EMS Research

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Comment by Rob Theriault on July 27, 2009 at 10:39pm

You're not wrong...."Survival" is defined as an ROSC with neuro function on par with the patient's neuro function pre-arrest. That usually means no neurological damage. I believe Utsteain uses the cerebral categories score with a score of 1 considere as "survival".

What I am suggesting is there is also an increase in the number of patients with an ROSC who have sustained serious is not catastrophic neurological damage as a result of the improvements in CPR standards and ITDs, etc. I suspect we'll have to collectively tackle this issue soon, or at least soon after the ROC trial.

The best place for information on the ROC Trial is at the Prehospital Care and Transport Medicine site.

cheers

Comment by Kay Vonderschmidt on July 23, 2009 at 4:28pm

Wow - i thought that the increase in survival also had good neuro outcomes...what level are they debilitated? (fetal position and to the NH) or home with some help?

can you give an overview of the ROC trial and what outcomes are they looking for

Comment by Rob Theriault on July 3, 2009 at 10:22pm

Is anyone else participating in the ROC Trial? Three things (maybe more) seem to be happening that are of interest:

1. we are getting a great deal more ROSC

2. survival seems to be increasing

3. ETCO2 readings seem to be higher with the new faster-deeper compressions with fewer and lower TV ventilations

Some interesting questions will, I predict, arise from these improvements (we'll wait for the final results of the research of course to draw any conclusions):

1. In addition to there being an increase in survival, as there appears to be so far, there also seems to be a significant increase in ROSCs with significant neurological damage. These patients inevitably end up in the ICU and become a significant drain on the health care system. Is it ethical to apply CPR and ALS resuscitation for all cardiac arrests (barring the usual gross rigor, decomposition, etc). And should EMS systems that don't have a good termination of resuscitation policy be encouraged to adopt one so that not all cardiac arrests are given the bells and whistles in terms of effort and technology?

2. ETCO2 readings of 10mmHg in a cardiac arrest used to be a good predictor of an ROSC and if the ETCO2 was 14 or greater the chances of an ROSC and survival (neorologically intact) was very good. Now, and this has just been my own experience, unwitnessed cardiac arrest are producing ETCO2 levels routinely above 20-30 with the new CPR standards. Add the impedence threshold device (ITD) and the readings seem to be even higher. This begs the questions: Do we need to reevaluate ETCO2 readings as a predictor of survival from cardiac arrest?

What are your thoughts?

Rob Theriault
my blog

Comment by Kay Vonderschmidt on July 1, 2009 at 9:16am

What other research projects are your depts working on? They can be clinical or system related? Do you use research data when making a decision on staffing? Has anyone been to the EMS six sigma classes?

Comment by Thomas Durkee on June 23, 2009 at 6:47pm

Competitive Grants for Trauma Systems for the Improvement of Trauma Care

proposed legislation in the Affordable Health Choices Act, due for a vote this year.
http://www.advocatesforems.org/_newsContent/Senate_HELP_Mark_Composite.pdf

page 71.

Funding would be awarded to eligible entities that propose a pilot project to design, implement, and evaluate an emergency medical and trauma system that:

(1) coordinates with health and emergency care providers throughout the region as specified;

(2) includes a mechanism to ensure the patient is taken to the medically appropriate facility in a timely manner;

(3) allows for the tracking of prehospital and hospital resources (e.g., inpatient bed and emergency department capacity) and the coordination of such tracking with regional communications and hospital destination decisions; and

(4) includes a region-wide data management system that reports data to the NEMIS, the NTDB, and Federal and State databanks and registries, and that contains sufficient information to evaluate key elements of emergency response and care, and relevant health outcomes.

It looks like ASPR (Kevin Yerskey) is gonna handle it.

-Tom @tomdurkee on Twitter

Comment by Kay Vonderschmidt on April 22, 2009 at 8:33am

Hello all,

Boy we have been slow. I did a presentation to the KY trauma committee yesterday on the Kampala Trauma Score for EMS. There weren't too many comments, but seemed well received.

Any other research out there that we can talk about?

Comment by Tim Erskine on March 26, 2009 at 7:51am

The research grants we have here are designated in law to three trauma-related categories: injury prevention, trauma victim rehab, and trauma medical procedures.

Comment by Kay Vonderschmidt on March 25, 2009 at 7:12pm

Good link Tim.....so....do we know of any grants coming soon that we can do a research study?

Comment by Tim Erskine on March 20, 2009 at 7:30am

Let's try that link again.... NY Times article

Comment by Tim Erskine on March 20, 2009 at 7:29am

It's already started...

http://www.nytimes.com/2009/03/20/health/research/20obese.html?partner=rss&emc=rss

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