Strategies to Prevent Post-EMS Contact Cardiac Arrest and Improve Outcomes in Crashing Patients
- 2 mins“Critical care is a type of care, not a location.” -Dr. Peter Safar
An acutely ill, decompensating (or “crashing”) patient must be gotten to a hospital as soon as possible, with interventions performed en route. There is no time to delay on scene; with these patients, we should “load and go.” Right?
I had the privilege of working as a data analysis intern with the City of Pittsburgh Bureau of EMS from 2017 to 2018 while finishing my undergraduate studies in statistics at Carnegie Mellon University. During my internship, I worked exclusively with then-Patient Care Coordinator Mark Pinchalk on a variety of analyses (including assessing an education bundle’s impact on paramedic performance). Our largest focus was on improving outcomes for “crashing patients,” or patients in acute distress and non-traumatic* shock. Of particular importance was identifying interventions to reduce the amount of post-EMS-contact cardiac arrests, where a patient’s heart stopped after the arrival of paramedics.
I assisted with a retrospective analysis of these “crashing patients” using electronic patient care reports and reviewed the effect of Bundles of Care education modles, seen by paramedics during training and continuing education, to determine which interventions were significantly correlated with improved outcomes. We identified several factors which can contribute to positive outcomes, including the application of physiological monitoring (including EKG and end-tidal CO2 monitoring), rapid assessment and management of “ABC” issues (including CPAP, BVM, or advanced airway interventions), early IV or IO access, maximal medical therapy, and patient movement to the ambulance only after the completino of these interventions. Additional, respiratory-specific and cardiac-specific interventions were also examined. Lastly, I created the visualizations and keynote (below) for Mark’s presentation regarding this analysis at the Pennsylvania Emergency Health Services Council’s 41st Annual Pennsylvania EMS Conference.
* We excluded patients with complaints related to traumatic shock, as the generally accepted best intervention for these patients is simply “diesel therapy”, or transporting the patient rapidly to a trauma center.
Tom Goode
Data Scientist & EMS Researcher