VACAR Annual Report 2011/12 - Ambulance Victoria

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Ambulance Victoria, Emergency Medical Service The state of Victoria, Australia has a population of 5.6 million with approximately 4 million residing in metropolitan Melbourne. The emergency medical service (EMS) comprises ambulance paramedics who have some advanced life support skills (laryngeal mask airway, intravenous epinephrine) and MICA paramedics who are authorised to perform endotracheal intubation, rapid sequence induction, Pneumocath® insertion and administer a wider range of drugs. Paramedics in Victoria have a base qualification of a three year bachelor degree in emergency health sciences or Paramedicine. MICA paramedics are experienced paramedics who undergo a university-level post graduate diploma in Intensive Care Paramedic Practice. The Medical Priority Dispatch System (MPDS) is operational in Victoria. MICA paramedics are dispatched to patients with critical illness, including patients with cardiac arrest. A first responder program for early defibrillation by fire-fighters operates for suspected cardiac arrest patients in the inner and some peripheral areas of Melbourne. In addition, AV co-responds with 29 volunteer community teams in smaller, predominately rural communities across the state. The cardiac arrest protocols follow the recommendations of the Australian Resuscitation Council. Ambulance Victoria paramedics are not obliged to commence resuscitation when the clinical presentation is inconsistent with life. This includes decapitation, presence of rigor mortis, decomposition or post mortem lividity, where death has been declared by a Medical Officer who is or has been at the scene and where the presenting rhythm was monitored as asystole for greater than 30 seconds, and there has been more than 10 minutes downtime with no evidence of hypothermia, drug overdose or family/bystander objections. Paramedics may discontinue resuscitation if advanced life support has been performed for 30 minutes without return of spontaneous circulation (ROSC), the rhythm is not Ventricular Fibrillation (VF) or Ventricular Tachycardia (VT), and there are no signs of life, no gasps or evidence of pupillary reaction and no evidence of hypothermia or drug overdose. VACAR Annual Report 2011/12 Page 14
About this report While cardiovascular mortality has declined over the last three decades, the case-fatality rate of sudden cardiac arrest has not declined (Nichol et al. Circ. 2008). Cardiac arrest is a significant cause of disability and death in Australia, with a reported incidence of 113 events per 100,000 peoples (Berdowski et al. Resus. 2010). Much of the burden associated to sudden cardiac death occurs before a patient reaches the hospital, and therefore EMS has a crucial role in reducing the burden of illness in our communities. The American Heart Association states that monitoring the treatment of out-of-hospital cardiac arrest (OHCA) by EMS agencies could be the sentinel measure of the quality of EMS care in our communities (Nichol et al. Circ. 2008). This report describes data from the Victorian Ambulance Cardiac Arrest Registry (VACAR) for all OHCA events attended by AV. The main focus of this report is to summarise data pertaining to adult and paediatric OHCA in Victoria within the most recent fiscal year, July 2011 to June 2012. Data for this report was extracted on 17 September 2012, with pending hospital follow-up remaining in a small proportion of events. The registry is based on the internationally recognised Utstein template and definitions (Jacobs et al. Resus. 2004). The data in the registry is subject to ongoing quality control, most of which has been incorporated back into the registry at the time of this report. Quality assurance measures are conducted routinely, leading to improvements in the integrity of the data with time. Data on survival to hospital discharge is also being continually updated and hence should be treated and interpreted with caution. Descriptive statistics in this report are presented as frequencies and proportions for categorical data, and median and interquartile ranges for continuous variables. Comparisons of proportions were undertaken using the chi-square test. A logistic regression analysis was used to describe the risk-adjusted odds of survival to hospital discharge across years and population regions of Victoria. These models were adjusted for known predictors of survival and are described in more detail in the report. Unless otherwise stated, all other statistical comparisons were unadjusted. Analyses in this report contain Metropolitan and Rural comparisons. Geospatial mapping has been used to define regional boundaries according to the Victorian Government Department of Health regions (www.health.vic.gov.au/regions). The Melbourne metropolitan region is comprised of three geographical boundaries including the North and West, Eastern and Southern Regions. Rural boundaries comprise the Barwon South West, Grampians, Loddon Mallee, Hume, and Gippsland regions. Population figures used in this report are defined by the Regional Population Growth reports published by the Australian Bureau of Statistics, 2012. The population figures are provided for the end of 30 June 2011, with a Victorian population estimate of 5,533,754 (excludes unincorporated populations). Local Government Areas (LGAs) are used to define population estimates within each Department of Health region. Patients who suffer a cardiac arrest in the presence of paramedics represent a unique subgroup of patients. These patients differ considerably in survival factors (e.g. response time, time to defibrillation, presenting rhythm etc.), and may therefore skew the analyses provided. Data relating to paramedic or EMS witnessed OHCA have therefore been analysed and depicted separately to those which are unwitnessed by paramedics. VACAR Annual Report 2011/12 Page 15
Page 1 and 2: [Cover Page] VACAR Annual Report 20
Page 3 and 4: Victorian Ambulance Cardiac Arrest
Page 5 and 6: This document has been prepared by
Page 7 and 8: Contents List of tables Page 9 List
Page 9 and 10: List of tables Table 1: VACAR inclu
Page 11 and 12: Figure 27: Direction of first bysta
Page 13: Victorian Ambulance Cardiac Arrest
Page 17 and 18: Data capture Ambulance Victoria’s
Page 19 and 20: Executive summary 1. There were 5,1
Page 21 and 22: VACAR Annual Report 2011/12 Page 21
Page 23 and 24: Frequency INCIDENCE Incidence of ad
Page 25 and 26: Age Category (Years) DEMOGRAPHICS D
Page 27 and 28: Age Category DEMOGRAPHICS Demograph
Page 29 and 30: PRECIPITATING EVENTS Paediatric pre
Page 31 and 32: Proportion LOCATION OF ARREST Arres
Page 35 and 36: Time (Minutes) EARLY ACCESS Emergen
Page 37 and 38: Time (Minutes) Survival EARLY DEFIB
Page 39 and 40: [This page is blank] VACAR Annual R
Page 43 and 44: Proportion SCENE OUTCOMES Return of
Page 45 and 46: Proportion Survival SURVIVAL OUTCOM
Page 47 and 48: SURVIVAL OUTCOMES Risk-adjusted odd
Page 49 and 50: QUALITY OF LIFE Discharge direction
Page 51 and 52: Glossary of terms Table 6: Glossary
Page 53 and 54: The VACAR group Table 8: Members of
Page 55 and 56: [This page is blank] VACAR Annual R

VACAR Annual Report 2011/12 - Ambulance Victoria

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