Out-of-hospital cardiac arrest (OHCA) is a common, life-threatening event that is a leading cause of death in the United States. However, it is unclear how to design strategies that can be successfully implemented in emergency medical services (EMS) agencies and broader emergency response systems (such as fire, police, dispatch, and bystanders to OHCA events) in different communities to help improve daily care processes and outcomes in OHCA. The National Heart, Lung, and Blood Institute–funded Enhancing Prehospital Outcomes for Cardiac Arrest (EPOC) study lays the foundation for future quality improvement efforts in OHCA by identifying, understanding, and validating the best practices adopted within emergency response systems to address these life-threatening events and by addressing potential barriers to implementation of these practices. RAND researchers developed recommendations covering all levels of the prehospital OHCA incident response and the principles of change management necessary to implement those recommendations.
- What are the variations in OHCA survival among EMS agencies and communities?
- Which approaches are system-of-care best practices for OHCA survival?
Researchers identified strategies to improve OHCA survival and potential practices to improve care delivery from a system-of-care perspective.
- Researchers conducted in-depth, semistructured key informant interviews and multidisciplinary focus groups with more than 160 personnel from 911/dispatch, EMS, non-transport fire, and police in nine emergency response systems with high-, intermediate-, and low-survival outcomes.
- Strategies identified from the qualitative analysis were extracted by two researchers into templates organized by different best-practices categories relating to the OHCA system-of-care to inform our recommendations.
- Researchers also conducted an environmental scan of peer-reviewed literature. Strategies were deemed applicable for our recommendations according to the level of supporting evidence from all of the qualitative and environmental scan data.
Researchers developed a total of 49 recommended strategies.
- These strategies address all phases of the prehospital OHCA incident response and the principles of change management necessary to implement the recommendations.
- The strategies cover the incident, stakeholder, and system levels. Strategies to improve OHCA outcomes can be adopted by individual stakeholders but are also applicable across the system of care.
Author(s): Mahshid Abir, Stephen R. Dowker, Wilson Nham, Nasma Berri, Sydney Fouche, Christopher Nelson, Jane Forman, Michael D. Fetters, Peter Mendel, Timothy Guetterman, Bill Forbush, Robert Neumar, Brahmajee Nallamothu