Improving Outcomes After Time Sensitive Prehospital Interventions: Rescu Epistry

The prehospital component of health care begins with a call to 911 and ends on arrival to the Emergency Department (ED). In Ontario, prehospital care is provided by a system which includes 22 dispatch centres, 218 Fire and 72 Emergency Medical Services (EMS) who respond to over 1 million 911 calls a year. The prehospital setting is a chaotic, unpredictable environment in which to deliver care and currently there is no data on whether or not this system of care makes a difference in patient outcomes. The question: are the right patients, receiving the right care and making it to the right institutions cannot readily be answered. Outcome-based information to guide future EMS care has been hampered by the lack of comprehensive prehospital data resources that include meaningful patient outcomes.

Why target cardiac arrest, trauma, acute stroke, and sepsis? Ischaemic heart disease is the leading cause of death worldwide, and second leading cause of death in Canada; over 240,000 deaths from heart disease annually. The mean age of cardiac arrest patients is around 65 years of age and this demographic is increasing over time with the population older than 65 expected to double within the next 25 years such that by 2041 about 1 in 4 Canadians will be 65 or older.

Trauma is the number one cause of death and disability in people younger than 40 and confirmed for Canada as well for those under the age of 45. Trauma statistics are biased by the fact that the only data we have comes from the trauma centres and this means a trauma victim must survive long enough to make it to a trauma centre to be counted.

Stroke is the second leading cause of death worldwide, and the leading cause of chronic disability. Stroke is most frequently caused by an interruption of blood supply to portions of the brain due to occlusion of a major brain artery. Stroke statistics have the same bias as trauma statistics. The current registries for trauma and stroke (national and provincial) are administrative data sets containing only patients that are treated at a stroke or trauma centre and miss all those that are treated and released from community centres that are located close enough to a stroke or trauma centre to be subject to a community bypass strategy or referral. Nor do these data sets capture the important prehospital data on the event and time sensitive interventions provided in the prehospital setting.

Sepsis is a clinical syndrome that results from dysregulation of the inflammatory response to severe infection. As sepsis progresses to septic shock it is marked by severe organ dysfunction, coagulopathy, and eventually circulatory collapse and death. The mortality associated with sepsis syndrome ranges from 20 to 50% with increased mortality in patients diagnosed with severe sepsis and septic shock. The average prehospital care interval exceeded 45 minutes, highlighting that there is great potential for early treatment to be delivered by paramedics.