KING COUNTY – Survival from out-of-hospital cardiac arrest is at an all-time high in King County, and a new method of resuscitation used by emergency medical responders in King County may be the reason. Since the protocol was adopted in 2005, survival rates jumped to 46% from 33% for the period of 2002 through 2004.
These findings were published as part of a study released today in Circulation: Journal of the American Heart Association. The new guidelines, which place more emphasis on CPR (chest compressions and ventilations), reflect the recommendations published by the American Heart Association in 2005.
“King County is known as one of the best places in the country to receive emergency medical care, and we have set a new standard with this survival rate,” said King County Executive Ron Sims. “Our innovation and cooperative effort is providing better emergency care and saving lives.”
Cardiac arrest is a dangerous, acute event in which the heart rhythm often suddenly becomes erratic, rendering the heart unable to effectively pump blood. Victims quickly collapse and die unless they are resuscitated within a few minutes.
“The new way of thinking is that emergency medical responders should administer shocks from a defibrillator only at key times in order to provide more CPR during the resuscitation,” said Thomas Rea, M.D., M.P.H., Medical Director for King County Medic One, lead author of the study and associate professor of medicine at the University of Washington School of Medicine based at Harborview Medical Center. “The idea is that the CPR prepares the heart to better accept the shock and have the shock work.”
Prior to 2005, traditional guidelines for emergency medical technicians (EMTs) called for some CPR, but emphasized giving shocks from a defibrillator.
The new guidelines call for emergency medical technicians to give a single shock from a defibrillator followed immediately by two minutes of CPR, beginning with chest compressions, compared to the old guidelines which called for repeated shocks and a pulse check before starting CPR.
To test whether the new approach improves survival compared to the traditional protocol, Rea and colleagues trained King County emergency medical technicians to provide the new protocol and re-programmed defibrillators to support the new guidelines. “The change in the protocol required substantial collaboration and effort by emergency medical responders and agencies across King County,” said Rea. “This is a shining example of how everyone is working together to deliver the very best emergency care possible.”
To determine whether EMTs were able to focus more on CPR, Rea and colleagues looked at how quickly they started providing CPR after a shock with the previous protocol versus the new recommendations. They found that the median interval between the first shock and the onset of CPR dropped from 28 seconds to 7 seconds.
The King County study is part of an accumulating body of scientific evidence suggesting the importance of EMTs providing high-quality CPR, particularly chest compressions, with minimal interruptions to increase survival rates for cardiac arrest.
“These are not definitive results, but our findings are encouraging,” said Rea. “Based on what we know now, changing to the new guidelines should be a high priority for other Emergency Medical Systems across the country.”
Electronic copies of the published study are available to media upon request. For more information on Emergency Medical Services in King County, visit http://www.metrokc.gov/health/ems.
Dr. Rea's article as published in Circulation: Journal of the American Heart Association.
The SPHERE (Supporting Public Health with Emergency Responders) pilot project was deemed a success and will go countywide starting in January 2007.
The goal of the pilot was to determine the best way to communicate vital health information to patients - information that is routinely collected during an EMS call. Patients with high blood pressure and/or high blood sugar were specifically targeted as determined by EMTs.
The pilot project was conducted in the South King Fire and Rescue, Kent Fire Department, and Port of Seattle Fire Department jurisdictions. Auburn Fire Department served as a control community. Kent and Port of Seattle EMTs provided personalized 'alerts' directly to patients at the scene while patients in South King received a letter from the EMS office two weeks after the EMS call. The alert and letter options both urged the patient to follow up with a health care professional to recheck blood pressure or blood sugar.
Patients were called one month after the alert or letter was provided to determine the actions taken by the patient. The alert was found to be the more effective method. In addition, 65% of patients said that information provided by the fire department EMTs prompted them to seek follow-up medical care. And 94% of patients said they were very satisfied to receive the information and said the program was an excellent service.
Due to this positive response, the program will go countywide beginning in January 2007. All CBT instructors have been informed of the new program and EMTs have been trained on the inclusion and exclusion criteria for patients. The EMS Division will contact approximately 1,000 patients during the upcoming year to determine follow-up actions they have taken.
November 1, 2006 -- EMTs, paramedics, and emergency dispatchers in Seattle and King County participate in a lot of studies. I think it safe to say that more EMS related research has eminated from this community than any other place in the world. I know this means extra training, extra record keeping, extra time, and extra effort. But it is well worth it. What we learn helps establish new standards for resuscitation and EMS care.
Currently we are participating in the following research:
- the Resuscitations Outcome Consortium Trial (one of ten sites in North America selected for this federally funded consortium)
- the DART Trial - (dispatcher assisted telephone CPR -- regular CPR versus chest compression only instructions)
- identification of patients with high blood pressure and high blood sugar by EMTs (SPHERE project)
- hypothermia for post resuscitated patients
- benefit of heart attack alerts distributed to older adults
- use of troponins in the identification of acute coronary syndrome patients
- benefit of changes in CPR and defibrillation protocols
- cardiac arrest blood study
In the past our community has studied:
- EMT defibrillation
- widespread citizen CPR training
- innovative ways to teach CPR
- dispatcher assisted telephone CPR
- public access defibrillation
- the benefit of prehospital thrombolysis
- 12-lead electrocardiograms
- bretylium versus lidocaine
- high dose epinephrine
- chest compression devices
- EMT glucometry
- EMT pulse oximetry
- EMT online continuing education
- computer-based training
- alternate transport destinations for patients
- compelling reasons for termination of CPR
- nurse advice lines for callers to 911
- AEDs in homes of high-risk patients
- CPR prior to defibrillation
- brain protectants following cardiac resuscitation
On behalf of all the medical directors, program administrators, and researchers in Seattle and King County, let me offer a most sincere and heartfelt thanks. -- Mickey Eisenberg, MD, PhD
