Download HS 12-035 - County of Simcoe

COUNTY OF SIMCOE
ITEM FOR:
HUMAN SERVICES COMMITTEE
SECTION:
Paramedic Services
ITEM NO.
HS 12-035
MEETING DATE:
March 13, 2012
SUBJECT:
Paramedic Services – Cardiac Arrest Research Study and Patient
Survival
RECOMMENDATION:
THAT Item HS 12-035, regarding Paramedic Services – Cardiac Arrest Research Study and
Patient Survival, be received for information.
BACKGROUND:
The County of Simcoe Paramedic Services has been participating in two (2) research studies
under “RESCU,” the pre-hospital research arm of St. Michael’s Hospital, and the University of
Toronto Division of Emergency Medicine. The two (2) studies are entitled, “Predict” and “ROC”
(Resuscitation Outcomes Consortium).
Predict Study
The Predict Study was an observational study with the objective of developing a comprehensive
web-based database to look at the current standard of care offered to Acute Coronary Syndrome
(heart attack) patients in the Province of Ontario, and to look at advantages of certain types of
patient management. The Predict study included all patients who were treated with the
medication Nitroglycerine based on a complaint of cardiac chest pain. The County of Simcoe
Paramedic Services enrolled 1,204 patients from October 8, 2008 to December 31, 2010 in this
study. An analysis and research paper will result from this work to demonstrate the patient impact
of varying ways of managing patients with heart attacks.
Resuscitation Outcomes Consortium (ROC)
“Epistry” is the database that assists “RESCU” to define the incidence and outcomes of out-ofhospital Cardiac Arrest and life-threatening traumatic injury. The County of Simcoe Paramedic
Services has been contributing to Epistry since 2005 with a total of 4,494 patients enrolled to the
end of December 2011. The breakdown of these patient types is as follows:
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221 patients with Cardiac Arrest due to trauma;
2,985 medical Cardiac Arrests;
1,288 life threatening trauma patients.
The Epistry database provides us with valuable clinical and operational performance feedback on
every Cardiac Arrest that our staff attends. This feedback includes:
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Cardio Pulmonary Resuscitation quality;
Return of spontaneous circulation;
March 13, 2012
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Human Services Committee HS 12-035
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Number of patients who had valid Do Not Resuscitate Orders (DNRs);
Number of patients that had resuscitation attempted;
Number of patients discharged from hospital;
Pediatric versus adult arrests;
Witnessed versus not witnessed arrests;
Bystander Cardio Pulmonary Resuscitation rates;
Public Access Defibrillator usage in the community;
Breakdown of different presenting heart rhythms (Ventricular Fibrillation / Ventricular
Tachycardia, Asystole, Pulseless Electrical Activity);
Call response intervals.
Provision of some of the above feedback to responders has been proven to enhance performance
and increase survival rates. This is illustrated with the efforts surrounding Cardiac Arrest. Every
Cardiac Arrest is reviewed for specific performance of Cardio Pulmonary Resuscitation process
and Defibrillation protocols with the results fed back to the individuals involved on the call
(Currently almost exclusively Paramedics within the County of Simcoe). The information on this
performance, as well as the defibrillator data is submitted to a major international research
initiative aimed at enhancing survival rates.
% Survival to Discharge
9%
8%
7%
6%
5%
4%
3%
2%
1%
0%
2006
2007
2008
2009
2010
2011
The increase in survival is encouraging, though it is important to understand that the number of
Cardiac Arrests is relatively small, making such statistics volatile. This survival rate has resulted
in 57 people being discharged from hospital over the last 3 years after suffering a cardiac arrest.
We know, based on statistics from other Emergency Medical Services participating in the
Research Outcomes Consortium that we can increase our survival rate through the engagement of
all responders to cardiac arrests. As outlined in previous reports the County of Simcoe Paramedic
Services continues to work with the Base Hospital and local Emergency Services to encourage
participation in quality review and feedback with a view to enhancing performance and
increasing the rate of survival from cardiac arrest. To date, 6 fire services and 1 police service
are engaged in the cardiac arrest quality assurance program with one service under the
Sunnybrook Centre for Prehospital Medicine and the remaining services with the County of
Simcoe Paramedic Services Public Access Defibrillation Program.
March 13, 2012
Human Services Committee HS 12-035
Page 3
DISCUSSION:
The County of Simcoe Paramedic Service is engaging in a compression ventilation strategy study
to compare cardiac arrest survival after continuous chest compressions versus standard American
Heart Association recommended cardiopulmonary resuscitation with interrupted chest
compressions. This study is called the Continuous Chest Compression Study.
There are two arms to this study which are the control group & the intervention group. The
control group represents the American Heart Association standard of thirty compressions to two
ventilations (30:2). The intervention group is ten compressions to one ventilation (10:1). Seattle,
Washington has been providing cardiopulmonary resuscitation utilizing the 10:1 ratio for the past
7 years and has the highest survival rate from cardiac arrest in North America. A randomized
control trial has never been done to prove that this intervention strategy is what made the
difference in combination with their other initiatives.
Study Approval Process:
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Sunnybrook Health Sciences Centre Research
 Ethics Board Approval, May 11, 2011
St. Michael’s Keenan Research Centre
 Ethics Board Approval, April 20, 2011
County of Simcoe Executive Committee
 Meeting December 14, 2011 & supported
Ministry of Health Sign-off
 Submission prepared & submitted Dec 13, 2011
 Letter of support received January 25, 2012 (Attached as Schedule 1)
All of the Paramedics have received the necessary training to commence this study scheduled for
January 31, 2012. There is no additional infrastructure required to support this study.
The County of Simcoe Paramedic Services continues to play a role in the study and development
of clinical research outcomes driving patient survival higher. Paramedic Services continues to
provide leadership in the development of systems approaches to out of hospital cardiac arrest and
is committed to improving patient outcomes.
FINANCIAL ANALYSIS:
There are no financial implications to this Item.
SCHEDULES:
The following schedule is attached and forms part of this Item.
March 13, 2012
Human Services Committee HS 12-035
Page 4
Schedule 1 - MOH-LTC Approval.
Schedule 1.pdf
PREPARED BY: Andrew Robert, Director and Chief, Paramedic Services
APPROVALS:
Jane Sinclair, General Manager, Health and Emergency Services
Lealand Sibbick, Deputy Treasurer
Mark Aitken, Chief Administrative Officer
Date:
February 25, 2012
March 1, 2012
March 5, 2012