EMS systems face a variety of barriers to achieving the ideal STEMI and Cardiac Resuscitation
However, there are solutions, as depicted in the chart below. These solutions are in addition to the STEMI systems barriers and solutions found here.
Emergency Medical Dispatch
| BARRIER: Delayed Identification of the Cardiac Arrest Victim |
EXAMPLES - Lack of formal dispatch protocols
- Lack of training needed to recognize the need for cardiopulmonary resuscitation
- Lack of quality improvement process
| SOLUTIONS - Uniform training of all 911 dispatch operators consistent with AHA ECC guidelines
- Implement a quality improvement process that includes the use of audits and feedback
- Adopt the first recorded time that the 911 system identifies call as “time 0”
|
| BARRIER: Lack of Dispatch Assisted CPR |
EXAMPLES - Lack of formal dispatch-assisted CPR protocols
- Lack of training to instruct bystander CPR
| SOLUTION - Dispatch instruct bystanders in Hands only CPR
- Initial training and annual competency of all dispatch operators to instruct the lay person on CPR
|
Paramedic/First Responder
| BARRIER: Lack of Resources to Implement Cardiac Resuscitation Systems of Care |
EXAMPLES - Lack of understanding why change is needed
- Lack of reallocation of resources – High effort → Low yield activities
- Insufficient integration of first responder training
- Insufficient quality review or quality improvement programs for cardiac resuscitation
| SOLUTIONS - Identify EMS champion to drive change
- Redistribute resources to Low effort →High yield activities
- Paramedics provide training to first responders
- Review outcomes and provide feedback to team on all cardiac resuscitation calls
|
| BARRIER: Providing Uninterrupted CPR |
EXAMPLES - Compressions are interruption for performing various interventions such as intubation and IV insertion
- Compression interruption to move the patient
| SOLUTION - Update CPR protocols to include new AHA CAB Guidelines (Compression, Airway, Breathing)
- Provide continuing education for first responder providers on excellent chest compression technique
- Dispatch sufficient number of providers with appropriate equipment (manual defibrillators) to the scene
- Provide effective ALS training
|
| BARRIER: Lack of Destination Protocols |
EXAMPLES - Lack of cardiac resuscitation designation for hospitals
- No national certification process to identify destination hospitals
- Need early alert to hospitals of arrival of cardiac arrest patient
| SOLUTION - Identify hospital champion to drive change
- Develop and maintain relationship between EMS and hospitals
- Establish a multidisciplinary approach to post cardiac arrest care
- Identify destination centers for cardiac resuscitation develop destination plan
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