MISSION POSSIBLE: CARDIAC ARREST SURVIVAL ODDS
March 16, 2012
By Journal Staff
FirstWatch is a real-time survelliance tool that is capable of tracking all aspects of EMS response and activity in a given system, using data from CAD and patient call reports.
For example, an application used by Las Vegas Fire & Rescue Deputy Chief and EMS Medical Director Dr. David Slattery alerts him whenever a cardiac arrest call is identified.
“My big mission and passion is improving cardiac survival in Las Vegas,” Slattery said.
For each cardiac arrest call, Slattery can immediately view the dispatcher’s notes and determine whether the victim received dispatcher-assisted chest compressions. “I think it’s so important for our communications specialists to know what an absolutely pivotal role they play in improving cardiac arrest survival,” Slattery said. “Too often our communications centers are hounded on call process—getting off the phone and moving on. What they have to get right 100% of the time is at least recognizing someone is in cardiac arrest or has abnormal breathing and being able to provide instructions to a bystander on starting chest compressions.”
Since deploying the FirstWatch alerts, Slattery said they’ve learned that their communications specialists have little problem giving instructions when a victim is clearly unconscious and not breathing. What communications specialists have more difficulty with is when a victim is agonal, an abnormal pattern of breathing or gasping that usually comes right before death.
“Callers are panicking,” Slattery said. “When we ask ‘Are they breathing?’ and the caller says, ‘Uh, yeah. I think so’ and gives an equivocal response, we found our communications specialists weren’t necessarily recommending chest compressions.”
Using the NAED protocol via ProQA that guides communications specialists through more detailed questions about the true state of respiration, dispatchers have gotten more consistent in knowing when to start giving instructions, Slattery said. “We teach communications specialists, when there’s doubt, err on the side of chest compressions.”
Those measures have helped improve cardiac arrest survival in the Las Vegas area. For witnessed ventricular fibrillation, survival is about 35%, up from5% in 2008.
“Every time I get that buzz on my Blackberry that I have a cardiac arrest, it keeps it at the forefront of my day,” Slattery said. “I listen to every one. Our communications specialists are heroes. They are doing amazing work. Cardiac arrest is an area where we can do a little bit better.” – Jennifer Goodwin