The Important Role EMS Plays in SCA Response
In 2015, the American Heart Association updated its Guidelines for CPR and Emergency Cardiovascular Care for SCA victims.
- Improving the recognition of SCA by 911 call takers and urging 911 call takers to instruct callers to begin chest compressions while awaiting EMS arrival.
- Providing high-quality CPR with minimal interruptions in chest compressions and with controlled ventilations. Beginning CPR with compressions rather than ventilations (C-A-B instead of A-B-C) to emphasize the primary importance of chest compressions and to decrease barriers to starting CPR.
- Establishing OHCA Systems of Care — including linking with community AED programs, coordinating with receiving hospitals to optimize post-cardiac arrest care, and measuring survival to hospital discharge.
- Implementing quantitative waveform capnography for intubated patients to monitor endotracheal tube placement and the quality of the resuscitation.
- Working as a team during resuscitation with defined roles and clear communication.
Improving EMS System Factors can Improve SCA Outcomes
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
Community SCA Response Planning Guide
While every community has a unique set of circumstances that may not allow for the commitment of resources that top-performing systems may have, similar results can be achieved.
Focusing on best practices does not mean cookie-cutter solutions. Incremental steps can be taken, starting with a number of possibilities including:
- Measuring OHCA at the basic level (e.g. ventricular fibrillation witnessed arrests)
- Improving CPR at the EMS level (e.g., implementing high performance CPR education at the EMT level)
- Implementing public-based CPR/AED education programs
- Providing 911 dispatchers with SCA recognition training and bystander CPR instructions
There is a correlation between the overall performance of an EMS system and SCA survival rates.
- The attributes of collaboration and measurement which contribute to good SCA outcomes also contribute to better EMS care in general
- Collaboration that’s required to improve SCA survival rates means connections between pre-hospital and hospital are strong, which has positive implications for the entire system
- Undertaking an effort to improve SCA outcomes can have a positive effect on the entire EMS system, in terms of building relationships, cultural changes, and an emphasis on performance and quality improvement