Matthew R Jordan1, Michael F O'Keefe2, David Weiss3, C Wes Cubberley2, Charles D MacLean4, Daniel L Wolfson5. 1. Division of Emergency Medicine, Department of Surgery, University of Vermont Medical Center, 111 Colchester Avenue, Burlington, Vermont, USA; LT, MC, USN, Department of Emergency Medicine, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA, USA. Electronic address: matthew.r.jordan@med.uvm.edu. 2. Division of Emergency Medicine, Department of Surgery, University of Vermont Medical Center, 111 Colchester Avenue, Burlington, Vermont, USA; Larner College of Medicine at the University of Vermont, 89 Beaumont Avenue, Burlington, VT, USA. 3. Division of Emergency Medicine, Department of Surgery, University of Vermont Medical Center, 111 Colchester Avenue, Burlington, Vermont, USA. 4. Larner College of Medicine at the University of Vermont, 89 Beaumont Avenue, Burlington, VT, USA. 5. Division of Emergency Medicine, Department of Surgery, University of Vermont Medical Center, 111 Colchester Avenue, Burlington, Vermont, USA; Larner College of Medicine at the University of Vermont, 89 Beaumont Avenue, Burlington, VT, USA; Vermont Department of Health, Division of Emergency Preparedness, Response & Injury Prevention,108 Cherry Street, Burlington, Vermont, USA.
Abstract
BACKGROUND: Emergency Medical Services (EMS) are often the first medical providers to begin resuscitation of out-of-hospital cardiac arrest (OHCA) victims. The universal Basic Life Support Termination of Resuscitation (BLS-TOR) rule is a validated clinical prediction tool used to identify patients in which continued resuscitation efforts are futile. OBJECTIVE: The primary aim is to compare the rate of transport of OHCA cases before and after the implementation of a BLS-TOR protocol and to determine the compliance rate of EMS personnel with the new protocol in a largely volunteer, rural system. METHODS: A retrospective cohort study was conducted using the statewide EMS electronic patient care report system. Cases were identified by searching for any incident that had a primary impression of "cardiac arrest" or a primary symptom of "cardiorespiratory arrest" or "death." Data were collected from the two years prior to and following implementation of the BLS-TOR rule from January 1, 2012 through March 31, 2016. RESULTS: There were 702 OHCA cases were identified, with 329 cases meeting inclusion criteria. The transport rate was 91.1% in the pre-intervention group compared with 69.4% in the post-intervention group (χ2=24.8; p<0.001). EMS compliance rate with the BLS-TOR rule was 66.7%. Of the 265 patients transported during the study, 87 patients met (post-intervention group; n=22) or retrospectively met (pre-intervention group; n=65) the BLS-TOR requirements for field termination of resuscitation. None of these patients survived to hospital discharge. CONCLUSION: Rural EMS systems may benefit from implementation and utilization of the universal BLS-TOR rule. Published by Elsevier B.V.
BACKGROUND: Emergency Medical Services (EMS) are often the first medical providers to begin resuscitation of out-of-hospital cardiac arrest (OHCA) victims. The universal Basic Life Support Termination of Resuscitation (BLS-TOR) rule is a validated clinical prediction tool used to identify patients in which continued resuscitation efforts are futile. OBJECTIVE: The primary aim is to compare the rate of transport of OHCA cases before and after the implementation of a BLS-TOR protocol and to determine the compliance rate of EMS personnel with the new protocol in a largely volunteer, rural system. METHODS: A retrospective cohort study was conducted using the statewide EMS electronic patient care report system. Cases were identified by searching for any incident that had a primary impression of "cardiac arrest" or a primary symptom of "cardiorespiratory arrest" or "death." Data were collected from the two years prior to and following implementation of the BLS-TOR rule from January 1, 2012 through March 31, 2016. RESULTS: There were 702 OHCA cases were identified, with 329 cases meeting inclusion criteria. The transport rate was 91.1% in the pre-intervention group compared with 69.4% in the post-intervention group (χ2=24.8; p<0.001). EMS compliance rate with the BLS-TOR rule was 66.7%. Of the 265 patients transported during the study, 87 patients met (post-intervention group; n=22) or retrospectively met (pre-intervention group; n=65) the BLS-TOR requirements for field termination of resuscitation. None of these patients survived to hospital discharge. CONCLUSION: Rural EMS systems may benefit from implementation and utilization of the universal BLS-TOR rule. Published by Elsevier B.V.