Improving Survival from Out-of-Hospital Cardiac Arrest Acting on the Call 2018 Update from the Global Resuscitation Alliance Including 27 Case Reports Improving Survival from Out-of-Hospital Cardiac Arrest Acting on the Call This document calls for action to improve survival from out-of-hospital cardiac arrest. Two facts stand out. Survival is low across communities and countries, often in the single The Global Resuscitation Alliance was proposed at a meeting digits. Survival is disparate with 15 fold differences between high performing communities on how to implement best practices in community resuscitation held and poorly performing communities. It is an unacceptable reality that where a person lives in the Utstein Abbey near Stavanger, Norway on June 6-7, 2015. determines if he lives. We know that best resuscitation practices can achieve survival rates of over 50% from ventricular fibrillation cardiac arrest. The GRA calls upon all communities The attendees unanimously supported the creation of a Global Resuscitation Alliance (GRA) to implement best resuscitation practices and afford every person a decent chance to survive and issued a report, “Improving Survival from Out-of-Hospital Cardiac Arrest: A Call to cardiac arrest. Establish a Global Resuscitation Alliance”. The GRA was formally launched at a follow up This document will be updated periodically to reflect evolving best practices and new knowl- Utstein Meeting held in connection with the EMS2016 Conference in Copenhagen on May edge on how best to implement successful resuscitation programs. 28-29, 2016. The following year the GRA at the EMS2017 Conference held on May 20-21 in Copenhagen the GRA requested an update to the original “A Call to Establish….”. Authors: Mickey Eisenberg, Director, Medical Quality Improvement, King County EMS, USA This report updates the original report and has a new title reflecting the countless actions Freddy K. Lippert, Chief Executive Director, Emergency Medical Services and global engagement leading toward improvement in cardiac arrest survival. Copenhagen, Denmark The new title is "Acting on the Call." Maaret Castren, Head of Department of Emergency Medicine and Services, Helsinki University Hospital, Finland April, 2018 Fionna Moore, CEO, London Ambulance Service, UK Marcus Ong, Medical Director, Prehospital Emergency Care, Ministry of Health, Singapore Tom Rea, Medical Director, King County EMS, USA Petter Andreas Steen, Prof. Emeritus, University of Oslo, Norway Improving Survival from Out-of-Hospital Cardiac Arrest: Tony Walker, Acting CEO, Victoria Ambulance Service Australia Sang Do Shin, Medical Director of Seoul Metropolitan Fire Department Improving Survival from Out-of-Hospital Cardiac Arrest With contributions from the following individuals: Acting on the Call, Global Resuscitation Alliance Update 2018 A Call to Establish Alexander Elgin White, Sen. Executive, Unit for Jan Thorsten Gräsner, Med Dir., Emergency a Global Resuscitation Including 27 Case Reports Prehospital Emergency Care, Singapore Medicine, Univ. Of Schleswig Holstein, Germany Alliance Anders Hede, Head of Research, Trygfonden Jo Kramer-Johansen, Prof., Norwegian Denmark National Advisory Unit for EMS, Norway Ann Doll, Exec. Director, Resuscitation Academy, Helge Myklebust, Dir. of Research, Laerdal USA Medical, Norway Brian Eigel, Senior VP of Emergency Cardiovas- Johan Herlitz, Prof. of Prehospital Care, Editor Call to Action 2016 cular Care (ECC) Swedish CPR Registry, Sweden Conrad A. Bjoershol, SAFER Simulation and John Freese, Dir. of Prehospital Research Fire Research Center, Stavanger, Norway Dept. of New York, USA David Waters, Chief Executive of Ambulance John Meiners, Exec. VP ECC Programs American Acting on the Call 2018 New Zealand Heart Association, USA Douglas Chamberlain, Advisor to Sussex Judy O’Sullivan, Dir. of Services and Clinical Ambulance Service, UK Lead, British Heart Foundation, UK Eldar Soreide, Medical Director of SAFER Matthew Huei-Ming Ma, Professor of Emergency Foundation, Stavanger, Norway Medicine, National Taiwan University The goal of the Global Resusitation Alliance is to help increase global Fredrik Folke, Head of research center, Michael Sayre, Medical Director for Medic One, Emergency Medical Services Copenhagen, Seattle Fire Department survival rates by 50% from 2015 to 2020 Denmark Ng Yih Yng, Chief medical officer, Singapore Civil Grethe Thomas, Project Director, Trygfonden Defence Force Denmark Paul Gowens, Lead, Scottish Government out-of Hideharu Tanaka, Chairman and Director of hospital cardiac arrest program, UK Tokyo EMS System Peter Kudenchuk, Medical Director for South James Ward, Medical Director of the Scottish King County Medic One Ambulance Service Tore Laerdal, Executive Director, Laerdal Foundation, Norway 2 3 Improving Survival from Out-of-Hospital Cardiac Arrest Acting on the Call Table of Contents Case Reports Executive Summary ............................................................................................. p 5 1. Tripling of survival in Denmark .................................................................................................20 Preface ................................................................................................................ p 7 2. The European Restart a Heart day goes global .............................................................21 Part 1. Cardiac Arrest in the Community ........................................................... p 9 3. How to resuscitate a cardiac arrest registry (Norway) ..............................................25 Part 2. Global Resuscitation Alliance ............................................................... p 14 4. Measuring the quality of life of OHCA survivors (Melbourne, Australia) .......26 Part 3. 10 Steps to Improve Community Survival Rates ................................... p 21 5. The South Australian Ambulance Service cardiac arrest registry ......................276 Part 4. 10 Actions to Achieve Implementation ................................................. p 46 6. Using OHCA registry data to inform and monitor operational initiatives Part 5. Conclusion ............................................................................................ p 53 and Government funding decisions (Melbourne, Australia) ....................................29 Part 6. Appendix .............................................................................................. p 54 7. Tripling of survival in Japan over 10 years ..........................................................................33 8. Telephone CPR program recommendations and performance measures (USA) ........................................................................................34 9. Improving bystander CPR with dispatcher assisted CPR (Seoul, South Korea) .......................................................................................................................38 10. Telephone CPR in Arizona, USA .......................................................................................... 38 11. Telephone CPR in Singapore ...................................................................................................39 12. Telephone CPR with ongoing training and QI (capitol Territory, Australia) .........................................................................................................40 13. Improve EMS CPR in King County with high-performance CPR .........................43 14. The big problem in the big apple (New York, USA) ....................................................44 15. Police defibrillation in King County (Washington, USA) ............................................48 16. Reducing response time and time to defibrillation (Melbourne, Australia) ....49 17. Would you DARE to save a life (Singapore) ....................................................................51 18. Verified responder (several US communities) .................................................................52 19. Restart a heart campaign in King County (Washington, USA) ..............................53 20. Saving 200 more lives from OHCA in Norway ............................................................54 21. Improving OHCA patient by empowering first responders (Belgium) ............55 22. Well underway to training 5 million in CPR in the UK by 2020 (UK) ...............58 23. School CPR is gaining momentum .........................................................................................59 24. Emergency Response at major sport events in Japan .................................................60 25. Increasing survival from OHCA in New Zealand .........................................................61 26. Impressive increases in survival (multiple countries) ....................................................65 27. Increasing OHCA survival in developing EMS systems ..............................................72 4 5 Improving Survival from Out-of-Hospital Cardiac Arrest Acting on the Call Acting on the Call - Executive Summary Timely application of several critical interventions determines the outcome from cardiac arrest and is shown in Table 1. In cardiac arrest the likelihood of surviving On June 6-7, 2015 at the Utstein Abbey near Stavanger, Norway, 36 Emergency declines by approximately 10% for every minute. Thus the intervals from collapse Medical Services (EMS) leaders, researchers, and experts from throughout the world to application of key interventions largely determine the likelihood of survival.