Resuscitate 2nd Edition PDF – How Your Community Can Improve Survival from Sudden Cardiac Arrest
In my line of work there is nothing more gratifying than speaking with a survivor of sudden cardiac arrest. Survivors are, needless to say, extremely grateful to their rescuers. The most common question they ask is how they can thank the people who saved their life. The rescuers are the people who are part of the EMS system and respond to the emergency—the dispatchers who help with telephone CPR instructions, the EMTs who perform CPR and deliver defibrillatory shocks, and the paramedics who provide airway control and medications. It is unfortunate that among those who have cardiac arrest, survivors comprise the minority—and in most communities throughout the nation a very, very small minority. When the patient dies we should ask why? Was death inevitable? Did the system fail? Was there something we could have done better? How can we improve? That’s what this book is all about—to provide the knowledge and tools to improve.
Perhaps only 1 percent of all calls to 911 involve attempted resuscitation from sudden cardiac arrest, but this 1 percent brings into play everything that is good and everything that is not so good about a community’s EMS system. The elements of care needed to resuscitate a victim of cardiac arrest are the same ones needed to help the victim of a car crash, a child with severe asthma, or people with other medical and traumatic emergencies. Every improvement in the treatment of sudden cardiac arrest benefits everyone who will ever need emergency care. And that’s why an EMS system’s management of cardiac arrest serves as a surrogate for the system itself. In short, survival from cardiac arrest is the metric upon which an entire EMS system’s quality may be judged.
The book is for the people—medical and administrative directors, fire chiefs, dispatch directors, and program supervisors—who direct and run EMS systems all across the country. But it will also have value for paramedics, EMTs, training officers, dispatchers, nurses, doctors, and other EMS professionals, as well as for elected officials, health services researchers, healthcare administrators, and ordinary concerned citizens. Because not every chapter will be equally relevant to every reader, those familiar with emergency medical services and resuscitation can skim or skip chapters 1–3. Those really pressed for time should read chapters 7, 9, and 10.
Chapter 1, “How We Die Suddenly,” describes sudden cardiac arrest and laments its generally low survival rates and its diversity in survival throughout the United States. Chapter 2, “A History of Resuscitation,” gives a brief account of resuscitation starting with Biblical times and ending with how modern emergency medical services came to pass.
Chapter 3, “The Causes of Sudden Cardiac Arrest,” describes the common and uncommon causes of this event.
Chapter 4, “A Profile of Sudden Cardiac Arrest,” provides demographics and elements of successful resuscitation and goes into some detail characterizing the time elements involved in providing care for cardiac arrest patients.
Chapter 5, “Who Will Live and Who Will Die,” identifies fifty factors associated with the likelihood of surviving or not surviving cardiac arrest. They are grouped into patient, event, system, and therapy factors and do much to explain why communities succeed or fail in the management of cardiac arrest.
Chapter 6, “Location, Location, Location: Best Places to Have a Cardiac Arrest,” gives details on the EMS systems in Seattle and King County, WA, and Rochester, MN, and profiles leaders in these EMS programs.
Chapter 7, “What Can Your Community Do?” challenges a community to assess its own performance with a Community Report Card.
Chapter 8, “A Completed Life,” poses the difficult question of who should be resuscitated, on the assumption that not everyone in cardiac arrest should be brought back to life.
Chapter 9, “Putting It All Together,” provides a framework for successful programs. Chapter 10, “An Action Plan,” provides a specific path with 15 concrete steps toward improvement. and lays out 4 immediate steps a community can take to improve survival. The first edition of Resuscitate! included 25 steps, but from listening to EMS administrators and medical directors, I have pared down and refocused the list to 15 steps. The national steps remain the most challenging to accomplish; they are included because I think attention must continue to be focused on the need for these changes, however difficult they may be.
Chapter 11, “A Vision of the Future,” describes both a short-term and a long-term vision. Currently, the national survival rate from cardiac arrest is abysmally low, yet it can be raised considerably higher. Though I may be constitutionally optimistic, I hope my vision is solidly based in reality. Time will tell.
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