Cardiac Response Lags in D.C.
Thursday, May 29, 2008
Only one in eight cardiac arrest patients transported by District ambulances make it to an emergency room with a pulse. Across the river in Arlington County and Alexandria, the rate is twice as high.
Patients in cardiac arrest, a condition usually triggered by an electrical disorder that disrupts the heart's blood-pumping, make up less than 1 percent of the District's 911 calls. That was 585 patients in 2005, the last year for which statistics are available. But experts say success in keeping those patients alive is one of the most telling indicators of the overall quality of an emergency medical system.
The number of cardiac arrest patients who are discharged and are able to resume their old lives is unknown because the hospitals do not provide that patient data to the District.
The District, at 61 square miles, would seem to have an advantage over more sprawling suburban counties in response time for patients in cardiac arrest. But its rate matches that of Prince George's County, which is 485 square miles and is growing so fast that officials are scrambling to provide more ambulance services. Arlington and Alexandria, jurisdictions similar to the District in density, lead the area in getting the patients to the hospital alive. Montgomery and Fairfax counties had rates of about one in six. Chances of survival increase in all jurisdictions when cardiac arrest is witnessed.
Although officials say the District is meeting a national standard of getting advanced life support units to critical cases within eight minutes 90 percent of the time, that's often too long. The likelihood of survival falls each minute patients in cardiac arrest go without treatment.
In 2005, only 12 percent, or 69, of the cardiac arrest patients treated by D.C. emergency medical personnel reached the hospital with a pulse, or in technical terms, a "return of spontaneous circulation." The numbers do not include those in cardiac arrest because of trauma.
"It's a clear indicator that the system in the District is not performing up to the [de facto national] standard of care," said Gregg C. Lord, associate director of the National Emergency Medical Services Preparedness Initiative at George Washington University. "If you improve cardiac arrest survival rates," then the EMS system will have been improved.
There is no national average for cardiac arrest survival, and not all jurisdictions calculate rates using the same method, Lord said. But no matter how you do the math, the District's percentage is low, he said.
In addition to response time, boosting rates depends on factors such as public access to defibrillators and people's willingness to help a stranger in distress, according to experts.
Michael Williams, chief medical officer for D.C. Fire and Emergency Medical Services, said that the District's rate is "too low" and that he has plans to boost the numbers, including training all D.C. government workers in CPR. But he said those plans are contingent on his department receiving supplemental funding. That money, which was approved by the D.C. Council this month but has not been disbursed, is also needed to address other shortcomings in the District's approach to emergency care.
Some are long-standing problems, despite efforts to remedy them.
For example, morphine and Valium, drugs commonly given to patients experiencing symptoms of a heart attack or seizure, respectively, are not stocked on District ambulances though they were approved for such use in 2002. Williams said he wants to use part of the designated $3.7 million to purchase the drugs.