The Power of Social Media to Share Our Stories

By Rachel Sobel - We talk about CPR a lot. In the field, at conferences, with industry peers and even on social media. If you follow our social media accounts (and we hope you do, cough cough), you will often see stories about the benefits of CPR. One of the biggest topics we call out, is the importance of CPR administered in pre-hospital situations, since it greatly impacts the chances of a more positive outcome.

We recently shared a story on Facebook about CPR and referenced that studies show that Bystander CPR and achieving a pulse BEFORE arriving at the hospital are critical to increased pediatric survival after cardiac arrest. As a matter of fact, in 2014 Polk County implemented the Handtevy System and their amazing field providers are doing exactly that. This year alone they have a 50% neurologically intact survival rate from pediatric cardiac arrest!

One of the most amazing aspects about sharing these things on social media is the conversation it sparks. Eliot Day, a paramedic, is one of those examples. Shortly after we shared our post, we noticed he shared it. But what made it even more meaningful was the context he shared around it. It was poignant and impactful and we just had to share it. Eliot’s words are so true and undoubtedly echo the sentiment of many in his position.

Eliot, thank you for engaging with us and sharing your story. We do what we do at Handtevy because we believe in incredible people just like you. We truly appreciate the time you took to share information about such an important area.

Posted by Eliot Day

Fellow Medics! I wanted to share something very close to my heart concerning a certain patient population in our field. Pediatric cardiac arrest patients. I happened upon this post from Pediatric Emergency Standards today and it got me very excited.

For a very long time now EMS has been notoriously stagnant in pediatric cardiac arrest care. I have quoted a portion from part 13 of the 2010 AHA PALS text that describes our survival to discharge rates as compared to our in-hospital counterparts. For the last several decades pediatric cardiac arrest survival has steadily and greatly improved in the in-hospital setting, while showing almost not movement in the out of hospital setting. Out of hospital survival rates have been around 3-6% where in hospital used to be equivalent but has since grown to 28-34%. AHA and the PALS algorithms have created a standard of care centered around the team approach, appropriate medications, and relevant equipment to be used. In almost all ALS ambulance systems paramedics have literally the same tools as the in hospital folks for the initial treatment and stabilization of cardiac arrest. The science is showing more and more with each study that the most effective portions of our treatment algorithms are the BLS components; that is quality CPR, ventilations, and proper electricity use.

I had read of a study done a few years ago that attempted to get to the bottom of why out of hospital arrest was so lacking by comparison. I have since lost that study. What I do remember was they were able to show that especially in the pediatric population the algorithms were not adhered to well. Many providers would do more of a "load and go" or "scoop and run" approach which showed a markedly low rate of time on compressions, sometimes as much as 50% or more time without CPR. Many pediatric codes failed to receive medications and airway and breathing maintenance was poor by comparison to in-hospital.

Long story short, basically the science and anecdotal data available at the moment is showing that the cardiac arrest patient most likely to survive is the one whose circulation was restored prior to arrival at ED. Regardless of being adult or pediatric. EMS is pretty guilty of being scared to treat pediatrics, and lets face it a pediatric code is the worst call you can be on. But the fact of the matter is that you are not doing anyone any favors by running scared with a kid in arrest. They need the same things their adult counterparts need, just with adjusted doses and generally more care centered around airway and ventilation maintenance. I know it is scary. Terrifying even. I have had peds codes and luckily most of mine have been successful. But I can tell you from first hand experience and many secondhand stories that most pediatric codes run by EMS fall very short of calm, cool, and professional when compared to the standards we generally perform to in adults.

ALS ambulance and first response systems are growing in capability and response ability almost daily. More and more we are carrying everything that is needed to get a patient to the next steps during the initial portion of resuscitation. There is no blue line at the ER door that says "if you can get your code here magic will happen". All you will generally find is another team that will run the same algorithm with similar or the same equipment that you were utilizing and the delay of getting that algorithm started and run properly is costing lives.

As EMS personnel and especially at the ALS level you are supposed to be a lifelong student of science and medicine for as long as you practice. No different that any RN, RT, PA, NP, MD, or DO. Trust in the science, trust in your equipment, and trust in your abilities. Continually practice and continually improve until you can run these calls as well as anyone and we will see more pediatric and overall cardiac arrest success in our field.

I will leave on this note that drives me: At the end of my time in the field if I ran 100 pediatric arrest calls I would not want to look back and know full well that as much a 25 or more of them would have lived had their arrest happened elsewhere because I failed to provide the quality of care I could have. Calm is smooth, smooth is fast, and the only patient that does well is the one who got the care they needed regardless of whom it came from.

I wish the best of luck to all EMS providers as you go out and serve your communities and I hope that in the near future we can catch up to and maybe even beat our in hospital counterparts!

AHA PALS Part 13 Quote:"Overall about 6%-8% of children who suffer an out-of-hospital cardiac arrest and 8% of those who receive prehospital emergency response resuscitation survive, but many suffer serious permanent brain injury as a result of their arrest.7,9,–,14 Out-of-hospital survival rates and neurological outcome can be improved with prompt bystander CPR,3,6,15,–,17 but only about one third to one half of infants and children who suffer cardiac arrest receive bystander CPR.3,9,12,18 Infants are less likely to survive out-of-hospital cardiac arrest (4%) than children (10%) or adolescents (13%), presumably because many infants included in the arrest figure are found dead after a substantial period of time, most from sudden infant death syndrome (SIDS).8 As in adults, survival is greater in pediatric patients with an initial rhythm of VF or pulseless ventricular tachycardia (VT) than in those with asystole or pulseless electric activity.7,8

Results of in-hospital resuscitation are better with an overall survival of 27%.19,–,21 The 2008 pediatric data from the National Registry of CardioPulmonary Resuscitation (NRCPR) recorded an overall survival of 33% for pulseless arrests among the 758 cases of in-hospital pediatric arrests that occurred in the participating hospitals. Pediatric patients with VF/pulseless VT had a 34% survival to discharge, while patients with pulseless electric activity had a 38% survival. The worst outcome was in patients with asystole, only 24% of whom survived to hospital discharge. Infants and children with a pulse, but poor perfusion and bradycardia who required CPR, had the best survival (64%) to discharge. Children are more likely to survive in-hospital arrests than adults,19 and infants have a higher survival rate than children."

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