If you could Mike I'd be grateful.
As you are aware I have no interest in figures of 8 minutes for serious
calls but the requirement of achieving it does make those guys at the top
sit up and take notice. Now, a 4 minute response would make a difference!
I'm pretty sure that the only way we are going to reduce these times is by a
community responding and I'm not just referring to the countryside!
To quote Professor Douglas Chamberlain " Resuscitation in the community is a
community problem."
Regard
Dave Fletcher
----- Original Message -----
From: "Michael Bjarkoy" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Saturday, December 04, 2004 10:58 PM
Subject: Re: Defining who will not survive out of hospital cardiac arrest
> Hi Dave
> I think the figure for 2003 - 2004 is 75.4 for Cat A's in the Westcountry.
> The service produces figures each week in a bulletin and last week was
> 78.58% which is about the norm nowadays. Without doubt the addition of
> responders hitting these targets has a beneficial effect - exact figures I
> am not aware of but I am sure I could find out.
> Mike
>
> ----- Original Message -----
> From: "dave.j.fletcher" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Saturday, December 04, 2004 8:56 PM
> Subject: Re: Defining who will not survive out of hospital cardiac arrest
>
>
>> Mike
>> Do you know the percentage of your services' Cat As calls achievement are
>> as
>> the result of responders?
>> Dave
>> ----- Original Message -----
>> From: "Michael Bjarkoy" <[log in to unmask]>
>> To: <[log in to unmask]>
>> Sent: Saturday, December 04, 2004 7:14 PM
>> Subject: Re: Defining who will not survive out of hospital cardiac arrest
>>
>>
>>> Hi Dave
>>> I appreciate the asystole phenomenon for cardiac related problems are
>>> due
>>> to
>>> poor response times. I intimated at this as "AMI arrested patients are
>>> usually in VF in the first instance" but probably didn't reinforce that
>>> patient degrade into asystole rapidly as I thought this was taken for
>>> granted - I should never assume should I. Apologies for not making this
>>> point clearer and glad that you picked up on it.
>>>
>>> Different areas have different response times. Where I am based at
>>> present
>>> (Falmouth, Cornwall) we are hitting our Cat As on average 92% of the
>>> time
>>> in
>>> 8 minutes and are indeed finding VF arrests and not PEA/Asystole. For
>>> areas
>>> where the response time is over 8 minutes on a consistent basis I accept
>>> that 'cardiac' asystole arrest is the rhythm that would be seen in the
>>> majority of cases.
>>>
>>> The focus of my posting was to identify the shortfall in education for
>>> paramedics in areas which we may have a degree of success - arrests for
>>> non-cardiac causes. To achieve this we need the tools and authority to
>>> do
>>> the job and need to be specialists not generalists.
>>>
>>> As a side issue, Dr.Michael Copass has stood down from the role as
>>> Med.Dir
>>> for Medic One the county Medical director is now Mickey Eisenberg and
>>> KCM1's
>>> medical director is Tom Rea. So there may be changes afoot in Seattle.
>>>
>>> regards
>>>
>>> Mike
>>>
>>>
>>>
>>>
>>> ----- Original Message -----
>>> From: "dave.j.fletcher" <[log in to unmask]>
>>> To: <[log in to unmask]>
>>> Sent: Saturday, December 04, 2004 6:38 PM
>>> Subject: Re: Defining who will not survive out of hospital cardiac
>>> arrest
>>>
>>>
>>>> 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.
>>>>>>
>>>>>>
>>>>>>
>>>>>
>>>>>
>>>>>
>>>>> --- This message has been thoroughly scanned by and is certified virus
>>>>> free by MacAce.net. --- avgxmacgbh
>>>>>
>>>>
>>>>
>>>
>>>
>>>
>>> --- This message has been thoroughly scanned by and is certified virus
>>> free by MacAce.net. --- avgxmacgbh
>>>
>>
>>
>>
>
>
>
> --- This message has been thoroughly scanned by and is certified virus
> free by MacAce.net. --- avgxmacgbh
>
|