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
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>>>>
>>>
>>>
>>
>>
>>
>> --- This message has been thoroughly scanned by and is certified virus
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>
>
>
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