Improving Cardiac Arrest Survival Rates
Nichol G, Thomas E, Callaway CW, et al: "Regional variation in out-of-hospital cardiac arrest incidence and outcome."JAMA. 300(12):1423Ï1431, 2008.
Prehospital cardiac arrest survival rates vary across the country. Is there something to learn from areas with good results? What changes do areas with poor results need to make? Using the Resuscitation Outcomes Consortium data, which covers eight U.S. and three Canadian sites, the authors evaluated all prehospital cardiac arrests from May 1, 2006, to April 30, 2008, to find out.
A total of 20,520 cardiac arrests were evaluated. Across all the agencies, 7.9% of treated cardiac arrests and 21% of patients with a first rhythm of ventricular tachycardia survived to discharge. A five-fold difference was found between the various sites for incidence, mortality and survival to discharge. The authors surmise most of these discrepancies reflect the local risk of cardiac arrest, the local approach to EMS, the level of post-resuscitation care at the hospital, and differences in bystander CPR and lay-responder defibrillation training programs.
In response to these findings, EMS personnel should become actively involved in preparing the public to respond to cardiac arrest with CPR, defibrillation and 9-1-1 notification. Systems should evaluate ways to provide ACLS-level care to cardiac arrest victims sooner and discuss post-resuscitation care and best practices for cardiac arrest survival to local hospitals. Take a look at your own cardiac arrest survival rate, and see if you can do anything to improve it.
Alternative Airway Devices
Trabold B, Schmidt C, Schneider B, et al: "Application of three airway devices during emergency medical training by health care providers: A manikin study."American Journal of Emergency Medicine. 26(7):783Ï788, 2008.
Emphasis has recently been placed on the need to use the fastest and most efficient device to deliver oxygen. The bag-valve mask often works well, but a more secure airway may be required. To avoid the delay associated with intubation, several obturator airways are available. But how easy are they to use, and how well do we retain training on each devices?
This study, conducted in Germany, used three different obturator airways and advanced-practice nurses from the intensive care and anesthesia unit. The three airways were similar in design: Each had a distal and proximal occlusion balloon, could be inserted blindly, and could be used for ventilation even if the tube were placed in the esophagus. The nurses were provided instruction on each device, and then they were tested and retested after one month to evaluate retention. Two of the devices, Combitube and Easytube, took the longest to insert during both evaluations. The Laryngeal tube was found easiest to use, possibly due to its shorter length and smaller balloon.
Providers should be able to quickly secure an airway and provide oxygen to a patient. Although intubation is the ultimate airway device, many of us don_t get enough training to maintain our skills, so finding another easy-to-use device would be beneficial.
National Highway Traffic Safety Administration: "Configurations of EMS systems: A pilot study."Annals of Emergency Medicine. 52(4):453Ï454, 2008.
EMS systems are configured differently depending on area, size, demographics and local politics. Understanding each type of configuration will go a long way toward developing best practices and standardization. This NHTSA pilot study is the first step in evaluating the differences and similarities between systems and establishing best practices for EMS. It was conducted in the mid-Atlantic states and District of Columbia.
The findings of the study aren_t surprising. Most of the respondents stated that more than one type of agency is involved in first response and transportation in their area. Although first response personnel were utilized in nearly every system, only 36% of the systems dispatched them on every 9-1-1 call. ACLS providers were the primary form of EMS transport in more than 80% of the systems.
This type of project has been recommended for years. We need a nationwide system evaluation to fully understand the role EMS plays in a community, the crew and system configurations that work best, and what personnel should keep doing to improve patient care. Your agency may be asked to participate in the future, so download this report atwww.ems.gov.
Protecting Children from Hazards
Schooley CB, Kelly AR: "Home hazards: Can children recognize the dangers?"Journal of Trauma Nursing. 15(3):131Ï135, 2008.
This study evaluated a child education program held in Stark County, Ohio, earlier this year. It tested how well children 3 to 17 years old could identify 13 common hazards in the home.
The home hazards included foil in the microwave, knives in the toaster, pills on the table, extension cords on the floor, potholders left on the stove and babies left unattended. Children had to go through each station and note each hazard they saw. The authors found that nearly all of the children could identify at least 50% of the hazards in the home. Interestingly, the 11Ï17 year olds missed many of the items in the kitchen, like the foil in the microwave and potholder on the stove, demonstrating an ongoing need for periodic safety reminders.
This type of educational activity could be easily redone in many safety programs, such as fire safety, home safety and pedestrian safety. Take a look at the report and get creative. Go towww.starkhealth.org/safekids/index.html.
Elizabeth Criss, NP, MEd, MS, CEN, CCRN, is a nurse practitioner in the emergency department at Tucson Medical Center. She was a founding member of the Board of Advisors of the Prehospital Care Research Forum. Criss has been involved in emergency care and disaster management since 1982. Contact her email@example.com.