Response Times

Now theres a subject and a half. The time excludes the length of time a
person may have been down (but its still the reason that 'poor response
times are sited as a cause of asystole') prior to being discovered. The
decision by the findee to call for assistance and achieving a good location
for the attending resource to travel to.

Control rooms have access to prompts to be able to initiate guided
resuscitation over the phone to the caller (that's not to say that most
callers want provide BLS)and that commences at the end of questioning.

We of course need vehicles available (or a community responder), Services
cannot afford to place vehicles in every location, let alone within 6
minutes running time of each patient, and for every caller that wants to
attend hospital that is one less vehicle for this particular patient.

Throw in busy times, poor weather, sickness, shift changes, insufficeint
funding in the infrastructure (the local hospital got a lower star rating so
the funds go there). Who should be happy that high priority calls are
allowed NOT to be achieved 25% of the time

-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of dave.j.fletcher
Sent: 04 December 2004 18:38
To: [log in to unmask]
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.
>>
>>
>>
>
>
>
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