better life."

At least 14 central Ohio cities and townships, including Columbus, offset EMS costs by charging health-insurance companies to transport patients to hospitals.

Columbus officials say they expect the fees to amount to $11.5 million this year.

"I don't think they (paramedics) make a decision based on that, but it does point out that the financial incentives aren't always aligned with what's the right thing to do," said Dr. Michael Sayre, an emergency-room doctor at Ohio State University Medical Center.

Experts say the best chance for a person to survive cardiac arrest is for bystanders to start chest compressions or use an automatic external defibrillator until paramedics arrive.




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