When a person experiences cardiac arrest, paramedics and first responders may use an Automated External Defibrillator to help “re-set” the heart rhythm. Not all cardiac arrests receive a shock, but all AEDs collect important heart rhythm and rate data that can help the Heart Health team determine what caused the heart to stop and guide treatment decisions. However, this data is not always easy to get. Dr. Daisy Dulay, Randall Town, Laura Shaw and Rosie Holmes set out to improve how the AED data is shared with their AED quality improvement project.
Randall is the clinical nurse leader of the Cardiac Care Unit at Royal Jubilee Hospital. Cardiac arrest patients from all over Vancouver Island arrive here and Randall and his team try to track down the AED rhythm strip for each arrest. Depending on where the cardiac arrest occurred and who got there first, Randall may have to call the BC Ambulance Service, local firefighters, police or community-based organization (for example: hockey arena, pharmacy, shopping mall) to try to get the rhythm strip.
The AED rhythm strip is very important as it can help cardiologists determine what caused the cardiac arrest and the recommended treatment plan.
There are many possible reasons why a person’s heart stops. Some cardiac arrests are not heart attack-related – the heart stops due to another reason. Also, unresponsiveness without a pulse is not the same as cardiac arrest.
Common treatments for people who experience cardiac arrest include pacemakers or more commonly implantable cardioverter defibrillators. These are significant treatments and require invasive surgery to install, so having more information helps inform the treatment plan and ensure that appropriate testing and procedures occur.
Tracking down AED rhythm strips also takes a significant amount of time and effort. Time that could be spent providing direct patient care.
With funding support from the Specialist Services Committee Facility Engagement Initiative from the Doctors of BC and help from Rosie, the Cardiac Care team first examined what happens to AED rhythm strips under the current system. Paramedics in advanced ambulances download AED rhythm strips from their ambulance, then they are added to the patient’s electronic health record. In basic ambulances they must download the strips at the station. These are then sent to the BC Ambulance database. Fire fighters and community AEDs do not have one process to download strips. Before the AED project began, half of the patients had their AED rhythm strips in their charts.
In phase one of the AED project, the team developed a template to clearly request AED rhythm strips from BC Emergency Health Services - a similar process that the Heart Quality team follows for heart attacks that require urgent intervention. The template helped clearly communicate what was needed and why. After two months of using the template, the rate of rhythm strips recovered from ambulance patients increased by 25 per cent.
Phase two focuses on improving rate of rhythm strips recovered from firefighters. Firefighters often arrive first to cardiac events and although they have AEDs, there is no standard and uploading procedures vary for each device.
Laura Shaw, a project analyst with the Heart Health team helped engage first responders with the AED Project Team. This allowed the team to share the project and have an open discussion about how to improve AED rhythm strip process. A collaborative lunch presentation was held and many potential improvements were discussed. These include a centralized AED contact email and the potential for more synchronization with the BC Emergency Health Services.
The AED Project team is hoping to refine phase one and continue to work with firefighters to improve the access for the AED information. Phase three is more challenging as it involves community and privately owned AEDs. Currently, the team is tracking how often this happens.
Next week the team will share their project with more first responders at the provincial level at the Fire Expo and Fire Chiefs Association of BC’s education summit in Penticton.