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A Systematic Approach to EMS PowerPoint Presentation

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Description : Check out this medical presentation on Emergency Medical Services (EMS), which is titled "A Systematic Approach to EMS - Cardiac Arrest Management Improves Survival for Out of Hospital Cardiac Arrest", to know about a systematic approach to EMS and how proper cardiac arrest management may improve the chances of survival for out of hospital cardiac arrest.

Tags : Emergency Medical Services, EMS, Approach, Cardiac Arrest, Management

Published on : Aug 06, 2021 | Views : 1704 | Downloads : 4

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Slide 1-

A Systematic Approach to EMS Cardiac Arrest Management Improves Survival for Out of Hospital Cardiac Arrest Angelo Salvucci, MD, FACEP
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AMR Medicine: Lynn White, MS Ventura County EMS: Chad Panke, EMT-P Katy Hadduck, RN David Chase, MD Santa Barbara County EMS: Jennie Simon, RN Les Hugie, EMT-P Alexia Armenta, BS Gregory Shinn, BS Contributing Authors
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FINANCIAL DISCLOSURE: None UNLABELED/UNAPPROVED USES DISCLOSURE: None Presenter Disclosure Information
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Santa Barbara Co. 440,000 5 Hospitals 2 SRCs Ventura Co. 840,000 8 Hospitals 3 SRCs EMS: MPDS EMD BLS & ALS FD FR ALS Ambulance ROSC to SRC: TTM & PCI
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Presentation Slide Title
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“My fear is that they won’t make much of a difference. You have this information in the ether, but there’s no point if people aren’t doing it to patients.” Sam Parnia, MD Director, Resuscitation Research Stony Brook Hospital New York Times; December 7, 2015
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“WHAT” VS “HOW”
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OHCA Survival 1980-2008 Sasson C et al. Circ Cardiovasc Qual Outcomes 2010;3:63-81
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Disparities ROC: 12,000, OHCAs 10 systems Overall survival 3.0% - 16.3%, median 8.4% VF survival 7.7% - 39.9%, median 22.0% Increase from median to max would prevent 15,000 deaths Nichol: JAMA. 2008;300(12):1423-1431. Sanders: JAMA. 2008;300(12):1462-1463.
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Objective To determine if a comprehensive system of education, training, treatment protocols and quality improvement would affect survival of patients in sudden cardiac arrest.
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Cardiac Arrest Management (CAM) System of care: Commitment of all participants Evidence-based treatment protocols 10:1 compression/ventilation w/o pause BLS airway preferred Targeted, goal-directed education 60 minutes didactic Teamwork, Positioning, CPR (CC, BMV), ALS, ROSC Individual and team training: 120 minutes Mandatory minimum proficiency thresholds Organized explicit system of rescuer roles QI program with process and outcome measures
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Process Multidisciplinary Development Committee All EMTs and Paramedics in the EMS system were trained Santa Barbara: December 2012 Ventura County: December 2013 Cardiac Arrest Registry to Enhance Survival (CARES) utilized for data management and comparison. Patient populations studied: All cardiac arrests of presumed cardiac etiology Bystander-witnessed cardiac arrest with shockable first rhythm
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To maximize the number of cardiac arrest patients that return home to their families neurologically intact Goal
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HOW TO ACHIEVE THE GOAL: Assigned roles Rapid and accurate assessment Adequate work space Continuous high quality chest compressions Airway with synchronized ventilations Prompt defibrillation ALS: Vascular access with medications Resuscitation Management & Teamwork Recognition of ROSC Strategies
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Cornerstones of treatment: Assessment Patient Positioning CPR Continuous Chest Compressions Airway/Ventilation/Oxygenation Defibrillation Possible, but unproven value: Intubation Vascular access (IV/IO) Pressors (epinephrine) Antiarrhythmics (lidocaine, amiodarone) Back to Basics
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Continuous High Quality Chest Compressions Rate 112/Minute (metronome) Depth 2-2.5 Inches Full Chest Recoil Increases likelihood of successful defibrillation Maintains brain viability Strategy #4
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Competency-Based Training
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Process Measures QI
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RESULTS
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Cardiac Etiology – All Rhythms Survival to Hospital Discharge (%) 2012 2013 National CARES Santa Barbara County p=0.002
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Bystander-Witnessed Shockable 1st Rhythm Survival to Hospital Discharge (%) 2012 2013 National CARES Santa Barbara County P> 0.05
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2011-12 2013-1Q15 Post- CAM Pre- CAM 8.1 15.8 Cardiac Etiology – All Rhythms Survival to Hospital Discharge (%)
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2011-12 2013-1Q15 Post- CAM Pre- CAM 25.9 45.0 Bystander-Witnessed Shockable 1st Rhythm Survival to Hospital Discharge (%)
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National CARES Ventura County CAM 2009 2010 2011 2012 2013 2014 Cardiac Etiology – All Rhythms Survival to Hospital Discharge (%)
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National CARES Ventura County CAM 2009 2010 2011 2012 2013 2014 Bystander-Witnessed Shockable 1st Rhythm Survival to Hospital Discharge (%)
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Lessons Learned Engage entire system. Build interest. Insist on consistency. Will sell itself. Process improvements (organization, CPR) precede outcome benefits. Costs are modest.
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Conclusions Introduction of an organized Cardiac Arrest Management (CAM) program resulted in a significant improvement in survival. Simultaneous introduction of entire bundle of care resulted in more convincing single-step improvement.
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Conclusions Emphasis on early, continuous, high-quality chest compressions with infrequent low-volume ventilations. System to enable that: Clear and detailed protocols Assigned roles EMTs responsible for BLS Competency-based individual and team training Ongoing active data-driven QI
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Survivor Group