Ensuring that local dispatch centers provide the most effective dispatch-assisted CPR instruction is the most effective way to improve bystander CPR in any community. See also Rea, TD et al: Dispatcher assisted cardiopulmonary resuscitation and survival in cardiac arrest. Circulation; 2001;104(21):p2513-6.
Circulation 2012: A Scientific Statement from the American Heart Association on Pre-Hospital Arrival, is available free of charge here.
EMS systems should train to provide high-performance resuscitation. This includes a well-planned, well-rehearsed, often choreographed and flawlessly executed approach to caring for the victim of SCA at the scene. The goals of high performance resuscitation include the provision of continuous, high-quality CPR, rapid defibrillation, non-aggressive airway placement, and the use of end tidal CO2 wavef-rm to both confirm tube placement and monitor the quality of the resuscitation efforts. Systems should have clear termination of resuscitation protocols, which allow the patient to receive the most complete care possible at the scene prior to termination of efforts.
Following the resuscitation, a post-event review should occur as soon as possible using all available quality improvement tools available. A review of system dispatch times allow crews to determine if quicker response is possible. Review should also include a determination of whether or not bystander CPR was provided by dispatch evaluation of CPR fraction and quality of compressions if possible, evaluation of ventilation rate and end tidal CO2 waveforms and appropriateness of all treatments provided in the field. Having crews and medical directors implement adjustments and improvements to these system components following review of the event constitutes a high performance resuscitation program.
Go to Seattle King County’s Resuscitation Academy for many resources, including a section on high performance CPR.
Additionally, The American Heart Association Guidelines for CPR and ECC are available online.
Sharing Best Practices
Improving EMS system factors can increase outcomes of SCA. These factors include:
- Time to CPR
- Dispatcher-assisted telephone CPR
- Recognition of agonal breathing
- High-performance resuscitation by EMS
- Community CPR training
- Time to defibrillation
- Rapid dispatch
- Community PAD
- Police defibrillation
Helpful links to resources and organizations
- EMS Resuscitation Academy: The renowned Seattle Medic One and King County EMS Resuscitation Academy offers four days of intensive training
- EMS Online: Continuing education resource from Seattle/King County EMS that offers online, interactive courses and content for emergency medical service professionals
- Wake County EMS: Nationally recognized for its cardiac arrest save rate, Wake County (N.C.) Office of EMS is a pioneer in induced hypothermia by EMS protocol
To improve SCA survival rates within a community, the three levels of response – bystander, prehospital and hospital – must be connected and coordinated.