A Worthy Effort - @ JEMS.com

A Worthy Effort

Cardiac-resuscitation rules would be useful, but further study is necessary



| Monday, October 13, 2008

COLUMBUS, Ohio -- Emergency medical resources are precious and expensive, so it is important that they not be wasted.

A study published last month in The Journal of the American Medical Association seeks to refocus efforts to resuscitate heart-attack patients so that medical resources can be used more wisely.

The study suggests that emergency medical crews apply a set of rules to heart-attack victims to determine whether taking them to a hospital for more treatment would make a difference in the outcome.

Heart attacks strike 166,000 Americans every year, and the vast majority -- 154,000 -- won't survive, regardless of whether they get to a hospital.

Keeping those patients who have no chance for survival out of the emergency room can free doctors, nurses and beds for other patients in need of care, saving time and money.

The study, which looked at 5,505 cases, put forth two sets of rules to evaluate patients. The first one, called basic life support, says EMS crews should stop resuscitation efforts if the patient's heart stopped before the crew arrived, no defibrillator was used and the crew was unable get the patient's blood to begin circulating. Under that rule, more than 1,600 trips to the emergency room would have been eliminated. However, of those patients who would have been declared dead on the scene under those guidelines, five survived and were released from the hospital.

The second rule, called advanced life support, is a more conservative approach. It adds two criteria: no one witnessed the heart attack and no one attempted CPR.

With those additional criteria, 245 trips to the emergency room would have been eliminated. None of the patients who would have been declared dead under advanced life support survived long enough to leave the hospital. In other words, everyone who would have been declared dead at the scene would have been declared dead at the hospital.

Having a set of rules to dictate the proper treatment of heart-attack victims would be useful. Of course, emergency medical crews are not equal. Some are as well-equipped to revive heart-attack victims as an emergency-room team.

Others get less training and have less experience. That's probably why survival rates for heart-attack victims differ widely throughout the country.

Such important policy decisions should not be based on one small study. More studies should be conducted. Fine-tuning EMS policies to husband medical resources without putting patients' lives in jeopardy is worth the effort.

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Related Topics: Cardiac and Circulation

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