# Paramedic Exposure to OOH Cardiac Arrest Resuscitation Is Associated w/ Surviv



## medicsb (Feb 2, 2016)

File under: No ****.

Circ Cardiovasc Qual Outcomes. 2016 Jan 26. pii: CIRCOUTCOMES.115.002317. [Epub ahead of print]
*Paramedic Exposure to Out-of-Hospital Cardiac Arrest Resuscitation Is Associated With Patient Survival.*
Dyson K1, Bray JE2, Smith K2, Bernard S2, Straney L2, Finn J2.
*Author information*
*Abstract*
*BACKGROUND: *
Although out-of-hospital cardiac arrest (OHCA) is a major public health problem, individual paramedics are rarely exposed to these cases. In this study, we examined whether previous paramedic exposure to OHCA resuscitation is associated with patient survival.

*METHODS AND RESULTS: *
For the period 2003 to 2012, we linked data from the Victorian Ambulance Cardiac Arrest Registry to Ambulance Victoria's employment data set. We defined exposure as the number of times a paramedic attended an OHCA where resuscitation was attempted in the 3 years preceding each case. Using a multivariable model adjusting for known predictors of survival, we measured the association between paramedic OHCA exposure and patient survival to hospital discharge. During the study period, there were 4151 paramedics employed and 48 291 OHCAs (44% with resuscitation attempted). The median exposure of all paramedics was 2 (interquartile range 1-3) OHCAs/year. Eleven percent of paramedics were not exposed to any OHCA cases. Increased paramedic exposure was associated with reduced odds of attempted resuscitation (P<0.001). In the 3 years preceding each OHCA where resuscitation was attempted, the median exposure of the treating paramedics was 11 (interquartile range 6-17) OHCAs. Compared with patients treated by paramedics with a median of ≤6 exposures during the previous 3 years (7% survival), the odds of survival were higher for patients treated by paramedics with >6 to 11 (12%, adjusted odds ratio 1.26, 95% confidence interval 1.04-1.54), >11 to 17 (14%, adjusted odds ratio 1.29, 95% confidence interval 1.04-1.59), and >17 exposures (17%, adjusted odds ratio 1.50, 95% confidence interval 1.22-1.86). Paramedic years of experience were not associated with survival.

*CONCLUSIONS: *
Patient survival after OHCA significantly increases with the number of OHCAs that paramedics have previously treated.


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## chaz90 (Feb 2, 2016)

Hahaha. Where are these people working that 11% of paramedics have not seen a single cardiac arrest or DOA in 3 years??? I mean, I guess those 11% could all be people who either started last week or only run 10 calls a year...

Who could have guessed practice makes perfect? At this rate, I should have my Lazarus like skills honed any day now.


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## STXmedic (Feb 2, 2016)

chaz90 said:


> Hahaha. Where are these people working that 11% of paramedics have not seen a single cardiac arrest or DOA in 3 years??? I mean, I guess those 11% could all be people who either started last week or only run 10 calls a year...


Most private services could fall into that category. At my first job, which was primarily IFT with a lot of nursing home contracts, I knew guys who had been medics for 5+ years and never seen a cardiac arrest.

One of our military fellowship docs is working on a nearly identical study which, not surprisingly, is showing identical results. Except since we run dual medic, he's primarily counting being a code leader, not just a participant of the code.


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## FiremanMike (Feb 4, 2016)

chaz90 said:


> Hahaha. Where are these people working that 11% of paramedics have not seen a single cardiac arrest or DOA in 3 years??? I mean, I guess those 11% could all be people who either started last week or only run 10 calls a year...
> 
> Who could have guessed practice makes perfect? At this rate, I should have my Lazarus like skills honed any day now.



Maybe they're using Seattle math, where only patients who are witnessed going into v-fib count as cardiac arrests.........





I kid


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## Carlos Danger (Feb 4, 2016)

chaz90 said:


> Hahaha. Where are these people working that 11% of paramedics have not seen a single cardiac arrest or DOA in 3 years??? I mean, I guess those 11% could all be people who either started last week or only run 10 calls a year...
> 
> Who could have guessed practice makes perfect? At this rate, I should have my Lazarus like skills honed any day now.



There was a study done a while ago that showed that most (something like 40%?) paramedics in PA intubate less than once per year. 

At that time every cardiac arrest was still getting intubated, so........


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## FiremanMike (Feb 5, 2016)

Remi said:


> There was a study done a while ago that showed that most (something like 40%?) paramedics in PA intubate less than once per year.
> 
> At that time every cardiac arrest was still getting intubated, so........



I suppose it depends on how many paramedics are on scene of said arrests.   Here you're getting 8-10 paramedics, it's likely that only one of them will intubate..


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## johnrsemt (Feb 12, 2016)

I hate to say it:  but I have not seen a 'workable' cardiac arrest for almost 8 years,  and I run 1-2 patients a month (48 hours on 5 days off)


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## STXmedic (Feb 12, 2016)

You work 48hrs/wk and you see 1-2 patients a month?? I'd lose my mind...


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## joshrunkle35 (Feb 12, 2016)

chaz90 said:


> Hahaha. Where are these people working that 11% of paramedics have not seen a single cardiac arrest or DOA in 3 years??? I mean, I guess those 11% could all be people who either started last week or only run 10 calls a year...
> 
> Who could have guessed practice makes perfect? At this rate, I should have my Lazarus like skills honed any day now.



The outliers of EMS: perhaps people who work in/on stuff like offshore oil rigs, amusement parks (I fit into this population at one of my jobs...5-40 patient contacts can be regular, but cardiac arrest is actually rare. We only get 2-3 a year, and I've only worked one there.), small rural volunteer areas where people go on 1 call or less a month, jobs like EMS on a tactical team or on a Search and Rescue Team (another one of my jobs...we see dead bodies on scene all year round, but we never work them...it would be a rare find if we did...I wish for the patient's sake that we did, it's just that they've usually either been dead from suicide/homicide or accidental death or death from exposure, drowning, etc., and they've usually been dead for hours, or sometimes days...medics on SAR are generally more for our own team than victims/survivors). 

Anyhow, there are lots of areas with odd patient populations that don't have a regular/typical focus on cardiac arrest, yet for one reason or another, they do require EMS. 

11% seems pretty on par with what I would expect for that.


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## gotbeerz001 (Feb 13, 2016)

I work in a busy urban system and in 2 years have been primary on 3 workable codes and assisted in 2 others... In a system that runs 140,000+ calls, you'd think we'd have more.


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## Carlos Danger (Feb 13, 2016)

When I was new in EMS and doing urban 911 in a medium-large city, I think I averaged about 1 arrest a week. Some weeks none, some weeks several. I always assumed that was a pretty typical experience.


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## STXmedic (Feb 13, 2016)

Remi said:


> When I was new in EMS and doing urban 911 in a medium-large city, I think I averaged about 1 arrest a week. Some weeks none, some weeks several. I always assumed that was a pretty typical experience.


That's fairly consistent with my experience. Large, inner city averaging 15-20 runs/shift, and one arrest about every other shift (24/72s)


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## chaz90 (Feb 13, 2016)

Hmm. Very interesting how many different factors seem to go into this apart from call volume. I'll start a separate thread so as to avoid thread jacking.


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## gotbeerz001 (Feb 13, 2016)

At our peak, we have 40+ ambulances on the street county-wide with only 4 smaller fire agencies also providing transport (maybe 8 additional ambulances total).


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## medicsb (Feb 14, 2016)

I think most people tend to over-estimate procedural frequency and proficiency.  Anyhow, two of my old medic (911) jobs had an e-PCR with a search function where I could look up the codes and patients that were intubated where I was a primary crew member, and it was possible to look up coworkers.  Based on data I still have from 12 years ago: My first fulltime job was for a service with 2 ALS ambulances with a total call volume of 2100.  I had one cardiac arrest (early ROSC, thus no intubation) in my first year.  Over a 15 month period we worked around 18 cardiac arrests.  We had 8 or 9 fulltime medics and 4-6 PRN medics.  This was in a "rural" (not really _that_ rural) section of a county that abutted a top 10 most populated US city.  It's easy for me to see how a sizable number of medics may not work any arrests in a year (or 3).


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## Summit (Feb 15, 2016)

The article... shows that experienced providers are better... I am shocked SHOCKED by these conclusions! (pun intended)



medicsb said:


> I think most people tend to over-estimate procedural frequency and proficiency.  Anyhow, two of my old medic (911) jobs had an e-PCR with a search function where I could look up the codes and patients that were intubated where I was a primary crew member, and it was possible to look up coworkers.  Based on data I still have from 12 years ago: My first fulltime job was for a service with 2 ALS ambulances with a total call volume of 2100.  I had one cardiac arrest (early ROSC, thus no intubation) in my first year.  Over a 15 month period we worked around 18 cardiac arrests.  We had 8 or 9 fulltime medics and 4-6 PRN medics.  This was in a "rural" (not really _that_ rural) section of a county that abutted a top 10 most populated US city.  It's easy for me to see how a sizable number of medics may not work any arrests in a year (or 3).


Spot on


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## Carlos Danger (Feb 15, 2016)

I have always thought "experience dilution" was a problem in EMS. I honestly can't imagine trying to learn to be a good paramedic in a system where there are numerous paramedics on every transport.


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