February 25, 2008–ANCHORAGE–How does the Anchorage Fire Department (AFD) compare to other cities in the delivery of emergency medical services? If you had a cardiac arrest and collapsed in Anchorage what chance would you have to survive?
A 2003 USA Today article found disparities in emergency medical care across the nation and said cities that carefully track their EMS performance save many more lives. Several cities including Houston, Anchorage, Austin, Cincinnati, Kansas City, Raleigh and Tucson have signed up for the Emory University/CDC (Centers for Disease Control) study known as Cardiac Arrest Registry to Enhance Survival, or CARES.
This five year, $1.5 million CDC project launched four years ago. Initial investigations found that emergency medical systems in most of the nation’s 50 largest cities were fragmented, inconsistent and slow. The number one cause of death for Americans is cardiovascular disease. More than 500,000 deaths occur each year secondary to cardiovascular disease. Approximately 250,000 of these deaths occur before the patient reaches the hospital. These out-of-hospital-cardiac-arrest (OOHCA) patients are responded to by emergency medical services (EMS) personnel.
According to the latest numbers from the American Heart Association, the current percentage of patients who survive OOHCA to be discharged from the hospital is 6.4%.Patient survival rates are measured and calculated using a set of criteria called the Utstein template. The Utstein template was first developed in 1991 to provide a consistent means of studying OOHCA resuscitation effort outcomes.
Since 1999, Dr. Michael Levy, AFD Medical Director, has applied the Utstein template to measure resuscitation rates in Anchorage and has shown a consistent upward slope in the graph of the city’s resuscitation rates. Using the Utstein criteria, the survival to hospital discharge rate from OOHCA in Anchorage, Alaska for 2007 is 40.1%.
The Anchorage data entered in the CARES study indicates Anchorage is in the top tier of cities with the best resuscitation rates in the country. These data are being presented to an assembly of EMS physician leaders this month and will be submitted for publication within the next year.
King County, Washington (Seattle) is routinely lauded as among the very best in the nation for survival from cardiac arrest reporting a 46% survival to discharge rate, up from 33%, since initiating the 2005 AHA guideline changes to BLS. The rate of bystander initiated CPR is among the highest in the nation, if not the highest, and is thought to contribute considerably to their good outcomes.
-Tom Kempton, Battalion Chief, Anchorage Fire Department