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A new model for cardiac arrest treatment

Essie Reed-Schrader, MD

By ESSIE REED-SCHRADER, MD

Watching emergency medical professionals race to save a life can be thrilling – and a little frightening. Providing potentially lifesaving support to a person in need can be even more intimidating.

But newly established guidelines in Pennsylvania are not only empowering emergency medical technicians and paramedics to save lives in the field but also educating the public that good Samaritans can be the first line of defense against cardiac arrest.

Cardiac arrest is loss of heart function, meaning the heart has stopped beating or is beating so inefficiently that it can’t provide blood to the rest of the body.

In the past, EMTs and paramedics were taught to immediately take a cardiac arrest patient to the hospital, particularly in a case when the patient’s heart has stopped beating. This “scoop and run” model grew out of the belief that simply getting patients to hospitals as quickly as possible would help save lives.

Generations of EMS providers have adhered to this philosophy. Popular media, from TV to Hollywood blockbusters, has sensationalized the image of cardiac arrest patients being miraculously saved on arrival to the hospital.

The science paints a very different picture.

Research consistently demonstrates patients who suffer an out-of-hospital cardiac arrest almost never survive if their heart has not been restarted at the scene.

Based on this knowledge, the Pennsylvania Department of Health has updated EMS protocols to care for those suffering a cardiac arrest. Educating our patients and community about this change is our goal at Geisinger – because it will lead to improved survival rate and better quality of prehospital care for cardiac arrest patients in our community.

The most notable change is the instruction to resuscitate on scene rather than immediately taking patients to the hospital. Moving the patient right away keeps EMTs and paramedics from performing lifesaving interventions, like CPR and defibrillation, quickly enough to improve survival chances. Transporting immediately disrupts the performance of high-quality CPR, and interrupted CPR is linked to lower survival rates.

We are fortunate to have early adopters of this practice in the Geisinger EMS system and among our community EMS partners. Geisinger’s EMS medical directors are stressing the importance of this change.

Members of our community can also improve cardiac arrest outcomes. It’s uncommon for bystanders to give patients CPR before the ambulance arrives. Without strengthening this weak link in the chain of survival, the odds are lower that our EMS providers will be able to revive cardiac arrest patients. That’s why we are encouraging our community members to perform CPR in emergency situations. Even if it’s not performed perfectly, any CPR is better than none at all.

Community members who’d like to learn CPR can take classes hosted by Geisinger. So-called “good Samaritan laws” offer legal protection to untrained members of the public who try to administer aid in an emergency with the sole intent of trying to save a life.

Changes like this don’t come easily. Seeing an EMS crew providing resuscitative measures in public may cause anxiety. Though it shouldn’t be taken lightly, public discomfort is a consequence emergency medical professionals are more than willing to endure – because immediate resuscitation efforts are critical to the survival of cardiac arrest patients. This dramatic shift in philosophy will require coordination among our EMS providers, our fire department partners, local hospital teams and people in the communities we serve. We’ll work to refine collective efforts and educate everyone involved. Because better health is possible when communities come together to make it happen.

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