Learn how to implement best practices for EMS programs
A cardiac arrest registry is the essence of measurement. Continuous measurement will determine if implementing changes cause improvements and help you identify further steps for improvement. A registry measures more than whether the patient lives or dies, but all aspects related to the care.
Dispatchers are the critical first link in the Chain of Survival. Many emergency dispatch centers have protocols in place, but fail to offer Telephone CPR (T-CPR). Identifying cardiac arrest and providing T-CPR to support bystanders has been shown to improve outcomes.
High performance CPR is high quality team performance. Not only is the time interval from collapse to onset of CPR predictive of survival; the quality of CPR is just as important. Ongoing training and quality improvement programs are key recommendations for ensuring high performance CPR.
With survival falling 10 percent for every minute of delay in CPR and defibrillation, rapid dispatch of emergency services can add 5-10 percent to a community's survival rate without additional staffing or resources. It is essential to have a clear list of incidents/symptoms that are used to initiate rapid dispatch and to measure dispatch time. The first mention of a critical symptom mandates immediate dispatch.
The defibrillator recording device creates a digital record that provides useful information to reconstruct events. Second-by-second data about cardiac rhythm and CPR synchronized with digital voice recording allows the full picture of the cardiac event to be reviewed and learned from.
Public safety or other first responders such as police and other security personnel have the potential to increase survival rates from cardiac arrest. Some communities embracing the use of defibrilltion by police have seen dramatic improvements in survival. In order for this to be successful, there must be total police and EMS support and every police officer should be taught in person, rather than video or web-based training.
Cardiac arrest response is a team effort. Smart technologies are useful to alert volunteer responders of a nearby cardiac arrest and identify the location of the nearest AED. The potential of a volunteer rescuer arriving at the scene prior to EMS increases the probability of success.
A population universally trained in CPR has the potential to double survival rates. In many countries, mandatory training in CPR has been part of school curricula for many years. In the United States, 34 states have made CPR training a requirement for high school graduation. That means more than 2 million students are trained in CPR every year.
An annual EMS performance report is the best way to determine accountability to the community. A system that is transparent in its performance shares vital information. The information can be used to promote the organisation if the results are positive. If the results are not positive, the information can be used to motivate community leaders and politicians to invest in efforts to improve.
Creating and nurturing a culture of excellence is the most difficult step. A Cuture of Excellence is an implicit awareness perceived by members of the organization that high expectations and high performance define the standard of care. It requires leadership with a determined vision and a long-term plan. Maintaining a Culture of Excellence demands ongoing quality improvement.