In many EMS systems, Category 9 or some code involving the number 9 is the code for cardiac arrest. This number comes from the Medical Priority Dispatch System “determinant” codes. And as we all know, the easiest, simplest, most low-hanging fruit of EMS metrics is some version of cardiac arrest survival. Dead/Not Dead. It doesn’t get easier than that.
But there’s a couple of rubs there. Define “cardiac arrest.” I think we all agree that there’s a wide spectrum of arrests. An obvious dead-on-scene in a lot of systems gets classified as a “cardiac arrest” in others.
And then there’s the voodoo. So many research physicians have convinced that they’ll be the next one to raise Lazarus from the dead if only they adopt XYZ protocol. Some are dubious, some have potential, and some have raised more questions than they’ve answered. Witness the debate over some supraglottic airways impeding carotid circulation or the current debate as to whether therapeutic hypothermia works. What we do know works is good CPR and electricity. But neither of those are “sexy” per se.
Here’s what bothers me, especially about certain services who constantly brag about a high percentage of “saves.” Even in the best systems, a successful resuscitation is a 50-50 proposition. And we know that cardiac arrests represent a very small percentage of EMS calls. So, in short, you’re designing an EMS system based on a super small percentage of patients.
Let’s work towards a new metric based on what our patients seem to really want — symptom relief. Did we make your breathing easier? Did we take your nausea away? And most importantly – did we take your pain away?
A system based on those metrics is the type of place where I’d be proud to practice medicine. Because after all, paramedicine is practicing medicine, albeit under relatively defined limits. And medicine is supposed to be about making people feel better.