I’d boil it down to a few key components:
- Bystander competency
- Provider skill
A measurable component of a save, timing plays a huge factor when you look at response times, plus it kind of feeds luck when the crew responds quickly and gets there fast or if they happen to be close by. Any way to shorten the downtime of the patient is a component of good timing.
By FAR one of the most important parts of any save. 88 percent of cardiac arrests occur at home, and of those only 32 percent recieve any type of bystander CPR prior to EMS arrival. 12 million adults receive CPR training annually (which I’m assuming includes a few million healthcare providers as well) so the instance that a bystander witnesses an out of hospital out of home cardiac arrest, and a viable save occurs, it’s usually because of bystander care prior to arrival, be it layperson or some sort of non-healthcare uniformed personnel.
In the absence of bystander CPR, it falls back to the skill of the provider. Sadly, most of the time the skill of the a healthcare provider out of hospital is a grab bag. Overall, I’d say the delivery over the profession is “so-so.”
ALS interventions are dependent upon the proper application BLS skills before deployment. Pharmaceuticals haven’t really been proven to provide much benefit to survival rates except in very narrow circumstances.
How Do We Get More
My suggestion? Full court press.
Technology can allow us to provide more opportunities to make being in the right place at the right time a big possibility. Most people don’t like SSM (System Status Management) in any capacity, but when used properly, we can make timing less of an issue and put EMS on the scene with less time between the report of the emergency and patient contact.
I like what Illinois has done with CPR training in schools. Improving SCA (Sudden Cardiac Arrest) survival rates and well as general wellness is in the interest of the public at large, so CPR and stroke recognition education will improve the chances that EMS is activated in a timely manner at the outset of these occurrences as well as what bystanders can do while the await professional arrival.
So what do we do about improving provider delivery? Many services have already began programs similar to Medic in Charlotte, NC to increase survival rates through training and educating their providers. Their experience unlatched resuscitation efforts from the Pit Crew concept and created a new idea based on the number of compressions provided and reducing delays in defibrillation.
The elusive “better than average” survival rates are out there, but it takes commitment for the service and community to take SCA survival seriously.