BackgroundOut-of-hospital cardiac arrest (OHCA) in Ireland accounts for approximately 5000 deaths annually. Little published evidence exists on survival from OHCA in this country to date. We aimed to characterise and describe ‘presumed cardiac’ OHCA in Cork City and County attended by the Ambulance Service.MethodsDispatch records, ambulance patient records and hospital records for a 1-year period were examined for patient demographics, OHCA characteristics, interventions and patient outcomes.ResultsThere were 231 ‘presumed cardiac’ OHCAs attended over the study period; 130 (56%) were in urban locations and 101 (44%) in rural. OHCAs were lay-witnessed in 20% (n=46), and 22% (n=50) received bystander CPR. Shockable rhythm was present in 36 cases (16%) on initial assessment, and there was no difference in presence of shockable rhythm between urban and rural OHCAs (18% vs 13%, p=0.31). Resuscitation was attempted in 176 cases (77.5%), of whom 27 (15%) achieved return of spontaneous circulation and 13 (7.4%) survived to leave hospital. Survival when the initial rhythm was shockable was 16.7% (6 of 36 patients). Despite longer response times for rural compared with urban OHCAs (median (IQR) 16.5 (11.0–23.5) vs 9 (7–12) min, p<0.001), survival to leave hospital alive where resuscitation was attempted was similar (7.4% vs 7.4%, p=0.99, respectively).ConclusionA survival rate of 16.7% in shockable rhythms indicates scope for improvement which would influence the overall survival rate which was found to be 7.4%. Real-time feedback of performance and quality of the continuum of patient care through a clinical-quality cardiac arrest registry would monitor and incentivise such initiatives.

Purchase of social services is an integral part of many social service delivery systems. Its advent was heralded by some as the fiscal salvation of hard-pressed social service agencies. This article reviews the problems of purchase of social services. It then discusses some of the literature and the research on the subject, including the author's own study in Utah, that are directly concerned with the variables of cost and quality. The author adds recommendations based on the findings presented.

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Introduction:The trauma care system in Ireland is being re-configured to have major trauma centers for severe injuries and other sites for less severe injuries. This is to ensure patients are brought quickly to the most appropriate hospital to manage their injuries. The National Ambulance Service (NAS) electronic Patient Care Record (ePCR) records what happens to patients before they reach the hospital and the Major Trauma Audit (MTA) captures data on patients’ hospital treatment. These datasets are currently separate and if they could be joined, they would inform important decisions on which hospitals to take patients. This study aims to investigate joining these datasets to create a seamless database of the patient journey from roadside to recovery.Method:Proof of Concept–The ePCR and MTA datasets will be linked on a once-off basis. The combined anonymized dataset will then be analyzed to identify pre-hospital characteristics that determine the need to bypass smaller hospitals and bring patients to a larger major trauma center or trauma unit.Stakeholder input for ongoing dataset combination and utilization–A stakeholder consultation process will explore the best way to make a GDPR-compliant combination of datasets on an on-going basis, including geo-location data and the inclusion of patient reported outcome measures. This will incorporate the requirements of the Data Protection Commissioner, National Office of Clinical Audit, patients, clinicians, NAS, HSE and other stakeholders.Geospatial implications of major trauma services–Once ongoing data combination is approved, we will determine geospatial implications of the trauma network for prehospital care configuration and the patient journey.Results:Study results will inform prehospital service configuration to ensure safe and equitable patient management.Conclusion:The data arising from this study will capture the full trauma patient journey. This data is essential to inform policy and practice for trauma care in Ireland.