The One Life Project

An innovative new project, The One Life Project, which aims to increase the survival rates of patients who suffer an out of hospital cardiac arrest (OHCA) in Ireland has been launched by the National Ambulance Service (NAS). Maureen Browne reports.

Dr. Cathal O’Donnell
Dr. Cathal O’Donnell

Dr. Cathal O’Donnell, Medical Director of the National Ambulance Service and himself a Consultant in Emergency Medicine said there were roughly 1,800 out of hospital cardiac arrests in Ireland each year which equates to 14 every 24 hours of whom 13 died.

Without instant attention the likelihood of a person with cardiac arrest dying increases very dramatically. If a patient does not receive CPR and defibrillation, survival rate drops by ten per cent per minute and after ten minutes without treatment a 100 per cent mortality can be expected.

“The National Ambulance Service has been working for some time to improve the recognition and treatment of out of hospital cardiac arrest and how patient outcomes are measured.

“We are one aspect of the continuum of care for OHCA patients. We want to identify areas where we can improve. Our ultimate objective is that more people are delivered to hospital with their hearts re-started. We want to get 40 per cent of patients who have an out of hospital cardiac arrest to hospital with their heart re-started,” said Dr. O’Donnell.

“We have analysed every single step in the management of cardiac arrest from the moment someone dials 999 until the patient is transported by ambulance to the Emergency Department and broken it down into about 100 parts. We have analysed each of these and looked at where we can improve, innovate or do something different to improve survival rate.

“Over the next 3 – 5 years we will address each of these steps and see how we can improve survival.  We have 1,600 staff based in 102 ambulance stations and a single national control centre on two sites.

“There are three strands to The One Life Project – triage of the patient with the provision of treatment as quickly as possible for patients, getting specially equipped ambulances with trained staff to the site as quickly as possible and getting the patients to the most appropriate hospital as quickly as possible.

“Life threatening ambulance calls, such as a cardiac arrest get priority. The specially trained NAS call taker will instruct the person making the emergency call, how to perform CPR and how to use an automated external defibrillator if one is available. This means treatment can begin immediately. The call takers are trained to assess the information they get and to ask the necessary questions from the caller to establish patient’s condition. We have ongoing training of our staff to support and improve this.

“The second strand are the new Community First Responders. The NAS has established a network of over 120 community responder groups all over Ireland which are integrated into our control network. These first responders are specially trained to deal with cardiac arrest. If we get a cardiac arrest in the community, the first responder group in that particular area is notified automatically by text message from the control centre. Each group has an area of five to 10 km. They are right there in the community and can do chest compression and use defibrillators. They can get there very quickly and they are almost always there ahead of our ambulances. We had 98 community first responders last Decembers and now have 123.

“The third strand are our ambulance crews of specially trained Advanced Paramedics. Our highly trained staff work to international resuscitation guidelines which are revised every year and new guidelines were introduced this year. Now we are actively implementing these to ensure our clinical protocols are as up to date as possible. Over the last 12 months we have spent €4million on new state-of-the art advanced defibrillators They are now standardised right across the flight We employ mechanical CPR devices which are battery operated devices in all our rapid response vehicles nationally. The helicopter service also plays a part as a small number of patients have to be transferred to hospital by air as the nearest hospital may not be the most appropriate one. The aviation service provide the aircraft and the NAS provides advanced paramedics as part of the crew to respond to all calls.”

Dr. O’Donnell said there were multiple inputs to OHCAs including the ambulance service and the hospital system and therefore the survival figures for OHCAs reflected the continuum of care (GP, ambulance and hospital with multiple inputs from each service). The NAS was trying to isolate effects that could be measured from the point of view of their service.

To do this we are using the Utstein comparator group criteria which cover a cardiac arrest or a presumed cardiac cause that was bystander witnessed with an initial rhythm of Ventricular Fibrillation (VF)/Ventricular Tachycardia (VT). |We have set a target for getting 40 per cent of the Utstein comparator group to hospital with their hearts re-started.”

The National Ambulance Service (NAS) serves a population of almost 4.6 million people in the Republic of Ireland and responds to over 300,000 ambulance calls each year. It employs over 1,600 staff across 100 locations and has a fleet of approximately 500 vehicles.