Mike
I think you will find that the majority of asystole we see in the community
is the result of poor response times.
An 8 minute call to arrival time is more specifically a call to monitoring
time of 12 minutes. It's hardly surprising we see so little coarse VF on
arrival!
Regards
Dave Fletcher
--- Original Message -----
From: "Michael Bjarkoy" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Saturday, December 04, 2004 1:26 PM
Subject: Re: Defining who will not survive out of hospital cardiac arrest
> Hi Rowley
> I have been thinking about this for a while and here are a few
> observations.
>
> AMI arrested patients are usually in VF in the first instance. Non
> shockable
> arrests are often (but not always) due to other mechanical causes such as
> trauma, OD, hypovolaemia (basically the 4 Hs and 4Ts).
>
> If we accept that in a hospital setting the patient has a better prognosis
> for the non-shockable side of the arrest flowchart than in a prehospital
> setting we should not just accept that it is a fact of life (or death) but
> challenge the flaws in the system which allows this to be.
>
> Since the ambulance dispute in the late 1980s we have had to accept the
> notion that there must be one paramedic on each ambulance. The result is
> mediocrity in education and application of care. If look toward a system
> (Medic One, Seattle) where success for non-shockable arrests are better we
> could learn some of valuable points.
> 1. Educate paramedics along side physicians in hospital by experienced
> physicians
> 2. Reduce paramedics to less than 20% of the workforce
> 3. Have 2 paramedics on a Medic Unit
> 4. Release paramedics from protocols and guidelines and allow autonomous
> practice
> 5. Reduce the type of incidents that paramedics go to ALS only
> 6. Give them the range of drug and invasive skill interventions that
> reflect
> an A&E dept
> 7. Offer a comprehensive in hospital continuing education
>
> If the above is implemented then the success rates from out of hospital
> arrests for non-VF/VT patients will increase.
>
> Now that is said, I do realise that it will never happen in the UK as
> there
> are too many political and medical reasons which would challenge this
> concept.
>
> On my return from one of my exchanges to Seattle I was asked by a medical
> director of an ambulance service what, if anything, I would like to see
> implemented into the local ambulance service. I replied - paralytics for
> airway management. The blood drained from the medical directors face as he
> stammered out the statement "I don't think we are currently politically or
> clinically ready for that sort of thing". To which I replied "Yes....
> Seattle have only been doing this for 30years. I suppose its a bit too
> soon
> for us".
> And there in lay the problem. The medical community are too conservative
> here in the UK (and Europe) for such concepts and until it does change we
> will never witness positive outcomes for such patients.
>
> Mike Bjarkoy
>
>
> ----- Original Message -----
> From: "Rowley Cottingham" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Monday, November 22, 2004 9:06 PM
> Subject: Defining who will not survive out of hospital cardiac arrest
>
>
>> Ambulance paramedics in Sweden prospectively surveyed 38 750 out of
>> hospital
>> cardiac arrests from 1990 to 2001. In 16 712 patients who were in
>> non-shockable
>> rhythm (that is, not ventricular fibrillation) and in whom
>> cardiopulmonary
>> resuscitation was attempted before the paramedics' arrival, overall
>> survival to one
>> month was 1% compared with 8% in patients in a shockable rhythm. None of
>> the
>> non-shockable group survived if the arrest was at home and not
>> witnessed, if there
>> was no bystander cardiopulmonary resuscitation, and if it took more than
>> 12 minutes
>> for the ambulance to arrive. No patient over 80 survived when the delay
>> was more
>> than eight minutes. The authors say their findings provide evidence on
>> which to
>> base non-resuscitation protocols, and they note the possible adverse
>> psychological
>> impact on families of any such lack of action.
>>
>> Heart 2004;90: 1114-8
>>
>> Why was this not done here? And now it HAS been done will we implement
>> it?
>>
>> Rowley.
>>
>>
>>
>
>
>
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