A shared response to cardiac arrest emergencies in remote communities

In some situations, time is critical. When someone goes into cardiac arrest, quick medical help can make the difference between life and death. In Scotland, there are low survival rates for out-of-hospital cardiac arrests (OHCA), around 9% – compared to other European countries with survival rates of around 18%. Chances of survival from OHCA drop by around 10% per minute without intervention.

A new project, led by the Scottish Ambulance Service in partnership with the Scottish Fire and Rescue Service, aims to improve response times and increase survival rates for patients experiencing immediate life-threatening emergencies in remote communities, particularly patients in cardiac arrest.

Coordinating responses between fire and ambulance services

In some areas of Scotland, it can sometimes be challenging to get an immediate response to a medical emergency due to the geographical location. This project aims to enhance the availability of existing resources (including community first and BASICS responders) by enabling the local fire service to respond to life-threatening emergency calls and handle the situation until an ambulance arrives. Coordinated responses like this between fire and ambulance services are used successfully in other countries, for example in Ireland, but more commonly in urban areas.

Dave Bywater, Consultant Paramedic and Project Manager explains, ‘In March 2015, the out-of-hospital cardiac arrest strategy for Scotland was launched. It’s well known that for every minute CPR and defibrillation is delayed, the chance of survival drops by 10%. We looked at how the Scottish Ambulance Service and the Scottish Fire and Rescue Service could work together to improve outcomes for people in remote and rural areas, using the existing skills of the fire service.’

The project is focused on the island of Mull and the town of Oban, on the west coast of Scotland. Most fire and rescue vehicles already carry automated external defibrillators and fire service personnel in the area are going to be trained in CPR and defibrillation.

Preparing the ground

Before starting the testing phase, the project team has been working to make sure all the necessary systems are in place.

Garry Mackay, Project Facilitator and Station Manager for Training and Employee Development at the Scottish Fire and Rescue Service, says, ‘We’ve done a lot of work to build the infrastructure we require at strategic and operational level, from a memorandum of understanding between the organisations to things like standard operating procedures. We’ve developed and tested the training package and we’re ready to deliver it to staff.’

The training, due to start in the autumn, will take the form of a 16-hour programme, developed specifically for the project and delivered collaboratively between the ambulance and fire services.

The workforce is partly made up of volunteers, so it is important to recognise that responders may not be called on to use these new skills regularly. Garry says, ‘Following the initial training, we’ll revisit them over the first 3-6 months. There will also be online support, such as assessments and practice scenarios. We don’t want those skills to drop away.’

The team has also been preparing to evaluate the project outcomes, looking at data on cardiac arrests, call outs and response times, and as part of this they intend to gather stories of patient experiences.

Dr Sue Baxter-Wynne, Strategy Implementation and Quality Improvement Manager at Scottish Ambulance Service and the project’s Improvement Adviser says, ‘We need to be mindful that not everything that matters can be counted, and when we respond to cardiac arrests in the test area, we’re keen to capture patient and family stories.’

Although the numbers are likely to be small, both organisations are aware of the potential difference the project could make to the communities where it is implemented and the people who live there.

Dave says, ‘Looking back at the figures from 2015 and 2016, there were around 30 out-of-hospital cardiac arrest calls on the island of Mull. It’s not a massive number, but if we can get somebody responding to every single one of these incidents as quickly as possible, it could literally be the difference between life and death.’

This project is funded as part of the Health Foundation’s Innovating for Improvement programme. You can find more information about the work on our website.