Paramedic Exposure to Out-of-Hospital Cardiac Arrest Resuscitation Is Associated With Patient Survival

Abstract

A lthough out-of-hospital cardiac arrest (OHCA) is a major public health problem, 1 individual paramedics are rarely exposed to these cases. [2][3][4][5][6][7] Survival to hospital discharge from OHCA is infrequent (<10%) 8 and dependent on the quality and timing of treatment provided by paramedics. [9][10][11][12][13][14][15] Given that resuscitation skills decay over time 16 and OHCA treatment often falls short of the recommended standard, 9-14 the number of OHCAs that paramedics are exposed to may be contributing to low survival rates.The limited literature available indicates that exposure to OHCA for individual paramedics is rare 2-7 and declining. 2,3 For example, in our region, we found that on average paramedics and first responders only treat 1.4 OHCAs a year. 2Such low exposure may impact on the paramedics' ability to perform resuscitation skills according to the guidelines, which is vital to patient survival. However, data exploring the association between OHCA exposure and survival is lacking, with a recent systematic review 17 finding only one previous study involving prehospital physicans 18 and no studies involving paramedics.Therefore, in this study, we aimed to examine the association between paramedic exposure to OHCA resuscitation and patient survival to hospital discharge. We also examined the paramedics' decision to initiate resuscitation in OHCA and 2 other exposure variables: (1) paramedic career experience and (2) time since previous paramedic exposure to OHCA resuscitation. MethodsWe conducted a retrospective cohort study using 10 years of data from the Victorian Ambulance Cardiac Arrest Registry (VACAR) and the Ambulance Victoria (AV) employment database to measure the association between paramedic exposure to OHCA resuscitation and OHCA patient survival. This study was approved by the Monash University Human Research Ethics Committee (project number: CF13/971-2013000471). The need for patient consent was waived Background-Although out-of-hospital cardiac arrest (OHCA) is a major public health problem, individual paramedics are rarely exposed to these cases. In this study, we examined whether previous paramedic exposure to OHCA resuscitation is associated with patient survival. Methods and Results-For the period 2003 to 2012, we linked data from the Victorian Ambulance Cardiac Arrest Registry to Ambulance Victoria's employment data set. We defined exposure as the number of times a paramedic attended an OHCA where resuscitation was attempted in the 3 years preceding each case. Using a multivariable model adjusting for known predictors of survival, we measured the association between paramedic OHCA exposure and patient survival to hospital discharge. During the study period, there were 4151 paramedics employed and 48 291 OHCAs (44% with resuscitation attempted). The median exposure of all paramedics was 2 (interquartile range 1-3) OHCAs/year. Eleven percent of paramedics were not exposed to any OHCA cases. Increased paramedic exposure was associated with reduced odds of attempted resuscit...

Paramedic resuscitation competency: A survey of Australian and New Zealand emergency medical services

“…By monitoring exposure and tailoring training to individual exposure levels, EMS agencies could efficiently target training to the paramedics who need it most. Although the value of in‐field exposure to OHCA for maintaining resuscitation competency is not fully understood, the number and recency of OHCA exposures is significantly associated with patient survival . By ensuring that paramedics are regularly practicing resuscitation, either in the field or during training, EMS agencies may be able to increase OHCA survival, especially among patients treated by the paramedics with low exposure.…”

33 Systematic review of the effectiveness of prehospital critical care following out-of-hospital cardiac arrest

“…10 The experience of ALS paramedics has been shown to have a significant association with survival after OHCA in a large Australian study. 33 Prehospital critical care providers will be highly experienced in the care of critically ill patients, including OHCA, through their practice in hospital or as a result of targeted dispatch to cases of severe illness or injury. 17,23 In addition, prehospital critical care providers often have the support of advanced clinical governance structures with regular case reviews and quality improvement projects, which might not be available to the cohort of ALS providers.…”

Low major trauma confidence among emergency physicians working outside major trauma services: Inevitable result of a centralised trauma system or evidence for change?

“…This is challenging for emergency doctors with minimal exposure who are then tasked with providing the clinical leadership and procedural skills to manage the ‘occasional’ major trauma presentation. Skill degradation in resuscitation is a well‐known and studied phenomenon . Skill degradation is not specific to the management of trauma patients.…”

“…Skill degradation is not specific to the management of trauma patients. For instance, recent work on out‐of‐hospital cardiac arrest has clearly demonstrated the link between clinician's exposure and patient outcome . Furthermore, in a system with an increasing number of trainees, skill degradation represents a significant challenge to all senior medical staff.…”