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march 21, 2007, kent, king county, washington Paul M., a firefighter, is grumbling to his lieutenant about all the extra work involved in a cardiac arrest, for himself and everyone else. But Paul and his lieutenant both know that his complaints are for show. Despite the detailed reporting requirements, these calls give him the most satisfaction. After every such event, Paul completes his single-page incident report, and then he returns to the station to complete the online report. The report for a cardiac arrest requires far more detailed information than a routine call does, with extra questions about the circumstances of the patient’s collapse, about any bystanders who performed CPR, and about the patient’s heart rhythm and response to defibrillatory shocks. One good thing, as far as Paul is concerned, is that the online report form automatically downloads the scene information—the address, the time of the call, the time of the dispatcher’s response, and the time of the EMTs’ arrival. Paul must also download the digitized AED record containing all the patient’s rhythms as well as voice recordings of everyone who spoke during the resuscitation. The AED record also reports when CPR occurred, the rate and depth of compression, and when ventilations were given. Paul then sends this digital tape file via a secure Web site to the cardiac arrest registry maintained by the King County EMS office, where all the information about a patient’s cardiac arrest flows. In addition, after every cardiac arrest, Paul has to call an 800 number to give information to a research nurse who records it for two ongoing studies of cardiac arrest. But this is only the beginning. In addition to the firefighter’s online report and the 58 four A Profile of Sudden Cardiac Arrest digital recording from the AED, the King County EMS office receives an online report of the care provided by paramedics. Since paramedics are able to provide more advanced care than EMTs, their reports contain a detailed flowchart of all clinical interventions— including medications, additional defibrillations, airway interventions, and the response of the patient—in an almost minute-by-minute account. The King County EMS office also requests a digital recording of the call from the dispatch center. If the patient has been admitted and discharged from the hospital, the patient’s hospital record is requested. And if the patient has died, a copy of the death certificate is obtained from the health department’s office of vital statistics. The totality of information from all these sources comprises hundreds of variables and data points—all this for one cardiac arrest. the king county registry: three decades of cardiac arrest surveillance Seattle and King County have the longest continuing cardiac arrest surveillance programs and registries of cardiac arrest in the world. Both registries were established when the paramedic programs began—1970 in Seattle, and 1975 in the county.1 The registries have become a font of scientific information about cardiac arrest and its circumstances. What is more important, the registries provide a baseline for measuring the effects of new and pilot interventions for treating cardiac arrest. The information contained in the registries has provided material for more than 250 published scientific articles. When special studies are under way (and they always are), additional information is requested from firefighters and/or paramedics, and interviews are often requested with surviving patients or family members. Also in connection with the surveillance programs and registries, there have been more than a dozen clinical trials to study new medications, new methods of defibrillation, and new resuscitation techniques.2 Several innovative programs that began in Seattle and King County have been endorsed nationally and serve to define current standards of care; for example, as mentioned in the previous chapter, Seattle initiated widespread training of citizens in CPR, and dispatcher-assisted telephone CPR and defibrillation by EMTs were first studied in King County. Now these programs have been instituted in every American city and in many other places around the world.3 The previous chapter explained the causes of sudden cardiac arrest—the “what.” This chapter takes a different approach, describing the “who,” the “when,” and the “where”—the characteristics of the victim, and the circumstances of the collapse. It describes several key factors associated with either survival or death. These are the presence or absence of witnesses to the victim’s collapse; the presence...

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