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Cardiac arrest can strike a seemingly healthy individual of any age, race, ethnicity, or gender at any time in any location, often without warning. Cardiac arrest is the third leading cause of death in the United States, following cancer and heart disease. Four out of five cardiac arrests occur in the home, and more than 90 percent of individuals with cardiac arrest die before reaching the hospital. First and foremost, cardiac arrest treatment is a community issue - local resources and personnel must provide appropriate, high-quality care to save the life of a community member. Time between onset of arrest and provision of care is fundamental, and shortening this time is one of the best ways to reduce the risk of death and disability from cardiac arrest. Specific actions can be implemented now to decrease this time, and recent advances in science could lead to new discoveries in the causes of, and treatments for, cardiac arrest. However, specific barriers must first be addressed. Strategies to Improve Cardiac Arrest Survival examines the complete system of response to cardiac arrest in the United States and identifies opportunities within existing and new treatments, strategies, and research that promise to improve the survival and recovery of patients. The recommendations of Strategies to Improve Cardiac Arrest Survival provide high-priority actions to advance the field as a whole. This report will help citizens, government agencies, and private industry to improve health outcomes from sudden cardiac arrest across the United States.
Sudden cardiac arrest can strike anyone at any time. But in many cities, people who suffer sudden cardiac arrest are up to 46 times more likely to die than those who experience cardiac arrest in Seattle and King County, Washington, or Rochester, Minnesota--an astonishing and completely preventable variance in survival rates.
The ESC Textbook of Intensive and Acute Cardiovascular Care is the official textbook of the Acute Cardiovascular Care Association (ACVC) of the ESC. Cardiovascular diseases (CVDs) are a major cause of premature death worldwide and a cause of loss of disability-adjusted life years. For most types of CVD early diagnosis and intervention are independent drivers of patient outcome. Clinicians must be properly trained and centres appropriately equipped in order to deal with these critically ill cardiac patients. This new updated edition of the textbook continues to comprehensively approach all the different issues relating to intensive and acute cardiovascular care and addresses all those involved in intensive and acute cardiac care, not only cardiologists but also critical care specialists, emergency physicians and healthcare professionals. The chapters cover the various acute cardiovascular diseases that need high quality intensive treatment as well as organisational issues, cooperation among professionals, and interaction with other specialities in medicine. SECTION 1 focusses on the definition, structure, organisation and function of ICCU's, ethical issues and quality of care. SECTION 2 addresses the pre-hospital and immediate in-hospital (ED) emergency cardiac care. SECTIONS 3-5 discuss patient monitoring, diagnosis and specific procedures. Acute coronary syndromes (ACS), acute decompensated heart failure (ADHF), and serious arrhythmias form SECTIONS 6-8. The main other cardiovascular acute conditions are grouped in SECTION 9. Finally SECTION 10 is dedicated to the many concomitant acute non-cardiovascular conditions that contribute to the patients' case mix in ICCU. This edition includes new chapters such as low cardiac output states and cardiogenic shock, and pacemaker and ICDs: troubleshooting and chapters have been extensively revised. Purchasers of the print edition will also receive an access code to access the online version of the textbook which includes additional figures, tables, and videos to better to better illustrate diagnostic and therapeutic techniques and procedures in IACC. The third edition of the ESC Textbook of Intensive and Acute Cardiovascular Care will establish a common basis of knowledge and a uniform and improved quality of care across the field.
Background: It has been proved that bystander cardiopulmonary resuscitation (CPR) saves lives; however, which training method in CPR is most instructive and whether survival is affected by the training level of the bystander have not yet been fully described. Aim: To identify the factors that may affect 7th grade students’ acquisition of CPR skills during CPR training and their willingness to act, and to describe 30-day survival from outof- hospital cardiac arrest (OHCA) after bystander CPR and the actions performed by laymen versus off-duty medically educated personnel. Methods: Studies I–III investigate a CPR training intervention given to students in 7th grade during 2013–2014. The classes were randomized to the main intervention: the mobile phone application (app) or DVD-based training. Some of the classes were randomized to one or several additional interventions: a practical test with feedback, reflection, a web course, a visit from elite athletes and automated external defibrillator (AED) training. The students’ practical skills, willingness to act and knowledge of stroke symptoms, symptoms of acute myocardial infarction (AMI) and lifestyle factors were assessed directly after training and at 6 months using the Laerdal PC SkillReporting system (and entered into a modified version of the Cardiff test scoring sheet) and a questionnaire. The Cardiff test resulted in a total score of 12–48 points, and the questionnaire resulted in a total score of 0–7 points for stroke symptoms, 0–9 points for symptoms of AMI and 0– 6 points on lifestyle factors. Study IV is based on retrospective data from the national quality register, the Swedish registry of cardiopulmonary resuscitation, 2010-2014. Results: A total of 1339 students were included in the CPR training intervention. The DVD-based group was superior to the app-based group in CPR skills, with a total score of 35 (SD 4.o) vs 33 (SD 4.2) points directly after training (p<0.001) and 33 (SD 4.0) vs 31 (SD 4.2) points at six months (p<0.001). Of the additional interventions, the practical test with feedback had the greatest influence regarding practical skills: at six months the intervention group scored 32 (SD 3.9) points and the control group (CPR only) scored 30 (SD 4.0) points (p<0.001). Reflection, the web course, visits from elite athletes and AED training did not further increase the students’ acquisition of practical CPR skills. The students who completed the web course Help-Brain-Heart received a higher total score for theoretical knowledge in comparison with the control group, directly after training: stroke 3.8 (SD 1.8) vs 2.7 (SD 2.0) points (p<0.001); AMI 4.0 (SD 2.0) vs 2.5 (SD 2.0) points (p<0.001); lifestyle factors 5.4 (SD 1.2) vs 4.5 (SD 2.0) points p<0.001. Most of the students (77% at 6 months), regardless of the intervention applied, expressed that they would perform both chest compressions and ventilations in a cardiac arrest (CA) situation involving a relative. If a stranger had CA, a significantly lower proportion of students (32%; p<0.001) would perform both compressions and ventilations. In this case, however, many would perform compressions only. In most cases of bystander-witnessed OHCA, CPR was performed by laymen. Off-duty health care personnel bystanders initiated CPR within 1 minute vs 2 minutes for laymen (p<0.0001). Thirty-day survival was 14.7% among patients who received CPR from laymen and 17.2% (p=0.02) among patients who received bystander CPR from off-duty health care personnel. Conclusions: The DVD-based method was superior to the app-based method in terms of teaching practical CPR skills to 7th grade students. Of the additional interventions, a practical test with feedback was the most efficient intervention to increase learning outcome. The additional interventions, reflection, web course, visit from elite athletes and AED did not increase CPR skills further. However, the web course Help-Brain-Heart improved the students’ acquisition of theoretical knowledge regarding stroke, AMI and lifestyle factors. For OHCA, off-duty health care personnel bystanders initiated CPR earlier and 30-day survival was higher compared with laymen bystanders.
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In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.
Emergency Medical Services (EMS) is a critical component of our nation's emergency and trauma care system, providing response and medical transport to millions of sick and injured Americans each year. At its best, EMS is a crucial link to survival in the chain of care, but within the last several years, complex problems facing the emergency care system have emerged. Press coverage has highlighted instances of slow EMS response times, ambulance diversions, trauma center closures, and ground and air medical crashes. This heightened public awareness of problems that have been building over time has underscored the need for a review of the U.S. emergency care system. Emergency Medical Services provides the first comprehensive study on this topic. This new book examines the operational structure of EMS by presenting an in-depth analysis of the current organization, delivery, and financing of these types of services and systems. By addressing its strengths, limitations, and future challenges this book draws upon a range of concerns: • The evolving role of EMS as an integral component of the overall health care system. • EMS system planning, preparedness, and coordination at the federal, state, and local levels. • EMS funding and infrastructure investments. • EMS workforce trends and professional education. • EMS research priorities and funding. Emergency Medical Services is one of three books in the Future of Emergency Care series. This book will be of particular interest to emergency care providers, professional organizations, and policy makers looking to address the deficiencies in emergency care systems.
This book focuses on the placement of vascular access devices under emergent conditions, including the techniques and devices needed to achieve successful device deployment in even the most critically-ill patient. Up-to-date references and evidence for best practices are provided, informing both the novice and experienced healthcare provider. Each chapter is meticulously researched, including individual chapters focusing upon peripheral intravenous, intraosseous, central venous, and ultrasound-guided catheter placement. Device selection and emergent decision-making are discussed at length, including such crucial determinants as infusion flow rates, device limitations, issues with medication incompatibility, complications of line placement, and the relative indications and contraindications associated with various vascular access approaches. Emergent Vascular Access is an essential resource for any healthcare provider who places or manages vascular access devices in critically-ill patients, including emergency and ICU physicians, residents, rapid response providers, EMS paramedics, patient care technicians, medical students, and nurses.