Peter Antevy argues EMS should shift pediatric cardiac arrest focus from hospital care to three earlier stages: family CPR before 911, dispatcher-assisted CPR during the call, and a focused 2-minute on-scene sequence with bag-valve-mask, compressions, and epinephrine. Polk County, Florida reached 78% neurologically intact survival by refocusing this way.
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Peter Antevy
December 31, 2015
78%
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Hello. Welcome, everyone, for the last edition of the Han TVI Minute for 2015 as we welcome 2016. What I wanted to talk about today was the pediatric cardiac arrest timeline. And I wanted to refocus us on a different part of that timeline to hopefully have better outcomes for 2016. So if you look at the pediatric arrest timeline, if the arrest happens right here, 911 is being called here.
Then we have EMS arrival.
And at the end we have EMS departure.
This, let's say, is about one minute here. Let's give it five minutes for arrival. Recent study shows that EMS typically stays on scene for 12 minutes. And what happens here after we depart until we get to the hospital.
This is typically where we're focusing all of our attention today for pediatric cardiac arrest. I want to refocus us right back to the beginning. And so, for example here, from the time the arrest happens until the 911 call is made, we have to focus on family CPR.
For the 911 call until the EMS arrival, we have to focus on 911 CPR.
And for EMS arrival until we depart, we have to talk about on scene.
Resuscitation.
So let's talk about those three things and talk about what we can do in 2016 to help our numbers. For family CPR, EMS has to engage the community.
These are with health fairs, advertisements, talking to school boards, getting our students involved. That's a very big part that we'll play in EMS for 911 CPR. I would recommend that you QA all.
Arrest audio calls. You'd be surprised what you would find on every one of these that you can feed back to dispatch so that we can help our dispatchers help our family members. And thirdly, for on scene resuscitation, I'm asking for two minutes, not 20, but start with two. And we're going to do the the A, B, C, D, E. And so we're going to do this.
This is critical. Arrive on scene, bvm chest compressions.
Drill, start an IO and give a dose of epinephrine. And what happens here is that if you can get ROSC.
And you end up at the hospital with a patient who has rosc, you will end up with a happy pat who then ultimately has a chance to go home. And I want to highlight what Polk county has done in Florida, where their ROSC rate skyrocketed and their neurologically intact survival went from zero to the end of this year being 78%. And so, kudos to the leadership there, kudos to the paramedics there. The folks in Denver are doing the same thing. And so if we focus all of our attention on this part of the timeline here.
And realize that this part of the timeline is really not, not as important as we thought, this is where the time is going to happen, and it's really in the first 18 to 20 minutes. And so with 2016 upon us, let's focus on this part. We have some things we can do to change those. And I wish you all a healthy and happy New Year. Thank you from Han. Teddy.
