At every Resuscitation Academy class, the faculty sets the stage with a few expressions we hope encapsulate a tiny bit of wisdom. We call them the “Resuscitation Academy Mantras.”
Mantra 1: Measure, improve, measure, improve. … This defines the essence of ongoing quality improvement. If you don’t measure something you can’t improve it. And once you measure it, you will reveal things that need improving. And then, once you improve the system, measure it again to see if it has improved. You should measure cardiac arrest events, and outcomes. You should also measure and evaluate time metrics, high- performance CPR metrics, and dispatcher-assisted CPR metrics.
Mantra 2: If you’ve seen one EMS system, you’ve seen one EMS system. No two systems are the same. What may be easy to accomplish in one system may be difficult if not downright impossible in another. Even if a medical director wishes to establish a dispatcher-assisted CPR program it would be impossible without the full cooperation of the dispatch director. And, one community may have a mandatory CPR training program for high school students — while another does not. This affects success.
Mantra 3: It’s not complicated, but it’s not easy. The science behind the steps to improve survival is not difficult to understand and the program requirements are fairly straight-forward. Change must start at the local level. It is the local medical, administrative, training, operations, and other personnel who are most accountable and can best decide how to bring about change.
Mantra 4: Change occurs step-by-step. EMS systems are complex organizations and not likely to be transformed overnight, no matter what the leadership may wish. With each change (improvement), one should remember the first mantra and continue to measure to see if the change really improved matters.
Mantra 5: Performance, not protocol. What counts during a resuscitation is the performance of the dispatchers, EMTs, and paramedics. Unless the system trains and requires its EMTs to achieve letter perfect performance, the protocol will be just so many empty words.
Mantra 6: Everyone in VF survives. Of course not everyone in VF will survive out-of-hospital cardiac arrest. But if there is a mindset that they will, behavior will subtly be altered to make it happen. If you keep the mantra in mind,”Everyone in VF survives,” it will create an expectation, a kind of self-fulfilling prophecy. Another aspect to this slogan is that medical directors and EMS directors will begin to scrutinize cases more closely, particularly those in which survival did not occur.
Mantra 7: It takes a “system” to save a victim. Given the unpredictable and catastrophic nature of sudden cardiac arrest, not to mention the brief therapeutic window of opportunity, it is remarkable that anyone can be resuscitated. It is amazingly complicated and difficult to save a victim of sudden cardiac arrest. Though it may be individuals who perform CPR, attach the defibrillator, secure the airway, and administer medications, it is a “system” that makes it all possible. The system is comprised of numerous agencies and literally hundreds of dispatchers, EMTs, paramedics, fire chiefs, medical services officers, medical services administrators, training officers, QI staff, medical director, hospital nurses, doctors, and support staff. The complex web and interaction all these agencies and staff comprise the system. Implied in this mantra is the modifier excellent. It takes an excellent system.
Tom Rea, MD, MPH, is medical director for King County Medic One and professor of medicine at the University of Washington.