CA Review JRT
Meeting Date: Aug. 20, 2024
To: Mayor and City Council
From: Scott Chadwick, City Manager
Staff Contact: Nathan Pearson, Fire Division Chief
[email protected], 442-339-2241
Subject: Resuscitation Outcomes, 2023-2024
Districts: All
Recommended Action
Receive a report describing recent outcomes of emergency medical services patients in cardiac arrest.
Executive Summary
The history of paramedicine is closely linked to the survival of patients experiencing cardiac arrest. Since its inception, paramedicine has focused on improving the survival of out-of- hospital cardiac arrests, and this measure remains a key indicator of system success worldwide.
The Carlsbad Fire Department has experienced sustained improvement in this area in recent years. Through timely response, enhanced training and equipment, public engagement, and tracking by the Community Health Nurse, the department has seen continuing improvement in outcomes, a positive trend that has exceeded national, state and regional averages in standardized measures.
Explanation and Analysis
Measures of success
In emergency medicine, a common indicator used to determine one’s resuscitation success rate is called sustained “return of spontaneous circulation.” This measures how often a patient without a heartbeat is treated with cardiopulmonary resuscitation and advanced life support and regains a pulse.
In a 2022 memo to the City Council, the Fire Department reported that, between 2017 and 2022, the rates of return of spontaneous circulation had shown a downward trend. In response, Fire Department personnel, including the Community Health Nurse, established additional tracking, training and public engagement efforts. This has led to a marked improvement in outcomes. Significantly, this improvement has continued, currently exceeding regional, state and national averages.
Aug. 20, 2024
Item #9 Page 1 of 3
In 2023, the Fire Department responded to 133 medical cardiac arrests. Of those, 109 met the medical criteria for treatment within San Diego County paramedic protocols.
There are two standard measures that the department monitors to determine performance in cardiac arrest scenarios:
• Survival to discharge, neurologically intact. This is a measure of cases in which CPR was performed in the field and the patient subsequently left the hospital with a healthy level of mental function.
• Utstein survival rate. This measure takes into consideration cardiac activity upon first contact and bystander CPR actions to look more specifically at circumstances in which the patient could potentially benefit from further intervention.
The table below shows the survival rates among cardiac resuscitation patients who are considered treatable during cardiac arrest under nationally accepted criteria:
Carlsbad survival rates comparison - 2023
Carlsbad Fire Countywide California National
Survival to discharge, neurologically intact 21.80% 7.40% 6.50% 8.10% Utstein survival rate 64.30% 43.30% 32.10% 32.80%
Contributing factors
The most obvious contributing factor is the timely response and performance of our emergency medical services personnel. However, the successful resuscitation of a patient also depends on what occurs before paramedics arrive.
The chance of surviving a cardiac arrest greatly increases with the immediate application of CPR and an automated external defibrillator by bystanders, guided by fire dispatch staff. The broad distribution of defibrillators, such as in Police Department vehicles, and the increased likelihood of interventions by bystanders because of educational programs such as “Sidewalk CPR” and the countywide “Revive and Survive” program, which the Carlsbad Fire Department supports, are also significant contributors to these improved outcomes.
While the Fire Department is encouraged by the increase in these measures of survival for cardiac patients, it must be acknowledged that despite the department’s best efforts, not every outcome is positive.
Examples
The following are short synopses of some successful cases.
July 2024, 64-yea r-old male
Recently, while spending the day with his family at a local beach, the patient came out of the water and collapsed on the sand. State lifeguards began CPR and provided one defibrillation.
City lifeguards and Carlsbad Fire personnel from Station 7 arrived within four minutes. Fire personnel provided CPR and advanced life support, including eight additional defibrillations.
The patient was transported to the emergency room with his pulse returned and was responding well. The patient continues to improve daily as he awaits heart surgery.
Aug. 20, 2024
Item #9 Page 2 of 3
June 2024, 74-year-old male
While playing softball at a local park, the patient collapsed on the field. Teammates trained in hands-only CPR-initiated care. Carlsbad Police officers arrived and used the defibrillator from a patrol vehicle, delivering one defibrillation before paramedics arrived. Carlsbad Fire personnel assumed care, continued CPR, established access for medications, and transported the patient to an emergency room. The patient became alert upon arrival at the hospital and was discharged home.
June 2023, 69 -year-old male
The patient collapsed during a pickleball game and other players initiated CPR. Carlsbad Fire personnel arrived, provided CPR, completed three defibrillations and treated the patient with medications. The patient had a pulse upon arrival at the emergency room and was discharged to go home four days later.
June 2023, 49 -year-old male
The patient became unconscious while dining at a local restaurant. A Carlsbad pool lifeguard was at the restaurant and began CPR. Carlsbad Police officers arrived shortly after and continued CPR and used the defibrillator from the patrol vehicle to provide one defibrillation.
The patient regained consciousness and Carlsbad Fire personnel transported him to the ER for treatment. The patient was ultimately discharged with an implanted defibrillation device.
March 2023, 28-ye ar-old female
The patient was discovered by her family members to be unresponsive and not breathing.
Carlsbad Police officers arrived and administered Narcan, a medicine that rapidly reverses an opioid overdose. Paramedics arrived, determined the patient to be in cardiac arrest, and began CPR with additional medical interventions. The patient’s pulse returned en route to the hospital. The patient was treated at the hospital and discharged.
Fiscal An alysis
There is no fiscal impact associated with receiving this report.
Next Steps
The Fire Department will continue to monitor the performance of the EMS system and implement evidence-based improvements to the care it provides to the community. The department will also continue to support education and training in CPR and the placement of automated external defibrillators throughout the city.
Environmental E valuation
This action does not constitute a project within the meaning of the California Environmental Quality Act under California Public Resources Code Section 21065 in that it has no potential to cause either a direct physical change or a reasonably foreseeable indirect physical change in the environment.
Exhibits
None
Aug. 20, 2024
Item #9 Page 3 of 3
RESUSCITATION
OUTCOMES 2024
Nate Pearson, Division Chief
Christina Gilmore, Community Health Nurse
Fire Department
August 20, 2024
{ City of
Carlsbad
2 TODAY’S PRESENTATION
• Review Cardiac Arrest and CPR
• Define Performance Measurement
• Provide Operational Update
• Summarize Positive Outcomes
ITEM 13: RESUSCITATION OUTCOMES 24
{ City of
Carlsbad
3 PROPOSED ACTION
Receive a report describing recent outcomes of
emergency medical services patients in cardiac
arrest.
ITEM 13: RESUSCITATION OUTCOMES 24
{ City of
Carlsbad
4 CARDIAC ARREST AND CPR
• Criteria for Inclusion
• What is CPR and AED?
• Return of Spontaneous Circulation
• Measuring Success
ITEM 13: RESUSCITATION OUTCOMES 24
{ City of
Carlsbad
5 CRITERIA FOR INCLUSION
CARDIAC
ARREST
911 ACCESS PATIENT
CRITERIA
TREATMENT
PROVIDED
6 CPR AND AEDS
ITEM 13: RESUSCITATION OUTCOMES 24
7 MEASURING SUCCESS
ITEM 13: RESUSCITATION OUTCOMES 24
ROSC – Return of Spontaneous Circulation
Utstein Survival Rate
Survival to Discharge, Neurologically Intact
0 8
8 CARLSBAD PERFORMANCE
25%
20%
15%
10%
5%
0%
Survival to discharge, neurologically intact
21.8%
~ 3 CARLSBAD
X higher survival
7.4% 6.5%
Carlsbad Countywide California
8.1%
National
9 9
CARLSBAD PERFORMANCE
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Utstein survival rate
2 CARLSBAD
r X higher survival
65.3%
43.3%
32.1%
Carlsbad Countywide California
32.8%
National
10 Case 1:
• 64 year old
• Went unconscious on beach
• Lifeguards and bystanders began CPR
• Paramedics defibrillated 8 times
• Has been responding well after
treatment
ITEM 13: RESUSCITATION OUTCOMES 24
( City of
Carlsbad
11 Case 2:
• 74 year old
• Collapsed on softball field
• Teammates provided CPR
• CPD used AED to deliver defibrillation
• Medic treated en route
• Discharged home
ITEM 13: RESUSCITATION OUTCOMES 24
( City of
Carlsbad
12 Case 3:
• 69 year old
• Collapsed during pickleball match
• Players provided CPR
• Medics arrived and defibrillated patient
• Transported to ER and was discharged
home 4 days later
ITEM 13: RESUSCITATION OUTCOMES 24
( City of
Carlsbad
13 Case 4:
• 49 year old
• Unresponsive at local restaurant
• Pool lifeguard dining began CPR
• CPD provided defibrillation with AED
• Patient regained consciousness before
arriving at hospital.
• Discharged home with AICD
ITEM 13: RESUSCITATION OUTCOMES 24
( City of
Carlsbad
14 Case 5:
• 28 year old
• Found unconscious by parents
• CPD arrived and administered Narcan
• Medics arrived with patient in cardiac
arrest
• Additional treatment and CPR, pulse
returned
• Patient discharged
ITEM 13: RESUSCITATION OUTCOMES 24
( City of
Carlsbad
15 RECENT EFFORTS
• Response times
• AEDs
• Sidewalk CPR and Revive and Survive
ITEM 13: RESUSCITATION OUTCOMES 24
( City of
Carlsbad
16 ITEM 13: RESUSCITATION OUTCOMES 24
QUESTIONS
•