IntroductionOut-of-hospital cardiac arrest (OHCA) is a common, life-threatening event encountered routinely by first responders, including police, fire and emergency medical services (EMS). Current ...literature suggests that there is significant regional variation in outcomes, some of which may be related to modifiable factors. Yet, there is a persistent knowledge gap regarding strategies to guide quality improvement efforts in OHCA care and, by extension, survival. The Enhancing Prehospital Outcomes for Cardiac Arrest (EPOC) study aims to fill these gaps and to improve outcomes.Methods and analysisThis mixed-methods study includes three aims. In aim I, we will define variation in OHCA survival to the emergency department (ED) among EMS agencies that participate in the Michigan Cardiac Arrest Registry to Enhance Survival (CARES) in order to sample EMS agencies with high-survival and low-survival outcomes. In aim II, we will conduct site visits to emergency medical systems—including 911/dispatch, police, non-transport fire, and EMS agencies—in approximately eight high-survival and low-survival communities identified in aim I. At each site, key informant interviews and a multidisciplinary focus group will identify themes associated with high OHCA survival. Transcripts will be coded using a structured codebook and analysed through thematic analysis. Results from aims I and II will inform the development of a survey instrument in aim III that will be administered to all EMS agencies in Michigan. This survey will test the generalisability of factors associated with increased OHCA survival in the qualitative work to ultimately build an EPOC Toolkit which will be distributed to a broad range of stakeholders as a practical ‘how-to’ guide to improve outcomes.Ethics and disseminationThe EPOC study was deemed exempt by the University of Michigan Institutional Review Board. Findings will be compiled in an ‘EPOC Toolkit’ and disseminated in the USA through partnerships including, but not limited to, policymakers, EMS leadership and health departments.
Background:
Community-engaged research engages the community in a collaborative manner to improve the local setting and has been increasingly applied to health services research. These complex ...studies require collaboration and team building among clinical experts, methodologists, and community stakeholders, yet few examples of this process have been published.
Aim:
Through a study of community emergency medical services, our aim was to understand team building among content experts and methodologists to advance the framework for adaptive community-engaged research.
Methods:
We collected process field notes and transcripts from the project kick-off meetings and analyzed the data using an immersion/crystallization process, which is an exploratory qualitative analysis characterized by continual review of the data collected. All 25 members of the study’s research team, who are both local to Michigan and reside out-of-state, were invited to attend.
Results:
We describe the process of the kick-off event for this community-engaged study and report major themes: collaborating throughout each stage of the kick-off meeting, building trusting relationships by challenging each other’s perspectives and sharing expertise, and gaining shared experiences of learning and understanding of study content and goals.
Conclusion:
Team-building in community engaged health research requires thoughtful effort, and planned kick-off meeting can be a useful strategy to build a shared vision among content experts and methodologists.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Fire and police first responders are often the first to arrive in medical emergencies and provide basic life support services until specialized personnel arrive. This study aims to evaluate rates of ...fire or police first responder-initiated cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use, as well as their associated impact on out-of-hospital cardiac arrest (OHCA) outcomes.
We completed a secondary data analysis of the MI-CARES registry from 2014 to 2019. We reported rates of CPR initiation and AED use by fire or police first responders. Multilevel modeling was utilized to evaluate the relationship between fire/police first responder-initiated interventions and outcomes of interest: ROSC upon emergency department arrival, survival to hospital discharge, and good neurologic outcome.
Our cohort included 25,067 OHCA incidents. We found fire or police first responders initiated CPR in 31.8% of OHCA events and AED use in 6.1% of OHCA events. Likelihood of sustained ROSC on ED arrival after CPR initiated by a fire/police first responder was not statistically different as compared to EMS initiated CPR (aOR 1.01, CI 0.93–1.11). However, fire/police first responder interventions were associated with significantly higher odds of survival to hospital discharge and survival with good neurologic outcome (aOR 1.25, 95% CI 1.08–1.45 and aOR 1.40, 95% CI 1.18–1.65, respectively). Similar associations were see when examining fire or police initiated AED use.
Fire or police first responders may be an underutilized, potentially powerful mechanism for improving OHCA survival. Future studies should investigate barriers and opportunities for increasing first responder interventions by these groups in OHCA.
Abstract only Introduction: EMS system factors key to improved survival for out-of-hospital cardiac arrest (OHCA) have not been well elucidated. This study explores factors associated with sustained ...return of spontaneous circulation (ROSC) in the field with pulse upon arrival to the ED-a measure of high quality of prehospital care-across the chain of survival. Methods: This sequential mixed methods study used data from the Michigan Cardiac Arrest Registry to Enhance Survival (MI-CARES) to evaluate variation in OHCA outcomes across EMS agencies. Sites were sampled based on geography, rurality, population density, and survival rate. We visited 1 low-, 1 middle-, and 3 high-survival EMS systems. At each site, we conducted key informant interviews with field staff, mid-level managers, and leadership from EMS, police, fire, and dispatch, as well as multidisciplinary focus groups. Transcripts were coded using a structured codebook and analyzed using thematic analysis. Results: An integrated multidisciplinary approach was critical for timely OHCA care coordination across the chain of survival. Themes that emerged across all stakeholders included: 1) OHCA education and multidisciplinary training; 2) shared awareness of roles in the chain of survival and system-wide response; 4) multidisciplinary QI; and 5) leadership and initiative (Table 1). Conclusions: Recognizing the critical role of each level in the chain of survival, this study identified specific practices from EMS system stakeholders that were associated with improved survival. The next phase of this work will include validating the factors associated with increased survival identified through a statewide survey of EMS agencies in Michigan. The final product of this work will include a toolkit of best practices and an implementation guide.
Abstract only Background: Out-of-hospital cardiac arrest (OHCA) outcomes vary significantly across U.S. communities; however, systems of care factors that increase the likelihood of survival have not ...been well elucidated. The Enhancing Pre-Hospital Outcomes for Cardiac Arrest (EPOC) study is quantifying variation in the rate of sustained return of spontaneous circulation (ROSC) upon ED arrival across Michigan EMS agencies as a first step to identifying ‘best practices’ in prehospital OHCA care. Methods: Michigan Cardiac Arrest Registry to Enhance Survival (CARES) data for the years 2014-2016 was used. EMS agencies with 5+ arrests over the study years were included in the analysis. Using mixed-effects logistic regression, we calculated each agency’s reliability-adjusted sustained ROSC upon ED arrival; these rates were standardized across patient-, community-, and arrest-level characteristics. Results: A total of 91 agencies covering >6.8 million lives met inclusion criteria. We included 14,219 OHCA patients with a mean age of 62.6, 40.0% female, and 18.2% with a shockable rhythm in the analyses. Across all agencies, the mean patient-standardized rate of sustained ROSC with pulse upon ED arrival was 25.3% (range, 6.1%-51.9%; IQR range, 18.9%-31.2%) ( Figure 1 ). There were 14 agencies with patient-standardized rates and 95% CIs that exceeded the overall mean survival rate suggesting better-than-average outcomes while 16 agencies had rates and 95% CIs that were lower than the overall mean survival rate. Conclusion: We found more than 8-fold variation in OHCA survival rates across EMS agencies in Michigan, suggesting large differences in the effectiveness of prehospital systems of care. Future qualitative work will seek to identify ‘best practices’ by further determining the role of key factors such as tele-dispatch CPR, EMS agencies, fire, and police within high performing systems.
Out-of-hospital cardiac arrest (OHCA) is a common, life-threatening event that is a leading cause of death in the United States. However, it is unclear how to design strategies that can be ...successfully implemented in emergency medical services (EMS) agencies and broader emergency response systems (such as fire, police, dispatch, and bystanders to OHCA events) in different communities to help improve daily care processes and outcomes in OHCA. The National Heart, Lung, and Blood Institute-funded Enhancing Prehospital Outcomes for Cardiac Arrest (EPOC) study lays the foundation for future quality improvement efforts in OHCA by identifying, understanding, and validating the best practices adopted within emergency response systems to address these life-threatening events and by addressing potential barriers to implementation of these practices. RAND researchers developed recommendations covering all levels of the prehospital OHCA incident response and the principles of change management necessary to implement those recommendations.
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