How EMS systems are changing for the better

We've seen a range of things happen to our industry and agencies in the past 12 months

The 2010 AHA ECC Guidelines were published in October 2010 (they are published every five years) and made the strongest statements yet about therapeutic hypothermia.

In fact, post-resuscitation care for sudden cardiac arrest is now considered to be so important that an entire section of the guidelines is dedicated to it[1] and the AHA has created a fifth link in the chain-of-survival.[2]

Image AHA

The new chain-of-survival includes: Immediate recognition and activation, early CPR, rapid defibrillation, effective advanced life support, and integrated post-resuscitation care.

This was on the heels of policy statement by the AHA for regional systems of care for out-of-hospital cardiac arrest that set the stage for the 2010 guidelines.[3]

Two key findings in the policy statement should concern all of us:

  • There is at least a five-fold regional variation in the outcome of out-of-hospital cardiac arrest in the ROC Consortium (a group of EMS systems that actually measure).
  • Large interhospital variations exist in survival to hospital discharge after admission.

In other words, the ability of both EMS systems and hospitals to treat sudden cardiac arrest is extremely variable. When it comes to patient safety or system performance, variability is bad! The entire point of process improvement is to identify best practices and make them the ordinary performance in a given system.

This is hard. It doesn't happen by accident. There is no system performance fairy that will raise a magic wand and bring system-wide improvement to any EMS system or hospital. It takes specific, thoughtful, coordinated actions on the part of individuals within the system.

It requires leadership, buy-in, cooperation, empowerment, measurement, accountability, and that scariest of all things, change.

Paramedics, emergency nurses, ED physicians and administrators work together during
a “Code ICE” drill at Hilton Head Hospital to work the bugs out of the system.

Often there are significant barriers to change. They include politics, organizational inertia, competing priorities, low morale, lack of empowerment, other than patient-centered culture, poor leadership, and comfort with the status quo.

A lack of money can be a barrier but, more often than not, I consider this to be more of an excuse than a barrier. We need to start with what we have now.

An awesome quote about change came from an interventional cardiologist we interviewed recently for the Code STEMI web series named Michael Hibbart, M.D. He said, "Change is always difficult. Change will be there though. It's not the strongest who survive. It's the people who are most able to adapt to change."[4]

We're seeing EMS systems change for the better. More and more systems are collecting data and optimizing their approach to sudden cardiac arrest through public education, public access AED programs, minimally interrupted chest compressions, controlled ventilations, therapeutic hypothermia, and early recognition of STEMI.

However, we'll reach our full potential as an industry (a term I despise) or as a profession until we commit to transparency and a patient-centered culture.

Medical Directors and hospital administrators need to do their part, too. HIPAA was never meant to be a barrier to data sharing and process improvement. Not only is it acceptable or legal for a hospital to share data with EMS, it's a duty and a responsibility. We need to collectively make that clear in every jurisdiction in the United States, but we can't do that until we get our houses in order and prepare ourselves to use that data constructively.

There are lots of organizations out there that can help, including the HeartRescue Project, Take Heart America, HEARTsafe Communities, the CARES Registry, local allies with the American Heart Association, and even blogs and podcasts.

The tools of Web 2.0 and the EMS 2.0 movement have made it so that none of us are isolated any longer. If you're trying to bring change to your own EMS system and you're meeting resistance, ask for help! Odds are the same problems have been faced elsewhere. Conversely, if you've overcome these hurdles, then I'm certain you have lots to share with our colleagues from around the country or even the world.

Together we can make significant improvements in our profession and minimize the death and suffering associated with coronary artery disease in our communities.


1. 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science. Circulation. Volume 122, Issue 18_suppl_3; Part 9: Post-Cardiac Arrest Care. November 2, 2010

2. 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science. Circulation. Volume 122, Issue 18_suppl_3; Part 4: CPR Overview. November 2, 2010

3. Regional systems of care for out-of-hospital cardiac arrest: A policy statement from the American Heart Association. Circulation. 2010 Feb 9;121(5):709-29. Epub 2010 Jan 14

4. Behind the Scenes with Dr. Michael Hibbard in Sioux Falls, Code STEMI web series, Setla and Bouthillet, December 2011, Retrieved 12/12/2011.

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