Out of Hospital Cardiac Arrest Registry – Annual Report 2016/17
St John’s fourth annual Out of Hospital Cardiac Arrest report sees the organisation’s survival rate results for patients well-placed when compared to several other ambulance services.
While numbers to survive a cardiac arrest are universally low, St John reports a 12 per cent survival rate, excluding those incidents where patients suffered a cardiac arrest that was witnessed by ambulance officers.
St John’s performance in this area continues to compare favourably with similar ambulance services.
There have been some changes to the way out of hospital cardiac arrests are reported in this year’s registry. Results differ from previous reporting as cardiac arrests that were witnessed by ambulance officers are now excluded from the data.
In the 2015/16 registry annual report, St John reported a 16 percent survival rate to hospital discharge and this included cardiac arrests witnessed by ambulance officers.
This year’s report has a focus on cardiac arrest survival rates using the international benchmark known as the Utstein Comparator Group that records incidents where the cardiac arrest was witnessed by bystanders, the patient had a shockable rhythm and where resuscitation was attempted by ambulance officers.
Using this new international benchmark, St John has achieved a 30 per cent survival rate. The Group ranks St John NZ results against Wellington Free Ambulance (30%), Ambulance Victoria (35%), London Ambulance Service (30%), St John Ambulance Western Australia (27%) and the King County EMS, USA (52%).
In future, St John will primarily report on survival rates compared to other ambulance services using the Utstein Comparator Group parameters, to ensure greater parity when benchmarking and reporting outcomes after an out of hospital cardiac arrest.
St John Medical Director Dr Tony Smith says about 1,800 people a year are treated for a cardiac arrest that occurs in the community and survival is largely due to the quick actions of bystanders who initiate CPR and use an automated external defibrillator (AED) within the first few minutes.
“It takes a system to save a patient in cardiac arrest and that begins with bystanders who are then supported by our people in the Clinical Control Centres who give life-saving advice over the phone, co-responders such as Fire and Emergency NZ personnel, and advanced support from ambulance service and hospital personnel.
“A cardiac arrest is allocated the highest priority response so the closest service is immediately dispatched along with ambulance personnel.
“In this reporting year Fire and Emergency NZ was fundamental in the early defibrillation of 102 adult patients prior to the arrival of St John emergency ambulance service. Of these, 18 per cent survived to be discharged from hospital.
“The more people who know how to do CPR and have access to an AED in the community, the greater the chances of patient survival are. For every minute without CPR or defibrillation, a patient’s chance of survival falls by 10-15 per cent.”
In keeping with its commitment to its Global Resuscitation Alliance membership, which promotes 10 steps for improving survival from cardiac arrest, St John will, in early 2018, roll out the GoodSAM (Smartphone Activated Medic) application to the public. This is designed to alert bystander responders to nearby cardiac arrests so that they can provide early CPR and use a local AED before ambulance officers arrive.
October 16 also saw St John NZ participate in its first Restart a Heart Day, another Global Resuscitation Alliance initiative aimed at improving bystander awareness of the importance of performing early CPR and AED use in the event of a cardiac arrest.
Much is being done to improve the survival rate of those who suffer a cardiac arrest. Since June this year St John has been implementing the Double Crewing Project which, by 2021, will see all its emergency ambulances double crewed, thereby improving patient care, patient outcomes and staff safety.
About 1,500 people die after suffering cardiac arrest every year in New Zealand.
“Death from cardiac arrest is our ‘silent toll’. It can happen to anyone of any age, including children. We remain focused on reducing this toll, but we can’t do it alone. We need all New Zealanders to help by knowing how to do CPR and use a defibrillator (or AED),” says Dr Smith.
Maori are disproportionately represented in cardiac arrest statistics and have a 20 per cent greater chance of suffering a cardiac arrest than other ethnic groups.
“In response to these findings, St John initiated the Out of Hospital Cardiac Arrest AED in Marae programme whereby training and discounted access to AEDs were supplied to several marae in early 2016. Building on that initiative, St John is donating 50 additional AEDs to selected marae or appropriate community facilities across the country.
“We support these projects with the free 3 Steps for Life programme, a course that teaches people how to perform CPR and use AEDs and is aimed at improving the survival rates of patients who suffer out of hospital cardiac arrest, most of which occur in the home,” Dr Smith said.
St John emergency response times to cardiac arrest events have improved since the first Out of Hospital Cardiac Arrest report was collated in 2013/14. Median response times to urban areas dropped from eight minutes to five, while in rural and remote areas the median fell from 11 minutes in 2013 to seven minutes in 2016/17.
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Out of Hospital Cardiac Arrest Report 2016/17.
St John supports several community initiatives and has online videos and a smartphone application that are available free to the public:
St John also offers a range of First Aid courses for individuals and organisations.
Facts at a glance:
- Most cardiac arrests (69 per cent) occur in a person’s home;
- Around 20 per cent of cardiac arrests occur in public places;
- Males suffer cardiac arrests at more than twice the rate of females – 69 per cent and 31 per cent respectively;
- The incidence rate for children in NZ (3 per cent of the total) is higher than that experienced by comparable services
Cardiac arrest should not be confused with heart attack:
- What is cardiac arrest? A cardiac arrest occurs when the heart stops beating and often happens without warning. No blood is pumped to the brain and seconds later the person will lose consciousness and have abnormal breathing. Death occurs within minutes if the person does not receive CPR and emergency treatment. The most common cause of cardiac arrest is a heart attack, but there are other causes including drowning and electrocution.
- What is a heart attack? A heart attack occurs when a blocked artery stops blood from reaching a section of the heart. If the blocked artery is not reopened quickly, the part of the heart supplied by that artery begins to die. The longer a person goes without treatment, the greater the damage. Symptoms of a heart attack include chest discomfort that may go into the arms, neck or jaw. Most patients having a heart attack will not have a cardiac arrest.