With wide variations in outcomes for trauma patients around the U.S., a new push is underway to improve emergency medical care from first responders and ambulance crews, today’s Informed Patient column reports.
A new report from the National Association of State EMS Officials finds wide variation in how emergency medical services systems are defined in each state, with little regulatory guidance, management, data or standardization. Moreover, the report notes, state EMS budgets have been significantly impacted by the current economic downturn, limiting their ability to provide leadership beyond baseline regulatory functions.
Patient safety is also a growing issue; with the help of federal funding, national emergency medical experts are working on a national EMS Culture of Safety plan, based at the University of Pittsburgh, that aims to improve quality and safety nationwide.
Of special concern are survival rates for cardiac arrest outside the hospital, which have remained low for years in all but a few communities. In one of those exceptions, Seattle, the survival rate for a common type of cardiac arrest that can be treated with a shock from a defibrillator is close to 50%, compared to in the single digits for many other cities.
To share its strategies, Seattle’s Medic One and King County EMS three years ago began sponsoring a three day tuition-free Resuscitation Academy for EMS managers and medical directors. “It’s just too much to ignore why some communities have superb resuscitation rates and others are just abysmal,” King County EMS medical director Mickey Eisenberg tells the Health Blog. “If you were to encounter that kind of disparity in any other public service you would be astonished and consider it unacceptable.”
A growing number of cities and states have been participating in the Emory University-based CARES (Cardiac Arrest Registry to Enhance Survival), a program launched in 2004 to gather data on survival and identify gaps that could lead to improvements in performance.
However, principal investigator Bryan McNally says that while the project is funded through the end of this year by the CDC, it needs additional funds to carry on its work. CARES does have some support from the new HeartRescue program, which will use CARES to measure its progress. The project aims to improve out-of-hospital cardiac arrest survival rates by at least 50% in five years in five pilot states.
A key component of improved survival rates, McNally says, is to improve bystander CPR in each community by focusing on new protocols that emphasize doing chest compressions only and not mouth-to-mouth resuscitation and by boosting the number of 911 operators to provide instructions over the phone. Ambulances are also turning to mechanical devices that provide continuous chest compressions so paramedics can insert breathing tubes and perform other lifesaving procedures without pausing to restore breathing.
Sabina Braithwaite, chair of the American College of Emergency Physicians’ EMS committee and medical director of the EMS system in Kansas’s Wichita-Sedgwick County, says another important change is the increased communication between EMS providers and hospitals — notably new technology such as a monitor that allows EMS paramedics to digitally transmit 12-lead electrocardiograms to the hospital.
That can help identify patients who are in need of an angioplasty and help hospitals meet the 90-minutes or less standard known as door-to-balloon time. Traditionally, Braithwaite notes, hospitals would wait until ambulance crews delivered patients to the emergency room to activate the catheterization lab and call in cardiologists.
“By calling ahead you make a huge dent in that door-to-balloon time,” she says. And while the system isn’t always perfect, she says it is worth a couple of wrong calls to save more patients.