we are improving outcomes - resuscitation council (uk) · • monash university (eoi still open)...
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We are improving outcomes
Assoc Prof Tony Walker ASM Chief Executive Officer
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►Serving 5.5M Victorians
►5000 paramedics and volunteers and integrated adult medical retrieval service
►230 road response locations, 5 helicopters and 4 fixed wing aircraft
►More than 900,000 case per annum
►Single Triple Zero (000) emergency number
►Medical Priority Dispatch System
►Two tier response (ALS and Intensive Care Paramedic)
Ambulance Victoria
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Out of Hospital Cardiac Arrest (OHCA) ►30,000 cardiac arrests in Australia each year
(more than 5800 in Victoria)
►Typically 10% or less survive
►Time is of the essence
►Chances of neurologically intact survival greatly increase where:
Bystander witnessed
EMS system activated promptly
CPR and Defibrillation provided quickly
Effective system of care exists
• .
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OHCA System of Care – ‘Chain of Survival’
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►Establish a Cardiac Arrest Registry (You can’t improve what you don’t measure)
►Begin telephone CPR (T-CPR) with ongoing training and QI
►Begin high Performance EMS CPR with ongoing training and QI
►Begin rapid dispatch to suspected cardiac arrest
►Measure professional resuscitation via defibrillator recording (and voice if possible)
►Begin an AED program for first responders
►Use smart technologies to extend CPR and public access to notify nearby volunteers
►Make CPR and AED use mandatory in schools and the community
►Work towards accountability – submit annual reports to the community
►Work towards a culture of excellence
Improving Survival from Out of Hospital Cardiac Arrest
Improving survival from out-of-hospital cardiac arrest. A call to establish a global resuscitation alliance. Utstein Meeting June 2015
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Victorian OHCA System of Care ►Cardiac Arrest Registry underpinning research and
continuous improvement
►Dispatcher assisted T-CPR
►4 Steps for Life CPR & AED training program
►Public Access Defibrillation program
►Automated External Defibrillator Registry
►Firefighter and Community co-responder programs
►Evidence based clinical practice guidelines
►Transport to PCI capable hospital where available
►Annual report and reported KPIs
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Outcomes in 2015-16
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Bystander CPR
Source: 2015-16 VACAR Annual Report
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Bystander CPR
Source: 2015-16 VACAR Annual Report
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Early Defibrillation
Source: 2015-16 VACAR Annual Report
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Where you are transported to makes a difference
Source: 2015-16 VACAR Annual Report
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Adult survival from all cause cardiac arrest
Source: 2015-16 VACAR Annual Report
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Adult survival from all cause cardiac arrest
Source: 2015-16 VACAR Annual Report
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Adult survival from shockable rhythms
Source: 2015-16 VACAR Annual Report
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Source: 2015-16 VACAR Annual Report
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Benchmarking
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Risk adjusted odds of survival (EMS treated)
2015-16 VACAR Annual Report
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Risk adjusted odds of survival (Shockable EMS Rx)
2015-16 VACAR Annual Report
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Long term outcomes
Source: 2015-16 VACAR Annual Report
►85% discharged home
►13% to rehabilitation
►2% to nursing homes
►Follow-up at 12 months found:
74% who worked prior to OHCA returned to work (94% to same role)
Good Health Related Quality of Life (SF-12, GOS-E and EQ-5D)
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Summary ►61% of patients witnessed to collapse by a bystander received bystander
CPR, compared to 36% of patients 10 years ago.
►Patients receiving bystander CPR were 11 times more likely to be found in a shockable rhythm and twice as likely to be discharged alive (12% vs 6%)
►Patients are twice as likely to survive to hospital discharge in 2015-16 compared to 2002-03 (three times if in a shockable rhythm)
►53% patients in a shockable rhythm obtain ROSC and 31% discharged alive
►74% OHCA survivors back at work at 12 months
►OHCA survivors report good health related quality of life at 12 months
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Where to from here ….. ►Improved access to AEDs in the community
►Improved CPR in low uptake communities
►High performance (pit-crew) CPR
►Resuscitation monitoring and feedback
►Targeted co-responder expansion in rural areas
►Aeromedical transport f rural patients to PCI capable centres
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Prehospital Emergency Care NHMRC Centre of Research Excellence 2017-2021 The right care, in the right place, at the right time
• 3 Full-time PhD scholarships ($33,313/year tax free for 3-years)
• Monash University (EOI still open) • Flinders University (EOI still open) • Curtin University (already filled)
• Chief Investigators: Prof Peter Cameron, Prof Judith Finn, Prof Stephen Bernard, Prof Hugh Grantham, Prof Karen Smith, Prof Daniel Fatovich, A/Prof Glenn Arendts, A/Prof Janet Bray, Dr Dion Stub, Prof Gavin Perkins
• Associate Investigators: A/Prof Paul Bailey, Mr Deon Brink, Dr Cindy Hein, Dr Judy Lowthian, Dr Ziad Nehme, Dr Cathrin Parsch, Dr Tony Smith, Mr Michael Stephenson, Prof Just Stoelwinder, Dr Teresa Williams
@prehosp_CRE
Contact: Prof Peter Cameron [email protected] Dr Janet Bray [email protected]
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Contact Details Email: [email protected]
Twitter: agwalker01
Web: www.ambulance.vic.gov.au
Acknowledgements Prof Karen Smith, Prof Stephen Bernard and all our dedicated researchers and responders
It takes a system to save a life!