City of Austin Performance Report 2014-15

Percent of Cardiac Arrest Due to Cardiac Cause that Arrive at Hospital with a Pulse

Measure Description
This measure provides the percentage of cases where first responders attempted resuscitation during a cardiac arrest event and the patient arrived at the hospital Emergency Department (ED) with a pulse. This measure is closely aligned with the new Cardiac Arrest Registry to Enhance Survival (CARES) standards for reporting patient survival rates. This measure provides a comprehensive picture as to how effective the "pit crew" model is at keeping patients alive until they reach the hospital. Pulse at hospital arrival reflects an essential step in patient survival of cardiac arrests.
Calculation Method
The number of cardiac arrest cases where CPR and/or AED (Automated External Defibrillator) was applied and the patients arrive at the hospital ED with a pulse divided by the number of confirmed cardiac arrest patients who received CPR and/or application of an AED by Austin Fire Department personnel.
FY 2014-15 Results
In FY 2014-15, 32 percent of cardiac arrest cases due to cardiac cause arrived at hospital with a pulse, missing the target of 40% by 8%.
Assessment of Results
In response to national data collection needs, the Office of the Medical Director (OMD) created a new CARES database to accommodate national-level CARES decisions. This measure closely aligns with the new CARES standards for reporting patient survival rates and provides a more accurate portrayal of the effectiveness of keeping patients alive until they reach the hospital. It is important to note the many variables present in this measure, including patient history and availability of early Cardio Pulmonary Resuscitation (CPR) and defibrillation prior to arrival of the first responders that may have an impact on the outcome. Although the FY 2014-15 result did not meet the desired target, the data fluctuations between FY 2011-12 and FY 2014-15 are within normal ranges.  
Picture of a Fire crew practicing CPR on a dummy.
Next Steps
In FY 2015-16 AFD purchased several CPR “pucks” to help measure chest compressions during manual CPR. Feedback from the CPR puck ensures that first responders are providing effective and consistent compressions so that AFD can improve the percentage of patients who arrive at the hospital with a pulse.  AFD Medical Operations is currently working on the training element for the new CPR pucks. In addition, AFD Medical Operations, in coordination with OMD, has re-trained all AFD uniform personnel on a new CPR (Pit Crew) model that integrates the LUCAS™ Chest Compression System device. The LUCAS™ device is a tool that standardizes chest compressions during CPR. Additionally, AFD is working closely with OMD on a program to develop a more thorough medication cross check documentation process to reduce error in medication administration.
Contact Information
For more information, contact Richard Davis, Assistant Chief, (512) 974-0133.