Spreading best EMS practice
THE CHALLENGE
Big differences in survival
Survival from out-of-hospital cardiac arrest is very dependent on where you live. While some Emergency Medical Systems (EMS) show survival rates above 50% of patients with ventricular fibrillation, others have close to 0%.
This difference is found not only between countries – but even within countries.
The opportunity
Implementing what works
The Global Resuscitation Alliance (GRA) was formed in 2015 to develop best practices and guidelines to remedy the geographical disparity in survival. Its mission is to advance resuscitation through the Resuscitation Academy model by accelerating community implementation of effective programs through a quality improvement strategy to measure and improve.
It identified 10 steps to improve survival from out-of-hospital cardiac arrest. There are now more than 100 case studies on the GRA's website covering their implementation.
The tools and training for this implementation are supported by secretariats in North America, Europe, Asia, and Australasia with biannual global webinars sharing new case studies.
The 10 best practice steps and actions defined by the Global Resuscitation Alliance
Lives are saved not just by highly trained EMS professionals, but also by highly efficient EMS systems. The Global Resuscitation Academy is proud to stand with leaders around the world working to save lives through system improvement. Working together, we aim to create a world where no one dies from cardiac arrest.
Ann Doll, Executive Director of the Resuscitation Academy
The impact
50 % increase in survival is possible
A 2019 case report showed that when the 10 steps are implemented effectively a 50% - or more - improvement in survival is achievable. The review also showed that even the best performing systems improve. The average improvement (dotted lines in graph) is remarkably similar across the different countries. Denmark stands out with a more rapid improvement – the reasons why remain to be explained.
The most recent survival data show that the coronavirus pandemic has caused a temporary reduction in some places, while survival seem to improve again from 2022.
the impact
New resuscitation alliances established
The promising development of the Global Resuscitation Alliance for out-of-hospital cardiac arrest has led to the expansion of the concept to several new areas:
- An In-hospital Pediatric Resuscitation Alliance was launched in 2022 (learn more here)
- 10 steps for Improving In-hospital Cardiac Arrest was developed and published in 2023 (more here), and a Global Resuscitation Alliance for in-hospital cardiac arrest will be established in 2024
- A Global Resuscitation Alliance for newborn resuscitation is being developed in 2024. Photo to the left: From the Newborn Global Resuscitation Meeting September 2024, at Utstein Abbey, Norway.
The Impact
Expanding to low-and middle income countries
While the 10 best practice steps have proven effective for many developed EMS systems, they may be too challenging for EMS systems which are in the early stages of development. A consensus process to define more relevant and achievable steps and quality indicators for such systems started in Singapore in 2022, involving EMS leaders from 13 Asian countries. They are developing a Pre-hospital emergency care system assessment toolkit for out-of-hospital cardiac arrest, stroke, trauma, and perinatal mortality.
working together
Workshops for high-performance resuscitation teams
High-performance CPR is one of the Global Resuscitation Alliance’s 10 steps for increasing survival from cardiac arrest. To support its implementation, we have continued to work and support the Seattle-based Resuscitation Academy and its nine US Lighthouse communities. By equipping and supporting these community leaders with essential tools, resources, and expertise, we have helped them double the number of professional responders who have learned about the 10 steps and how to train and implement high-performance CPR in their communities.
A beacon for all
Mickey Eisenberg
Mickey Eisenberg has been, and remains, an untiring pioneer in lifesaving of worldwide importance. Under his leadership King County, Seattle has been a beacon for everyone with survival rates for witnessed cases with a shockable rhythm – the Utstein benchmark - exceeding 50%.
The research conducted with his colleagues in the Center for Evaluation of Emergency Medical Services has been crucial for identifying what works best and has been the basis for many updates of international guidelines.
The basic principles are set out in his book “Resuscitate! How Your Community Can Improve Survival from Sudden Cardiac Arrest” and are being spread to communities across the world through the GRA.
