Emergency medicine journal : EMJ
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A cardiac arrest occurs when the heart stops beating suddenly. It is one of the most extreme medical emergencies. 60,000 people suffer an out of hospital cardiac arrest (OHCA) in the UK each year, with resuscitation attempted in less than half, and less than 10% surviving to hospital discharge. The Cardiac Arrest Individual Registry and Outcomes (CAIRO) Programme includes a comprehensive patient registry: the CAIRO database. This registry will allow us to confidentially link data from different sources to track each cardiac arrest patient from their initial collapse through to hospital discharge and, with the patient's consent, subsequently in the community through follow-up assessments of progress. ⋯ To determine whether it is feasible to set up the CAIRO database in this patient population, by linking sources of routinely collected data. To chart the patient pathway and estimate the completeness of the data obtained from routine data sources Conditional on sufficient data being available to allow meaningful analysis; OBJECTIVE 1: To compare the survival to hospital discharge, ICU stay, complications and neurological outcomes in patients in whom the arterial oxygen concentration in the first 24 hours following cardiac arrest was or was not maintained between 60 mm Hg to 200 mm Hg. OBJECTIVE 2: To compare the survival to hospital discharge of patients who were or were not transported or transferred to a cardiac care centre within 12 hours of the cardiac arrest. OBJECTIVE 3: To compare the survival to 1-year of patients who underwent coronary angiography within 8 hours of the cardiac arrest or more than 8 hours after the cardiac arrest. OBJECTIVE 4: To compare the healthcare resource use to 1-year of patients who were or were not within 5 miles of the receiving heart attack centre when they had an OHCA.
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A shift from a predominantly emergency service, towards one where a wide range of conditions are managed and treated on scene presents numerous challenges for ambulance services and clinicians. The effective management of a broad range of patients and conditions in the ambulance setting will have an impact on other parts of the health service including emergency departments and primary care. ⋯ Decisions regarding the most appropriate care for patients presenting to the ambulance service are best informed by access to accurate and complete health information and records. An understanding of patients' pre-existing medical conditions, recent treatments and health information is needed for the selection of the most appropriate care; this information is often difficult to obtain in the ambulance service setting.
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Major trauma guidelines specify that if the patient can be safely managed and the MTC can be reached within 45 minutes of leaving scene then the patient should be conveyed to the MTC. However, there is no evidence that supports the 45 minute timeframe. Given the rurality of the South West, an increase in the running time to the MTC to 60 minutes has been discussed amongst major trauma experts. ⋯ An increase in running time to 60 minutes to the MTC for patients in the South West could significantly improve the level of care that many patients receive in the first few hours following major trauma injuries. With the information available it is not possible to quantify the operational impact such a change would have.
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Research into the care of cardiac arrest patients outside of hospital is limited. Evidence from hospital settings suggests that human factors including both technical and non-technical skills and performance may impact on care. This study sought staff views from a UK ambulance service aiming to investigate areas for improvement in resuscitation performance. ⋯ The findings demonstrate poor staff confidence in several non-technical skills, including teamwork and communication. Limitations of the survey included lack of recording of training received-where this has shifted in recent years from in-service to higher education routes-and missing demographic data. However, the findings provide specific areas for improvement activity. This has already included best practice slides displayed in ambulance stations, and proposals for identification wristbands, a role-based work standard to reduce task omission and duplication, and a policy to send higher numbers of rescuers to cardiac arrest cases.