Of the 38 people who are treated for a cardiac arrest by St John each week, 11 are successfully resuscitated and transported to hospital. Six of those people will later be discharged – that’s a 15% survival rate which is comparable to, or even better than, rates of a number of other ambulance services internationally.
St John crews assisted 2,740 people* who had a cardiac arrest in their home or community in the nine months to 30 June 2014. Ambulance officers attempted resuscitation on 1,313 of those (adults) and 30% were admitted to hospital - 15% of those people were later discharged.
That figure compares very well to organisations that St John benchmarks itself against:
- London Ambulance Service (4,466 people; 31% admitted, 9% discharged)
- South Western Ambulance Service in the UK (2,635 people; 25% admitted, 8% discharged)
- Ambulance Victoria in Australia (2,561 people; 30% admitted, 10% discharged)
- Wellington Free Ambulance (201 people; 48% admitted, 18% discharged).
“This is good news for New Zealanders and this outcome reflects the skills of our ambulance officers and the quality of their care. ‘Out of hospital cardiac arrest’ survival to discharge is one of the most important measures for an ambulance service. We can never be complacent and all emergency care providers need to strive to improve their performance in this area,” says St John Clinical and Community Programmes Director Norma Lane.
Another key measure for ambulance services is the ‘Return of Spontaneous Circulation’ (‘ROSC’) rate for cardiac arrest patients. This is when – following a cardiac arrest - the patient’s heart is restarted. “In this nine month period, 30% of the adult cardiac arrest patients that St John ambulance officers assisted were successfully resuscitated – or brought back to life - again, this is a good result.”
These results have been published in St John’s first Out-of-Hospital Cardiac Arrest Registry Annual Report. The report is an analysis of data collected with District Health Boards, to establish a national cardiac arrest data registry and benchmark St John outcomes with those of other ambulance services.
“The findings from this first report will inform our training and our strategies, to help us improve patient outcomes from cardiac arrest. Specifically what we’d like to see in New Zealand is an increase in the number of people who are trained in CPR and prepared to help in an emergency and we need more defibrillators in public places,” says Lane.
“Almost 20% of all cardiac arrests occur in public and it is very encouraging to see that in 56% of cardiac arrests that occurred in public and were witnessed, a bystander performed CPR. Internationally, this is a great figure that we’d like to improve on. Only 3% of people received defibrillation by a bystander.”
In St John, improving outcomes from cardiac arrest is a team effort - 111 Call Handlers advise over the phone how to do CPR, public first aid trainers, PRIME** GPs and nurses, and frontline ambulance officers all play a part in improving patient survival. And increasingly partner agencies such as the New Zealand Fire Service are ensuring that patients in cardiac arrest are reached in the shortest time possible by responders trained in CPR and with access to a defibrillator.
In addition, community directed programmes such as the HEARTsafe initiative are providing CPR training to the community and ready access to defibrillators. Our key partner ASB has also taken an interest in this area and has installed defibrillators in some of its branches.
The report also highlights:
Demographics
- Rural New Zealanders had more than double the incidence of cardiac arrest than those in urban centres - approximately 160 versus 78 (per 100,000 person-years).***
- 66% of patients were male with the median age of 65 years (69 years for women).
- The most common cause of cardiac arrest was heart disease - 76%.
- When the incidence of cardiac arrest attended by St John crews was standardised to the New Zealand ethnic populations, Māori were disproportionally affected with a higher incidence of cardiac arrest (128) compared with all other ethnic groups (less than 85) per 100,000 person-years.
The full report is available here.
*Across New Zealand – excluding Wellington and the Wairarapa.
** Primary Response in Medical Emergencies – a programme where specially trained GPs and registered nurses provide emergency responses in rural locations.
*** If there were 100,000 people in the study and they were followed for a year.