2006 was a different time, wasn’t it? Backboards were all the rage, tourniquets had just started to make a comeback with NREMT regulations, and AHA dropped a bombshell with their 2005 updates. Turns out minimizing interruptions in compressions to maximize their benefit was now a thing. Most of us were completely satisfied in our data-free systems to run codes the way they had always been. Sure, most everyone died, and very few had any “good” survival stories. But, what we did have was the tradition. Despite Einstein’s definition of insanity, we were dedicated to repeating our not-so-tried-and-true efforts expecting a different result.
I was in the same rut of resuscitation tradition, but worse. I taught others our “traditions” and was applauded for my efforts. I likely would have continued towing the traditional line if it wasn’t for “Norma.”
“Norma” went into cardiac arrest in her home a few days after the 2005 AHA updates were released. Striving to be a good teacher, I had read the updates and thought the “minimizing compressions” thing was interesting. So, on the way to the call, I told my partner to continue compressions no matter what, and get all the crews responding on the same page. As we were walking in the house, I muttered to my partner “remember, never stop compressions – even if I whine about it.”
The daughter was doing compressions when we got there, and she had witnessed the arrest and called 911. We continued the resuscitation giving two shocks and intubating her. True to his word, my partner did continuous compressions and made sure the team prioritized never stopping compressions. True to my word, I did whine a bit as it was hard to see the rhythm on the monitor. Don’t judge; it was 2006, and we took a while to stare thoughtfully at the monitor during codes. Like I said, a much different time.
We had just delivered the last shock, and to our absolute surprise, “Norma” was in sinus rhythm. With a pulse, and blood pressure. A good blood pressure.
What? Well now, what do we do? We had 50 years of experience on the team, and we all stared at each other. Fortunately, the awkwardness was short-lived, and we prepared for transport.
At the hospital, “Norma” remained stable and I thought she would be like all the other codes. She would go to ICU, where she would linger and die; I felt bad for the daughter and family. When it came to codes, I had learned that you win very few and lose nearly all and had accepted that as usual. 98% resuscitation failure rate was…normal.
To verify my failure rate was on track, I called ICU to check on her status. As I said, 2006 was a different time, a HIPPA lite version of EMS. One of my favorite ICU nurses was about to be a part of changing how I looked at resuscitation and EMS, and she didn’t even know it. When I asked how “Norma” was, she replied “Great! She’s in there talking to her daughter.”
What? Seriously? “Norma” is alive and talking?
It wasn’t until I went to her hospital room and chatted with “Norma” (who did not remember me) and hugged her crying daughter that I realized what working to improve outcomes really meant.
Improving outcomes is no longer an amorphous concept for me; it has a face and a family. For me, it is “Norma.” “Norma” benefitted from bystander CPR, early defibrillation and continuous compressions done within a cohesive team approach. As a result, she got to celebrate and enjoy another Thanksgiving with her family.
2006 was a different time in EMS. And 2018 already promises more changes in healthcare. Heck, in 2006 we only ordered books from Amazon; in 2018 we might order prescriptions. Striving to improve outcomes will likely change your perception of normal. But, improving means change, and while that might bring some whining, “Norma” and her family will tell you it is worth it.
According to a 2015 Institute of Medicine report, our prehospital cardiac arrest survival data is pretty depressing. Nearly 30% of those who arrested survived to hospital admission, unfortunately only 10.9% of those survived to hospital discharge. 10.9% can hardly be called successful in a resuscitation system, and certainly not in EMS. However, there are much smarter minds that will discuss improving outcomes and creating solutions, and we’ll hear from them in upcoming issues.
Chief Connector and High-Performance Leadership Instructor