Convergence Analysis of 119 Multi-tiered Ambulance Service in Gyeonggido - Case of Out-of-hospital Cardiac Arrest Patients -

2021 ◽  
Vol 5 (6) ◽  
pp. 1104-1115
Author(s):  
Sung-Hoon Hwang ◽  
◽  
Jong-Ho Kim ◽  
Jee-Hee Kim
Keyword(s):  
Cardiac Arrest ◽  
Convergence Analysis ◽  
Ambulance Service ◽  
Hospital Cardiac Arrest

scholarly journals UK ambulance service resuscitation management of pulseless electrical activity: a systematic review protocol of text and opinion

2020 ◽  
Vol 5 (1) ◽  
pp. 20-25
Author(s):  
Alison Coppola ◽  
Sarah Black ◽  
Sasha Johnston ◽  
Ruth Endacott
Keyword(s):  
Systematic Review ◽  
Cardiac Arrest ◽  
Electrical Activity ◽  
Life Support ◽  
Guideline Implementation ◽  
Pulseless Electrical Activity ◽  
Ambulance Service ◽  
Synthesis Process ◽  
Reference List ◽  
Hospital Cardiac Arrest

Background: Out-of-hospital cardiac arrest patients with pulseless electrical activity are treated by paramedics using basic and advanced life support resuscitation. When resuscitation fails to achieve return of spontaneous circulation, there are limited evidence and national guidelines on when to continue or stop resuscitation. This has led to ambulance services in the United Kingdom developing local guidelines to support paramedics in the resuscitative management of pulseless electrical activity. The content of each guideline is unknown, as is any association between guideline implementation and patient survival. We aim to identify and synthesise local ambulance service guidelines to help improve the consistency of paramedic-led decision-making for the resuscitation of pulseless electrical activity in out-of-hospital cardiac arrest.Methods: A systematic review of text and opinion will be conducted on ambulance service guidelines for resuscitating adult cardiac arrest patients with pulseless electrical activity. Data will be gathered direct from the ambulance service website. The review will be guided by the methods of the Joanna Briggs Institute (JBI). The search strategy will be conducted in three stages: 1) a website search of the 14 ambulance services; 2) a search of the evidence listed in support of the guideline; and 3) an examination of the reference list of documents found in the first and second stages and reported using the Preferred Reporting Items for Systematic Reviews and Meta-analyses. Each document will be assessed against the inclusion criteria, and quality of evidence will be assessed using the JBI Critical Appraisal Checklist for Text and Opinion. Data will be extracted using the JBI methods of textual data extraction and a three-stage data synthesis process: 1) extraction of opinion statements; 2) categorisation of statements according to similarity of meaning; and 3) meta-synthesis of statements to create a new collection of findings. Confidence of findings will be assessed using the graded ConQual approach.

Out-of-Hospital Cardiac Arrest—Review of Demographics in South Australia to Inform Decisions about the Provision of Automatic External Defibrillators within the Community

2010 ◽  
Vol 25 (6) ◽  
pp. 521-526 ◽  
Author(s):  
Kathryn Zeitz ◽  
Hugh Grantham ◽  
Robert Elliot ◽  
Chris Zeitz
Keyword(s):  
Cardiac Arrest ◽  
South Australia ◽  
Mean Value ◽  
Public Access ◽  
Ambulance Service ◽  
Case Review ◽  
Retrospective Case ◽  
Bystander Cpr ◽  
The Impact ◽  
Hospital Cardiac Arrest

AbstractIntroduction:Sudden, out-of-hospital cardiac arrest (OHCA) has an annual incidence of approximately 50 per 100,000 population. Public access defibrillation is seen as one of the key strategies in the chain-of-survival for OHCA. Positioning of these devices is important for the maximization of public health outcomes. The literature strongly advocates widespread public access to automated external defibrillatiors (AEDs). The most efficient placement of AEDs within individual communities remains unclear.Methods:A retrospective case review of OHCAs attended by the South Australia Ambulance Service in metropolitan and rural South Australia over a 30-month period was performed. Data were analyzed using Utstein-type indicators. Detailed demographics, summative data, and clinical data were recorded.Results:A total of 1,305 cases of cardiac arrest were reviewed. The annual rate of OHCA was 35 per 100,000 population. Of the cases, the mean value for the ages was 66.3 years, 517 (39.6%) were transported to hospital, 761 (58.3%) were judged by the paramedic to be cardiac, and 838 (64.2%) were witnessed. Bystander cardiopulmonary resuscitation (CPR) was performed in 495 (37.9%) of cases. The rhythm on arrival was ventricular fibrillation (VF) or ventricular tachycardia (VT) in 419 (32.1%) cases, and 315 (24.1%) of all arrests had return of spontaneous circulation (ROSC) before or on arrival at the hospital. For cardiac arrest cases that were witnessed by the ambulance service (n = 121), the incidence of ROSC was 47.1%.During the 30-month period, there only was one location that recorded more than one cardiac arrest. No other location recorded recurrent episodes.Conclusions:This study did not identify any specific location that would justify defibrillator placement over any other location without an existing defibrillator. The impact of bystander CPR and the relatively low rate of bystander CPR in this study points to an area of need. The relative potential impact of increasing bystander CPR rates versus investing in defibrillators in the community is worthy of further consideration.

scholarly journals PP12 New ‘nature of call’ telephone screening tool, employed prior to nhs pathways triage, can accurately identify those later treated for out of hospital cardiac arrest: analysis of sensitivity and specificity using routine ambulance service data

2019 ◽  
Vol 36 (1) ◽  
pp. e5.2-e5
Author(s):  
Jonathan Green ◽  
Sean Ewings ◽  
Richard Wortham ◽  
Bronagh Walsh
Keyword(s):  
Cardiac Arrest ◽  
Sensitivity And Specificity ◽  
Screening Tool ◽  
Early Recognition ◽  
High Sensitivity ◽  
Ambulance Service ◽  
Current Function ◽  
Ambulance Dispatch ◽  
Clinical Records ◽  
Hospital Cardiac Arrest

BackgroundA new pre-triage emergency medical call screening tool, Nature of Call (NoC), has been introduced into UK ambulance services which employ the NHS Pathways (NHSP) triage system. Its current function is to provide a rapid sieve, differentiating between patients who may need treatment for Out-of-Hospital Cardiac Arrest (OHCA), and therefore require immediate ambulance dispatch, and all other calls, for which ambulance dispatch is withheld whilst further triage is undertaken.ObjectiveTo evaluate the accuracy of NoC in identifying patients with potentially treatable OHCA or peri-arrest conditions.MethodsStudy of diagnostic accuracy. The sample was a retrospective cohort of consecutive calls to a UK ambulance service, taken over a four-month period. Sensitivity and specificity were determined, comparing allocated priority dispositions with an OHCA Treatment Registry. Context was supplied by the evaluation of subsequent categorisation by NHSP. The accuracy of the combined NoC and NHSP allocations was also investigated.ResultsA total of 1 87 419 emergency calls were received. Of these, 71 373 were allocated both NoC and NHSP priority dispositions and were associated with electronic Patient Clinical Records. 590 (0.8%) of these patients received treatment for OHCA. NoC, sensitivity=77.6% (95% CI 74.1 to 80.8); specificity=86.9% (95% CI 86.6 to 87.1). NHSP, sensitivity=79.2% (95% CI 75.7 to 82.2); specificity=93.4% (93.2 to 93.6). NoC and NHSP combined, sensitivity=84.1% (95% CI 80.9 to 86.8); specificity=95.0% (95% CI 94.8 to 95.3).ConclusionsNoC and subsequent NHSP call categorisation each achieved relatively high sensitivity for the identification of treated OHCA, predicting similar groups of registry patients (although 6% were identified by NoC alone). Overall accuracy was enhanced when NoC and subsequent NHSP Results were combined. The unidentified group of treated OHCA patients (16%) present a challenge to the current dispatch system which relies on the early recognition of patients who may require treatment for OHCA.

scholarly journals Optimising ambulance service contribution to clinical trials: a phenomenological exploration using focus groups

2019 ◽  
Vol 4 (3) ◽  
pp. 8-15
Author(s):  
Helen Pocock ◽  
Michelle Thomson ◽  
Sarah Taylor ◽  
Charles D. Deakin ◽  
Ed England
Keyword(s):  
Cardiac Arrest ◽  
Focus Groups ◽  
Large Scale ◽  
Public Awareness ◽  
Ambulance Service ◽  
Successful Outcome ◽  
Medical Progress ◽  
Ethical Concerns ◽  
Geographical Regions ◽  
Hospital Cardiac Arrest

Introduction: Out-of-hospital cardiac arrest trials can prove challenging and there is a need to share learning from those that have recruited successfully. We have just completed three years of recruitment to PARAMEDIC2, a placebo-controlled trial of adrenaline in out-of-hospital cardiac arrest. This study was designed to describe the experience of operational ambulance staff involved in recruiting patients into PARAMEDIC2.Methods: Four focus groups involving trial paramedics and supporting members of the emergency care team were conducted across different geographical regions of a single UK ambulance service participating in the PARAMEDIC2 study. Data analysis was supported by NVivo 12 and themes were identified using a thematic analysis approach.Results: Forty-four participants contributed to the focus groups. Four overarching themes were identified: context for the research, ethical concerns, concerns at the patient’s side and ongoing trial support. Participants felt that research such as PARAMEDIC2 is important and necessary to drive medical progress. They valued the opportunity to be part of a large project. Due to the deferred consent model employed, public awareness of the trial was felt to be important. Most expressed equipoise regarding adrenaline, but some felt concerned about enrolling younger patients and there was discussion around what constitutes a successful outcome. Struggles with ethical concerns were overcome through training and one-to-one discussion with research paramedics. Participants valued feedback on their performance of trial tasks, but also wanted feedback on their resuscitation skills. Cardiac arrest places a high cognitive demand on paramedics; simplicity and reinforcement of trial processes were key to facilitating recruitment. Caring for relatives was a high priority for paramedics and some felt conflicted about not discussing the trial with them.Conclusions: This study has provided insights into paramedic experience of a large-scale pre-hospital trial. Investment in time and resource to provide face-to-face training and personalised feedback to paramedics can foster engagement and optimise performance.

PP22 Sandpiper wildcat project – saving lives after out-of-hospital cardiac arrest in rural grampian

2019 ◽  
Vol 36 (1) ◽  
pp. e9.1-e9
Author(s):  
Keri Fickling ◽  
Gareth Clegg ◽  
Keith Jensen ◽  
Lorna Donaldson ◽  
Colville Laird ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Urban Areas ◽  
Ambulance Service ◽  
Added Value ◽  
Recent Analysis ◽  
High Quality ◽  
Risk Of Death ◽  
Ecg Compression ◽  
Service Staff ◽  
Hospital Cardiac Arrest

BackgroundRecent analysis shows a higher risk of death after Out of Hospital Cardiac Arrest (OHCA) for patients who lived in rural areas of UK in casemix adjusted comparison with urban areas. Sandpiper Wildcat is an action research project aiming to increase survival rates through the implementation of a novel network of trained responders in rural Grampian.MethodsAfter using historic data to identify 50 locations with poor response times but significant numbers of OHCA we established teams of trained volunteer responders equipped with automatic external defibrillators (AED 3, Zoll) and Vehicle Locator Systems. Responders were trained and made available for dispatch to OHCA by ambulance control. In addition to real time CPR quality feedback the AED 3 also records ECG, compression metrics and audio of the incident for analysis and debrief.ResultsAround 500 responders were successfully trained and deployed in 53 rural locations during the first 6 months. They were mobilised to 109 OHCA, arriving on scene an average of 7 min (−15 to 48 mins) before Scottish ambulance service resources. Analysis of metrics from defibrillator downloads showed high quality resuscitation. In addition there were many reports of significant ‘added value’ to patients, families and Scottish Ambulance Service staff as a result of Sandpiper Wildcat responders’ attendance. Responders replied overwhelmingly positively to debrief questions ‘did you feel of value at scene’ and ‘do you feel you made a difference’, all indicated that they would be willing to respond again.ConclusionsSandpiper Wildcat project has reduced the response time to OHCA in rural Grampian and increased the number of responders at each OHCA. Responders have delivered high quality BLS and provided assistance to SAS personnel. Further analysis will examine the spread and sustainability of this approach in rural UK and the longer term impact on clinical outcomes.

scholarly journals Cost-effectiveness of advanced life support and prehospital critical care for out-of-hospital cardiac arrest in England: a decision analysis model

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e028574
Author(s):  
Johannes von Vopelius-Feldt ◽  
Jane Powell ◽  
Jonathan Richard Benger
Keyword(s):  
Cardiac Arrest ◽  
Critical Care ◽  
Cost Effectiveness ◽  
Life Support ◽  
Advanced Life Support ◽  
Cost Effective ◽  
Ambulance Service ◽  
Sensitivity Analyses ◽  
Decision Analysis Model ◽  
Hospital Cardiac Arrest

ObjectivesThis research aimed to answer the following questions: What are the costs of prehospital advanced life support (ALS) and prehospital critical care for out-of-hospital cardiac arrest (OHCA)? What is the cost-effectiveness of prehospital ALS? What improvement in survival rates from OHCA would prehospital critical care need to achieve in order to be cost-effective?SettingA single National Health Service ambulance service and a charity-funded prehospital critical care service in England.ParticipantsThe patient population is adult, non-traumatic OHCA.MethodsWe combined data from previously published research with data provided by a regional ambulance service and air ambulance charity to create a decision tree model, coupled with a Markov model, of costs and outcomes following OHCA. We compared no treatment for OHCA to the current standard of care of prehospital ALS, and prehospital ALS to prehospital critical care. To reflect the uncertainty in the underlying data, we used probabilistic and two-way sensitivity analyses.ResultsCosts of prehospital ALS and prehospital critical care were £347 and £1711 per patient, respectively. When costs and outcomes of prehospital, in-hospital and postdischarge phase of OHCA care were combined, prehospital ALS was estimated to be cost-effective at £11 407/quality-adjusted life year. In order to be cost-effective in addition to ALS, prehospital critical care for OHCA would need to achieve a minimally economically important difference (MEID) in survival to hospital discharge of 3%–5%.ConclusionThis is the first economic analysis to address the question of cost-effectiveness of prehospital critical care following OHCA. While costs of either prehospital ALS and/or critical care per patient with OHCA are relatively low, significant costs are incurred during hospital treatment and after discharge in patients who survive. Knowledge of the MEID for prehospital critical care can guide future research in this field.Trial registration numberISRCTN18375201

scholarly journals Incidence of emergency calls and out-of-hospital cardiac arrest deaths during the COVID-19 pandemic: findings from a cross-sectional study in a UK ambulance service

2021 ◽  
pp. emermed-2020-210291
Author(s):  
Karl Charlton ◽  
Matthew Limmer ◽  
Hayley Moore
Keyword(s):  
Cardiac Arrest ◽  
Cross Sectional Study ◽  
Ambulance Service ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
Coronary Syndrome ◽  
Emergency Calls ◽  
North East ◽  
Hospital Cardiac Arrest

BackgroundIn response to the COVID-19 pandemic, a national lockdown was introduced on 23 March 2020. In the following weeks, emergency departments in the UK reported a reduction in attendances. We aimed to explore the incidence of emergency calls across North East England, as well as the number of out-of-hospital cardiac arrest (OHCA) deaths.MethodsData were collected for all patients who contacted North East Ambulance Service between 4 March 2019–2 June 2019 and 2 March 2020–31 May 2020 suffering stroke, ST elevation myocardial infarction, allergy, asthma, chronic obstructive pulmonary disease, falls, intoxication, seizure, sepsis, acute coronary syndrome and OHCA.ResultsThere were a reduction in incidence of calls, excluding OHCA, resulting in ambulance activation during the pandemic compared with same period in 2019, 16 743 versus 19 639, respectively (−14.74%). The decline in calls was partially reversed by the end of May 2020. Incidence of OHCA at the time of the national lockdown had increased by 13.79% with a peak increase of 73.56% in the second week in April 2020. OHCA deaths peaked in the first 2 weeks in April 2020, 95.65% and 90.07%, respectively, but by the end May 2020, incidence of OHCA and OHCA deaths had returned to prelockdown levels.ConclusionIncidence of emergency calls were reduced during the pandemic compared with 2019. There was a rise in incidence of OHCA and OHCA deaths during the same period; however, these changes appear transient. Further research is required to understand patient behaviour towards seeking help during the pandemic and the long-term consequences of not doing so.

PP10  How senior paramedics determine a futile resuscitation in pulseless electrical activity out of hospital cardiac arrest: a mixed methods study

2020 ◽  
Vol 37 (10) ◽  
pp. e6.1-e6
Author(s):  
Ali Coppola ◽  
Sarah Black ◽  
Ruth Endacott
Keyword(s):  
Decision Making ◽  
Cardiac Arrest ◽  
Electrical Activity ◽  
Pulseless Electrical Activity ◽  
Ambulance Service ◽  
Clinical Factors ◽  
Patient Demographics ◽  
System Factors ◽  
The Impact ◽  
Hospital Cardiac Arrest

BackgroundPulseless electrical activity, a non-shockable cardiac arrest, is treated using advanced life support resuscitation. When resuscitation fails, evidenced-based guidelines are limited on when to stop resuscitation. This led to one UK Ambulance Service developing a local guideline for senior paramedics to cease resuscitation when considered futile. The aim of this study was to examine clinical, patient and system factors of a futile resuscitation for pulseless electrical activity and how senior paramedics apply these factors to the decision-making process.Design and MethodsAn explanatory sequential mixed method design conducted in a single UK Ambulance Service. Cessation of resuscitation data was retrieved for all adult patients suffering an Out of Hospital Cardiac Arrest from 1st December 2015 to 31st December 2018. Cases subject to a coronial or police investigation were excluded. Senior paramedics made decisions to cease resuscitation for 50 patients at the scene and these were reviewed in detail. Interviews were conducted with six senior paramedics, who provide telephone clinical support to on-scene paramedics.ResultsThe mean patient age was 78 years, the majority were male (n=30, 60%) had a witnessed collapse (n=37, 74%) and had a PEA rate below 50 (n=46, 92%). There were no significant associations between patient demographics and clinical or system factors. Themes arising from paramedic interviews included concepts that defined futility, the impact of decision-making, conflicting views and supportive clinical decision tools.ConclusionWhilst there were no significant associations between variables, senior paramedics balanced patient survival with resuscitation futility by interpreting key factors, such as patient demographics and clinical factors. This multifactorial approach questions termination of resuscitation based on clinical factors alone. It identifies a group of PEA patients, when resuscitation is not successful, may be considered for termination of resuscitation. Research using a larger sample is warranted to explore the validity of these criteria.AcknowledgementsThe authors would like to thank Professor Jonathan Benger for his valuable input and guidance as the educational supervisor for this study. J. Lynde and H. Trebilcock for quantitative data extraction. L. Tremayne and E. Freeman, qualitative data coding. Thank you to all the paramedics who participated.

scholarly journals Improving Cardiac Arrest Care in Ireland

2016 ◽  
Vol 1 (1) ◽  
Author(s):  
David Hennelly
Keyword(s):  
Cardiac Arrest ◽  
Emergency Medical Services ◽  
Ambulance Service ◽  
Standards Of Care ◽  
Collaborative Project ◽  
Life Project ◽  
The Past ◽  
The Republic ◽  
The One ◽  
Hospital Cardiac Arrest

<p>The National Ambulance Service (NAS) serves a population of almost 4.6 million people in the Republic of Ireland, the service responds to over 300,000 ambulance calls each year.  The NAS employs over 1,600 staff across 100 locations and has a fleet of approximately 500 vehicles. Emergency Medical Services attempt resuscitation on just under 2000 Out of Hospital Cardiac Arrest (OHCA) cases each year.</p><p>Over the past two years the National Ambulance service has engaged with both the country’s leading resuscitation experts and our international counterparts in a collaborative project focused on developing and expanding the National Ambulance Services response to out of hospital cardiac arrest. The One Life Project not only represents our commitment to improve standards of care it also represents our commitment to measure and publicly report on clinical outcomes of patients. </p>

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