Rialto Fire: 71% Neurologic Intact Cardiac Arrest Survival Rate?

NPO

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Rialto Fire is claiming a 71% neurologically intact at discharge Cardiac Arrest Survival rate.

Does anyone has a link to the study or data on this?

I find it hard to believe and want to see what this number truly represents.

If they DO have a true 71% survival rate, I want to know what they're doing right.
 

VentMonkey

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So, my buddy was a probie firefighter there a few years ago. He has since moved on to another department, but according to him they had a fairly high OOH SCA survival-to-neuro intact rate then, and apparently it’s further improved.

He’s not 100% sure what all is different, but said that they did/ do pit-crew, use the AutoPulse and don’t really stop compressions (assuming no changes in ROSC?).

They’re all ALS, and have plenty of “hands on deck”, but why is it so hard to fathom? Soon enough this will be the norm in EMS, not just pockets of EMS agencies across the country. But all in all it further sounds like it proves what we all already know, the ALS part counts so much less than the basics performed efficiently, and effectively until ED arrival.

ETA~ think about all of the ROSC patients you’ve had that went a smooth as possible. I’m willing to bet that it was by in large due to seamless teamwork.

The problem we have here is that the team with each call is a crapshoot, but when an entire agencies providers are dialed in on their specific roles with such events is it really all that surprising? I say it is not.
 
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DesertMedic66

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They are an ALS fire transport system. They use mechanical CPR devices, res-q-pod type devices, do heads up CPR, de-emphasize the use of Epi and a couple of other things. I have several buddies who currently work as medics for them so I’ll see if I can reach out.
 
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but why is it so hard to fathom?
Because it's so much higher than anywhere else.

The number I saw was 71% of OHCA to neurologic intact discharge... Not of ROSC patients, not of witnessed arrests, of ALL cardiac arrests.

I don't think I've got a personal 71% ROSC rate, let along neuro-intact rates.

I suspect the 71% number is the result of a bit of statistical gerrymandering, but even so, I don't discount their performance. If just like to see their studies and what their "magic bullet" is.
 

EpiEMS

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71% Utstein survival rate...aka "survival to hospital discharge of those cardiac patients whose arrest events were witnessed by a bystander and that involved persons who had an initial rhythm of ventricular fibrillation or pulseless ventricular tachycardia."

They're also claiming 60% ROSC rate for adult non-traumatic arrests. That's great and all, but ROSC without neurologically intact survival to discharge is basically meaningless.
There it is.

I knew there were some qualifiers that weren't quoted with the number.
 

VentMonkey

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I don't think I've got a personal 71% ROSC rate, let along neuro-intact rates.
I don’t believe I ever cared enough to count my percentage, my point was this:
...by in large it’s due to seamless teamwork.
Even with all the trials, criteria, studies etc. Even if their numbers aren’t what they’re saying they are, I’m willing to bet that they’re still better than the national average.

Also, if as @DesertMedic66 says is true, and they’re de-emphasizing things that have continuously proven of little-to-no merit why is our collective first reaction skepticism?

All this coming from a single-role provider who has more than shared his opinion on many faulty SoCal fire-based systems (ironic timing with the @RocketMedic fire-based thread). Is it skewed? Yes? No? I don’t know? Maybe?

Either way, they’re at least setting a bar that much higher, getting others (like us) talking, and providing a good, solid service to their citizens.

Do you think these studies and trials we’re holding in comparison matter much to the people within their catchment area that are walking away neurologically intact?

I look back at my fresh paramedic self 10 years ago, ask this question, and chuckle at my younger, more foolish-minded self.
 

StCEMT

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My experience is much more limited, but I don't think it is too much of a stretch. Personally I am somewhere in the 60's for rosc and 40's for neuro intact. If I have a short down time with CPR right away, my odds have been pretty successful. It's the unknown downtime and/or terminally ill codes I've worked that don't usually go well.
 
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NPO

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I don’t believe I ever cared enough to count my percentage, my point was this:

Even with all the trials, criteria, studies etc. Even if their numbers aren’t what they’re saying they are, I’m willing to bet that they’re still better than the national average.

Also, if as @DesertMedic66 says is true, and they’re de-emphasizing things that have continuously proven of little-to-no merit why is our collective first reaction skepticism?

All this coming from a single-role provider who has more than shared his opinion on many faulty SoCal fire-based systems (ironic timing with the @RocketMedic fire-based thread). Is it skewed? Yes? No? I don’t know? Maybe?

Either way, they’re at least setting a bar that much higher, getting others (like us) talking, and providing a good, solid service to their citizens.

Do you think these studies and trials we’re holding in comparison matter much to the people within their catchment area that are walking away neurologically intact?

I look back at my fresh paramedic self 10 years ago, ask this question, and chuckle at my younger, more foolish-minded self.
I'm not disagreeing that what they're doing is working, or discounting it in anyway. But the 71% number was obviously wrong to me (turns out it's just wrong in the way that it was reported to me). I can't credit them properly or see the effectiveness of their improvements if I don't know how well it's improving things.

I agree with all of the things that they're doing. We use a pit-crew based, CCR model with mechanical CPR. I think the mechanical CPR (in our case the Lucas 2) is the biggest game changer in outcomes for us, but it's all supported by CCR and Pit Crew. We require 3 ALS providers on scene of every arrest, and focus on compressions over ALS interventions. We're not even supposed to intubate until after 600 compressions. In post-arrest incident analysis we regularly see maximum "off chest time" around 5 seconds. We also do agressive after action meetings on all arrests where we look at everything from the initial 911 call, to dispatching audio, GPS playback, monitor data, etc... It all goes towards improving protocols and policies.

In fact, because of one of these after action meetings we have approached our director to look at new management of PEA, and have launched a new program to completely redo out mapping system to improve response times to hotels, apartments, etc...
 

Carlos Danger

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Also, if as @DesertMedic66 says is true, and they’re de-emphasizing things that have continuously proven of little-to-no merit why is our collective first reaction skepticism?

My first reaction is skepticism because on its face, the idea of 71% success on ALL arrests is simply unrealistic.

If you narrow it down to folks who had CPR started right away, that makes more sense. An impressive achievement, but not unrealistic like it would be without that qualifier.

I have no idea if they do this or not, but intentionally leaving out that important caveat (immediate CPR) is not only disingenuous but also potentially counterproductive to the greater cause.
 
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My first reaction is skepticism because on its face, the idea of 71% success on ALL arrests is simply unrealistic.

If you narrow it down to folks who had CPR started right away, that makes more sense. An impressive achievement, but not unrealistic like it would be without that qualifier.

I have no idea if they do this or not, but intentionally leaving out that important caveat (immediate CPR) is not only disingenuous but also potentially counterproductive to the greater cause.
He gets my original question. I don't have a problem with the number, I have a problem with the number as it was presented.

I personally have a 100% neuro-intact to discharge survival rate in patients who were discharged without neurologic deficit...

My point wasn't what they are or are not doing, but what did the 71% represent.
 

DesertMedic66

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I think it is very important to state what they are basing their numbers on. 71% sounds great and to the general public that sounds amazing until you start breaking it down to how they are actually getting those numbers.
 

VentMonkey

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I don’t run arrests based off of numbers or percentages; if you all do, that’s cool.

Best practices? Yes, absolutely, but define “best practices”. It’s all ever-changing. Good system, bad system, middle of the road system I’m more concerned about what I can do for my particular patient at that moment in time based off of best practices within my scope, power, clinical judgement and yes from collective data. But, the latter comes from constantly evolving. Apples, and oranges, but I just refuse to let numbers (skewed or not) in another system

In an all too ironic twist, on my way back home with the girls my daughter hands me the latest Jems issue in the mail (I thought my scrip had lapsed), and front cover is the Rialto FD. The supplemental mag mentions the OHCA and portable ECMO @cruiseforever mentioned in another thread...

For the record, I’m hardly harping on anyone. The numbers and percentages just isn’t my forte when it comes to how, I, as one measly individual paramedic chooses to serve his populous:).
 
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I don’t run arrests based off of numbers or percentages; if you all do, that’s cool.

Best practices? Yes, absolutely, but define “best practices”. It’s all ever-changing. Good system, bad system, middle of the road system I’m more concerned about what I can do for my particular patient at that moment in time based off of best practices within my scope, power, clinical judgement and yes from collective data. But, the latter comes from constantly evolving. Apples, and oranges, but I just refuse to let numbers (skewed or not) in another system

In an all too ironic twist, on my way back home with the girls my daughter hands me the latest Jems issue in the mail (I thought my scrip had lapsed), and front cover is the Rialto FD. The supplemental mag mentions the OHCA and portable ECMO @cruiseforever mentioned in another thread...

For the record, I’m hardly harping on anyone, the numbers and percentages just isn’t my forte when it comes to how I, as one measly individual paramedic chooses to serve his populous:).
No one here is about the numbers, I think. But when someone throws up a number like 71% it catches my attention. Not "wow how can I get my numbers that high" but "wow how can I improve my agencies practices to match that kind of result."
 

VentMonkey

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No one here is about the numbers, I think. But when someone throws up a number like 71% it catches my attention. Not "wow how can I get my numbers that high" but "wow how can I improve my agencies practices to match that kind of result."
I never said I didn’t understand what you were saying. What I am talking about is something else.

It would seem nearly every region has some cutting edge tactic, some “new”, or “improved” way of reinventing the wheel. It may, or may not be followed by numbers that support it in a non-biased fashion.

Someone else always challenge such theories, often for and with impressive results of their own. I get it, it’s how we all improve, evolve, and ultimately help to improve patient outcomes.

I stand by something I have said before: little of what I do matters, often what happens down the line is something regardless of how cutting-edge I may view things renders my thought process, and education irrelevant.

A topic for another thread or forum perhaps:).
 

VFlutter

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It is a great accomplishment and something to be proud of however it’s disingenuous if they are claiming the number without stating their inclusion criteria for the sake of sounding good. Witnessed cardiac arrests presenting with VF likely have the best survival in any system.
 

Carlos Danger

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This is a really good forum. Any other forum or FB page would have degenerated into a pissing match right about now.
 
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This is a really good forum. Any other forum or FB page would have degenerated into a pissing match right about now.
That's why I stick around. I've learned so much here. But not wanting to ever be in the position across a desk from my medical director explaining "a smart guy on this EMT forum told me to", I often take the ideas presented here, do my own research, expand my understanding on the topic and modify my practices to better patient care based on that. The end result is greater than the sum of it's parts.
 
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