Dallas Fire Department EMS Care - Quality

Sounds like laziness. Of course, it is under investigation and not facts or proof yet.
 
a couple of years ago, a doc friend of mine studying out of hospital cardiac arrest survival dug up that of all the departments using the Utstein criteria (which in both of our opinions is highly flawed anyway) Dallas came in at the bottom of all reporting.

Coincidence? I don't think so...
 
Veneficus,

Do you have a link to that study by any chance?

Just curious...what are some concerns about using the Utstein criteria? Isn't this the standard for reporting survival rates?
 
foreverbound said:
Veneficus,

Do you have a link to that study by any chance?

Just curious...what are some concerns about using the Utstein criteria? Isn't this the standard for reporting survival rates?
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to my knowledge his research on the matter was not published in any journal, it was used primarily for an anti-fire take over of an EMS system so there is no link.

Utstein is a standard, not everyone uses it.

The major sticking point is some of the criteria is not validated. It is basically opinion or a guess.
 
I don't see anything wrong with comparing survival rates amongst different agencies provided they use the same standard.

But yes, you are correct. A quick google on the utstein criteria shows that not all agencies use it. It seems to only apply to a very specific group of patients...witnessed cadiac arrest with a shockable rhythm upon EMS arrival.
 
foreverbound said:
I don't see anything wrong with comparing survival rates amongst different agencies provided they use the same standard..
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If the data does not reflect reality, then it is useless because all conclusions drawn from it are flawed.
 
"If the data does not reflect reality, then it is useless because all conclusions drawn from it are flawed."

What part of reality doesn't it reflect? The Utstein criteria simply reflects the survival rate for cardiac arrest victims who have a witnessed arrest and present in a shockable rhtyhm.
 
foreverbound said:
"If the data does not reflect reality, then it is useless because all conclusions drawn from it are flawed."

What part of reality doesn't it reflect? The Utstein criteria simply reflects the survival rate for cardiac arrest victims who have a witnessed arrest and present in a shockable rhtyhm.
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It is also used to evaluate the effectiveness of EMS agencies and procedures.

How do you accurately evaluate agency performance on unsubstantiated benchmarks?
 
Cardiac arrest survival rates can be one sign of the quality of care a system provides, provided a system is compared to another system that uses the same reporting criteria.

A system that has a 40% save rate vs a system with a 5% save rate can be concluded that they are more effective, provided both system's survival rate was reported using the same criteria.

Who said they're not good benchmarks? The Utstein criteria is simply one reporting system that only includes cardiac arrest victims who are witnessed and in a shockable rhythm.

I'll be down to say that it's almost always true that the systems with the best survival rates are the best systems over all.
 
I believe you can see Dallas' Utstein survival rate in a few of the Resuscitation Outcomes Consortium studies. I can't find an article off hand, but I did find this really quickly:
822px-Jama_cardiac_arrest_survival_rates.png


In case anyone is curious about the most recent recommendation for data collection according to the Utstein template:
http://circ.ahajournals.org/content/110/21/3385.full?sid=18adadb2-a5f2-4991-9d69-82c78c3c8cf8
 
foreverbound said:
Cardiac arrest survival rates can be one sign of the quality of care a system provides, provided a system is compared to another system that uses the same reporting criteria.

A system that has a 40% save rate vs a system with a 5% save rate can be concluded that they are more effective, provided both system's survival rate was reported using the same criteria.
Click to expand...

I've actually had this same argument before.

A system like King County, which has a relatively healthy, middle class, and well educated populous cannot possibly be compared to a system for example in Ohio, NJ, etc that has a destitute, unhealthy, and largely uneducated urban populous. Wouldn't you naturally expect better numbers in the former?

(which is actually another major flaw) comparing systems without the general health of the population.

In my mind, that makes it a rather poor indicator of system effectiveness.
 
Veneficus,

I'm not really sure where the whole FD based EMS vs non-FD based EMS thing came into play here. I didn't say that FD based EMS systems have higher survival rates. I simply said that systems that have higher survival rates are generally better systems, assuming these systems are compared on an equal level.

According to that video, yes, non-FD based EMS systems DO have higher survival rates. I'm not surprised DFD ranked amongst the lowest.
 
foreverbound said:
Veneficus,

I'm not really sure where the whole FD based EMS vs non-FD based EMS thing came into play here. I didn't say that FD based EMS systems have higher survival rates. I simply said that systems that have higher survival rates are generally better systems, assuming these systems are compared on an equal level.

According to that video, yes, non-FD based EMS systems DO have higher survival rates. I'm not surprised DFD ranked amongst the lowest.
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it was a link to the information gathered by my friend regarding the save rates for Dallas.

You asked for it, I found it.
 
Veneficus said:
I've actually had this same argument before.

A system like King County, which has a relatively healthy, middle class, and well educated populous cannot possibly be compared to a system for example in Ohio, NJ, etc that has a destitute, unhealthy, and largely uneducated urban populous. Wouldn't you naturally expect better numbers in the former?

(which is actually another major flaw) comparing systems without the general health of the population.

In my mind, that makes it a rather poor indicator of system effectiveness.
Click to expand...

Does it really matter how healthy, how rich, and how educated a population is when comparing arrest saver rates if you're comparing them against another city using the SAME reporting criteria?

Are you saying that in Ohio/NJ, a poorer person who is less educated is going to have a lower chance of surviving a witnessed VF arrest than a rich degree holding citizen in Seattle who also experiences a witnessed VF arrest?

I hope I am understanding what you mean by educated. College, I assume? Or are you talking about educated about CPR? Perhaps that IS one thing that could affect how reliable comparing cities using the Utstein criteria can be. I could see an argument made that using the Utstein criteria for Seattle vs...lets say Dallas...while they're using the same reporting criteria...Seattle might have a better survival rate because of their CPR education and public awareness?
 
Veneficus said:
It is also used to evaluate the effectiveness of EMS agencies and procedures.

How do you accurately evaluate agency performance on unsubstantiated benchmarks?
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i want this data that you and your friend compiled!
 
Fish said:
i want this data that you and your friend compiled!
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posted in the link above.

incidentally, it was all him, I can take no credit for it.
 
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