Those of us here in King County are lucky enough to live in one of the best places in the nation (perhaps, the world) for emergency response. Our cardiac arrest survival rate, the gold standard in emergency response, has been documented everywhere from academic journals to the Wall Street Journal, and our system is studied far and wide.
In honor of EMS week, we met with Dr. Mickey Eisenberg, King County Emergency Medical Services Medical Director, Co-Director of the Center for the Evaluation of Emergency Medical Services (CEEMS), and the guy who wrote the book on EMS, to learn more about what makes King County’s system work so well.
You’ve been providing medical leadership to King County EMS for a number of years. What is the most remarkable thing about our system?
We are always learning and trying to do better. The founder of the paramedic system, Dr. Leonard Cobb (along with Gordon Vickery, Seattle’s Fire Chief), established the practice of studying every cardiac arrest to learn what went right and what went wrong. Based on this information, we have steadily improved our system such that EMS care for cardiac arrest in Seattle and King County is considered to be among the best in the world, if not the best.
Seattle/King County is among the world’s best for cardiac arrest survival. What makes our Medic One/Emergency Medical System (EMS) different than others across the country?
There is no pixie dust or secret sauce – just a lot of hard work. Our mantra is “It takes a system to save a victim.”
Our system starts with the public who learn how to do CPR and perform CPR when it’s needed. Then there are the hundreds of telecommunicators (911 emergency dispatchers), who can provide CPR instructions over the phone. The first to the scene are the firefighter EMTs, who provide high-performance CPR and the first defibrillatory shock, if needed. Next, the paramedics (who are the best trained in the nation) arrive a few minutes later to provide advanced care. And last, hospitals receive the patients and provide state-of-the-art post-resuscitative care.
If you think about the complex requirements to save someone in cardiac arrest, you might wonder how we save anyone. All the moving parts have to arrive in time, every time. But it is more than a sequence of interventions that matter – it is the attitude our guys and gals bring to the scene. This attitude says, “We are going to save this person.”
Cardiac arrest survival is considered the gold standard measure for overall Medic One/EMS system effectiveness. What makes this statistic so important for the overall health of the Medic One/EMS system?
We have always said that management of cardiac arrest is the best indicator of an EMS system’s overall performance. For one thing cardiac arrest is the most critical medical emergency. The EMS system is completely responsible for saving the person’s life and therefore we think it is the best metric to gauge a system. Plus the skills required to successfully resuscitate someone tests every aspect of the system. If a system does well treating cardiac arrest it likely does well in all conditions.
King County residents have a reputation for being well-trained on CPR. Is that true, and does it make a difference for survival outcomes?
The reputation is well deserved. A survey a few years ago estimated 80% of the population had received CPR training within the past five years. CPR training is mandatory in most county high schools. And, most importantly, in 75% of cardiac arrests, CPR is begun by a citizen before the fire department EMTs arrive. When a bystander initiates CPR, about half of the time they are able to do so because they were trained. The other half of the time bystanders are instructed via telecomunicators.
King County Medic One/EMS has a reputation as an innovator. What new programs are we working on now to improve our system?
We are always trying new ways to improve survival rates. Right now, we are participating in three large national studies: one to define the best method of CPR, one to determine which (if any) medication is useful to help achieve a stable heart rhythm in cardiac arrest, and one to help patients with major trauma. We are also very interested in finding new ways to provide quick defibrillation to someone in cardiac arrest. Perhaps in 10 years a small, inexpensive personal defibrillator will be in everyone’s home.
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