EMS World

JAN 2018

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

Issue link: http://emsworld.epubxp.com/i/917718

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Page 20 of 51

EMSWORLD.com | JANUARY 2018 21 bystander CPR was 42.8%, and bystanders applied AEDs on 4.6% of OHCAs. AEDs were applied by someone (bystander, police officer, or other first responder) before EMS arrived in 21.9% of OHCAs. Targeted temperature management was performed for 36.5% of all patients and 55.4% of the Utstein subgroup. For the all-rhythm OHCA group, the unadjusted (unadjusted simply means they calculated the percentage without making any statistical adjustments for other important or confounding vari- ables) percentage who survived to hospital discharge was 11.4%, and the percentage discharged with good cerebral performance was 9.4%. For the Utstein subgroup the numbers were better, with 34.0% surviving to hospital discharge and 30.4% being dis- charged with good cerebral function. No Change? Here is where the results get less encouraging: When the authors looked for changes over time in the all-rhythm group, the unadjusted percentage surviving to hospital discharge actu- ally decreased. In 2011 this percentage was 13.7%, and in 2015 it was 10.5%. This was statistically significant, with a p-value less than 0.001 (a p-value of less than 0.05 is typically considered statistically significant). The percentage with good cerebral function at hospital discharge also decreased from 10.4% to 8.9% (p=0.002), but after logistic regression adjustment that decrease was no longer statistically significant (p=0.08). The Utstein group did not see a statistically significant differ- ence in the percentage of survival to hospital discharge (34.7% to 34.6%, p=0.84) or in good cerebral function (28.5% to 31.5%, p=0.42). This remained statistically insignificant after logistic regression. Those last two paragraphs basically say that from 2011 to 2015, there was no change in survival or the percentage discharged with good cerebral function. Initially that seems somewhat unbe - lievable, with all the time and effort we put into improving out- comes for OHCA patients. However, remember whose survival data was missing: The patients without it were often younger, had witnessed arrests in public, and had shockable rhythms. There were only 153 of these patients, but they're the ones most likely to have good outcomes. Still, it looks like we have more work to do to improve outcomes for OHCA patients. And what better time to identify things we can improve than the start of a new year? While there are some limita- tions here (as there are with all studies), this paper is extremely important because it provides a clear picture of where we are. Try to read this manuscript in its entirety—it has a lot of important and interesting information, including supplemental tables. Happy new year, everyone! ABOUT THE AUTHOR Antonio R. Fernandez, PhD, NRP, FAHA, is research director at the EMS Performance Improvement Center and an assistant professor in the Department of Emergency Medicine at the University of North Carolina–Chapel Hill. He has been a nationally certified paramedic since 2005 and completed the EMS Research Fellowship at the National Registry of Emergency Medical Technicians. For More Information Circle 22 on Reader Service Card For More Information Circle 19 on Reader Service Card EMERGENCY MEDICAL SCIENCE Paramedic Certification (Hybrid Program) • Fully CAAHEP Accredited • Hybrid Paramedic program offered through LCC Continuing Education Department. Only four on-site visits required for skills training and evaluations. All coursework is done online. Tuition is $360. • Clinicals can be completed in your area. Contact LCC regarding available areas. • Different course options that allow currently credentialed EMTs, AEMTs, or individuals with no certification to train for their Paramedic certification. • Graduates are eligible for the NCOEMS Paramedic exam and the National Registry Paramedic exam. Associate Degree in Emergency Medical Science — Bridging • All degree classes offered 100% online. • Currently credentialed state and national Paramedics earn up to 45 credits toward their degree just for being certified! • Designed for demanding EMS work schedules. Complete the degree at your own pace! Earn Your Degree Online! 231 Hwy. 58 South, Kinston, NC www.lenoircc.edu (252) 527-6223, ext. 115 jgtilghman38@lenoircc.edu Ranked Second in the Nation by bestcolleges.com!

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