Published February 8, 2018
Physicians in the Department of Emergency Medicine have implemented a new protocol for treating out-of-hospital cardiac arrest patients in Western New York that has more than doubled the patient survivor rate.
The physicians instituted the change in their role as medical directors of American Medical Response (AMR), which provides ambulance service to the city of Buffalo and surrounding communities.
“When a patient collapses from cardiac arrest in the community, the chance they will survive is low to begin with,” says Brian Clemency, DO, associate professor of emergency medicine and director of the Emergency Medical Services (EMS) fellowship. “But their chances get even worse if EMS providers automatically try to take the patient to the hospital, rather than maximizing their care on scene.”
Instead of immediately transporting the patient to the hospital, often at high speeds in an ambulance, a procedure known as “scoop and run,” the physicians found that patients are more likely to survive when first responders stay on the scene to focus on high-quality cardiac pulmonary resuscitation (CPR) and defibrillation.
With this change, first implemented in April, the Jacobs School of Medicine and Biomedical Sciences physicians have seen the number of patients who eventually were discharged from the hospital with favorable neurologic function increase from 1.3 per month to 3.0 per month.
AMR has tracked progress through a national database that links ambulance care with outcomes from local hospitals.
“We are thrilled with the results of our new program. Measurable gains like these inspire caregiver buy-in, which will continue to drive favorable patient outcomes,” says Eric Dievendorf, clinical manager at AMR.
“This is the value of academic medicine,” adds Clemency, medical director of AMR and a physician at UBMD Emergency Medicine. “The mission of faculty at the Jacobs School is to conduct research and promote evidence-based medicine so that the community benefits.”
Clemency and his colleagues are now working with local EMS providers to promote treating cardiac arrest in the field instead of rushing patients to the hospital, where they are often pronounced dead.
He also intends to launch a public information campaign that promotes CPR training among bystanders.
“Taking the patient to the hospital right away robs precious time when that patient could have been getting CPR,” Clemency says. “The message we’ve learned for emergency medical technicians is: ‘Stay on the scene. Wherever we find you is where we’ll work on you.’”
This isn’t the first time Clemency has questioned the status quo in emergency medicine.
In 2017, he was named one of the nation’s Top 10 Innovators in Emergency Medical Services by the Journal of Emergency Medical Services for his work helping New York State to end the routine use of backboards for patients with back or neck injuries.
Studies led by Clemency and his Jacobs School colleague Joseph A. Bart, DO, clinical assistant professor of emergency medicine, helped challenge this long-standing paradigm.