How Many Medics Does It Take to Get ROSC? No Joke!

Written by Andy Hogan

Spoon Feed
Larger numbers of EMS personnel at the scene of an out-of-hospital cardiac arrest (OHCA) resuscitation were associated with improved patient outcomes.

Why does this matter?
OHCA resuscitation requires many time-sensitive interventions including chest compressions, rhythm analysis, defibrillation, vascular access, and medication administration. This study provides insight into the optimal number of personnel needed to perform these tasks.

Two’s company, three’s a crowd, nine’s a ROSC
It takes a village…or at least a few extra sets of hands to resuscitate OHCA. This study performed secondary analysis of patients from the Resuscitation Outcomes Consortium (ROC) Cardiac Arrest Epidemiologic Registries (Epistries) to pin down the ideal number of personnel needed for this task. Epistry patients from 2005-2011 and 2011-2015 were included but evaluated separately due to revisions to ACLS guidelines in 2010. Focusing on the critical first 10 minutes of resuscitation, investigators calculated the number of EMS providers on scene for each arrest using recorded times of arrival and number of crewmembers on each responding emergency vehicle. With 5-6 providers as a reference point, analysis of both the 2005-2011 and 2011-2015 groups revealed significantly higher odds of survival to hospital discharge when 7 EMS providers were present on scene. The 2005-2011 group did not collect data on neurological outcomes, but analysis of the 2011-2015 group also determined significantly higher odds of favorable neurological status (modified Rankin Score ≤3) on discharge when ≥7 EMS providers were present. Across all date ranges, odds of both survival to discharge and favorable neurological status were highest when 9 EMS providers were present. Despite these interesting findings, deploying 9 EMS providers on a single response represents a large burden on any EMS system. In rural or geographically remote urban settings, a response of this size may be impossible. Furthermore, Epistry data did not discern whether EMS personnel were paramedics or lower-level providers (eg, EMTs or EMRs). This raises the question: could 3-4 paramedics resuscitate better than 1 paramedic and 8 EMTs? Nevertheless, this study paves an interesting path for future research on this topic.

Source
The Association Between the Number of Prehospital Providers On-Scene and Out-of-Hospital Cardiac Arrest Outcomes. [published online ahead of print, 2021 Nov 22]. Prehosp Emerg Care. 2021;1-10. doi:10.1080/10903127.2021.1995799

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