Resuscitation Outcomes Consortium Progress Report

ROC logo

It’s been about seven months since we talked about the Resuscitation Outcomes Consortium (ROC). In case you missed it, the ROC consists of 10 Regional Clinical Centers that provide the necessary infrastructure to conduct collaborative trials that aid in promising scientific advances to improve resuscitation outcomes.

The ROC is of great interest to us at Iridia as our founder and first responder medical director, Dr. Allan Holmes is involved with the ROC in the collaboration with many fire rescue services throughout British Columbia. 

The ROC is the first large-scale effort in the world to conduct clinical trials focusing on the early delivery of interventions by EMS to better optimize patient survival.

Since we last spoke about the ROC, they’ve released a progress report updating us on statistics within British Columbia.

You can view the entire report below, but here are a few key highlights from the report:

  • The ROC is now a major contributor to Emergency Medical Services (EMS) resuscitation research
  • The implementation of ROC’s multi-site EMS resuscitation consortium is the most efficient means of providing out-of-hospital research
  • ROC Impact on Medical Practice:
    • Has influenced the American Heart Association 2010 Guidelines for CPR and Cardiovascular Care
    • Insights from ROC trials contribute to the Military Joint Forces Combat and Casualty Care Summits

The most important highlight however is the emphasis on quality CPR in BC, which has led to an increase in survival to 13.8 percent in 2012; the highest reported in Canada. This is great news for us at Iridia – every little bit helps, and together we are all making a difference.

If you’d like to help further, join us in celebration of CPR Month, we are offering a discount of 10% on Cardiac Arrest Management (CAM) courses booked during the month of November!

For more information and statistics about the ROC collaboration within British Columbia, please see September 2013 BC ROC Report:

Resuscitation Outcomes Consortium

Learn More About the ROC.

 

Local First Responders Enhance Their Scope of Practice

Fire rescue services are often the first to arrive at the scene of an emergency. However, responding fire fighters must work within the scope of their Emergency Medical Assistants (EMA) License and within their of their level of training.

Iridia Medical currently assists fire departments interested in enhanced training opportunities.   With our medical team having decades of experience in pre-hospital care and as the provider of medical direction to over 140 fire departments in British Columbia, Iridia Medical is in a unique position of assisting fire rescue services in improving their pre-hospital emergency skills and training.

EMR License

Through collaboration between firefighters, paramedics and physicians, Iridia Medical has helped develop enhanced skills and training for rural and metro first responder programs, as well as assisted departments in transitioning from an EMA-FR to an Emergency Medical Responder license level. 

One notable fire department on the path to their EMR license is Delta Fire Rescue ServicesAs Delta Fire moves towards the EMR license level the following key training modules have been introduced to all its current first responders: 

Delta Fire is among a select few fire departments across the province have undertaken these advanced modules. As good fortune would have it, soon after completing their training, first responders from Delta Fire responded to an emergency where they put Iridia Medical’s advanced training modules into action.

Delta Fire Chief Dan Copeland on the incident:

“It was brought to my attention that on November 27, 2012 a shift crew was called to the Ladner Leisure Centre to attend a patient having a severe allergic reaction. The wife of the patient informed crew members that the patient was suffering a severe reaction to shellfish and did not have his epi-pen with him. Now that Delta Fire & Emergency Services carry epi-pens, the crew was able to provide one for the patient who was then able to self-administer. 

BC Ambulance Service dispatch was contacted and provided information from the fire crew who monitored the patient until they arrived approximately 6 minutes after the fire crew.

In an anaphylactic situation, time is critical to a positive outcome for the patient and in this instance our crews were instrumental in a successful outcome for the patient.

I would like to compliment the crew who attended this incident for their quick thinking and providing excellent patient care. Also, compliments to our F.R. Instructors and all personnel for the smooth and efficient implementation of the 3 additional F.R. protocols.

Training on 3 protocols (pulse oximetry, blood pressure & epi-pens) began earlier in the year, with the support of Mayor and Council. Delta Fire instructors received training and attained instructor status on the 3 protocols. This training is part of a process to enhance training in an effort to attain their  EMR license.

This incident provides encouraging testimony that enhanced training for fire fighters can improve pre-hospital patient care in the event that BCAS is unable to attend a scene immediately. Thank you for a job well done!”

Iridia Medical is thrilled with Delta Fire’s quick response to the anaphylactic emergency and their ability to aid in the positive outcome due to the enhanced training. Iridia looks forward to its continued relationship with Delta Fire and believe their enhanced role as first responders can be a model for other fire departments in the province.

What is the Resuscitation Outcomes Consortium?

The Resuscitation Outcomes Consortium (ROC) was created in 2005 to conduct clinical research in the areas of cardiopulmonary resuscitation and traumatic injury.

The ROC consists of 10 Regional Clinical Centers (RCCs) and a Data and Coordinating Center that provides the necessary infrastructure to conduct multiple collaborative trials to aid rapid translation of promising scientific and clinical advances to improve resuscitation outcomes.

The ROC is the first large-scale effort in the world to conduct clinical trials focusing on the early delivery of interventions by EMS to better optimize patient survival.

As a first responder medical director, Dr. Allan Holmes (founder of Iridia Medical) is involved with the ROC through the collaboration of many fire rescue services throughout British Columbia. 

Fore more information and statistics about the ROC collaboration within British Columbia, please see April 2013 BC ROC Report:

ROC Report

Click to view the report.

The ROC is Sponsored By:

Learn More About the ROC

Automated External Defibrillators and Children

Automated External Defibrillators

An automatic external defibrillator is used to restart a heart that is pumping with an ineffective rhythm that does not adequately circulate blood. In most cases AEDs come equipped with defibrillator electrode pads made just for children, but not always.

To address a few concerns, the following is a recent statement to our first-responders on the use of Automated External Defibrillators (AEDs) for children.

Automated External Defibrillators and Children

Position Statement

Iridia supports the use of Automated External Defibrillators (AED) in the pediatric population.

The following recommendations are provided for First-Responder Services with AED programs and are consistent with the current Heart and Stroke Foundation guidelines:

  • AEDs equipped with pediatric dose attenuator and pads should be used on children (aged 1-8) and infants (less than 1 year) with no signs of life
  • Pads should be placed in the standard anterior-apex position or in the anterior-posterior position
  • Should pediatric dose attenuator and pads not be immediately available, adult pads may be used on both children and infants with no signs of life.

For more information on AEDs  and their use, please visit our website.

Best Regards,
Dr. Allan Holmes
Medical Director, Iridia

Medical Director Update – BC Ambulance AEDs reconfiguration

BC Ambulance AEDs

A recent memo was circulated by the Director of First Responder Services Randy Shaw regarding the reconfiguration of the BC Ambulance AEDs. In part this memo outlines the following. The BCAS AEDs are being reset to eliminate the “charge‐up whine” when a shockable rhythm is detected and instead prompt the responders to resume CPR – See appendix 1 for the complete memo.

This AED reconfiguration is being done to encourage crews to continue chest compressions during the charge‐up phase of the AED and is one more step in maximizing time on the chest.

Although I am in agreement in principle with this initiative, it has come to my attention that there may be a considerable cost for some Fire Service AEDs to be reconfigured. This cost depends on the software version installed in the AED. In discussions with BCAS and the Emergency Health Services Commission, the following is recommended based on the model of AED and the software version:

lp500/1000

1. LP 1000s with software version 2.42
Recommend – reconfigure as these units contain the same software as BCAS AEDS (no costs incurred)

2. LP 1000’s with software versions older than version 2.42
Recommend – reconfigure not required ‐ The cost to upgrade ($700.00 per unit) does not justify the benefit

3. LP 500
Recommend – reconfigure not required ‐ The cost to upgrade ($300.00 per unit)does not justify the benefit

For those units where there is a recommendation not to reconfigure, the same benefit (chest compressions during charge‐up) can be obtained by reminding crews that chest compressions should continue throughout the “charge‐up whine”.

Best regards,
Allan Holmes
Medical Director, Iridia Medical

Appendix 1

TO ALL FIRST RESPONDER AGENCIES, SENT ON BEHALF OF RANDY SHAW, DIRECTOR, FIRST RESPONDER SERVICES

This note is to advise you that effective this week BC Ambulance Service (BCAS) AEDs will begin to undergo a minor reconfiguration. The AEDs are being reset to eliminate the “charge‐up whine” when a shockable rhythm is detected and instead prompt the responders to resume CPR.

If a shockable rhythm was detected on analysis, the AED will begin to charge and a 15 second timer will show in the display window. At 12 seconds, the AED will warn the responders that a shock is advised and at 15 seconds, prompt the responders to stand clear and to push the shock button.

There is no change in the procedures for CPR.

As you know, we teach that chest compressions are to resume during the charge‐up phase. This change in AED configuration is purely intended to support the re‐establishment of chest compressions during that phase. Please notify your first responder agencies accordingly both so that they are aware of the BCAS AED change and so that first responder agency medical oversight may consider the change with their own AEDs if similarly configurable.

A Look at the Sun Peaks EMR Pilot

Sun Peak Fire Rescue

Sun Peaks

Sun Peaks Fire Rescue is a rare department. Staffed by 3 full-time fire officers and 20 volunteer firefighters, they have made significant improvements in meeting the emergency response needs of Sun Peaks Mountain Resort Municipality.

These improvements were driven by the need for trained emergency response personnel to attend at the scene of an incident promptly where BC Ambulance paramedics were unable to do so.  To meet this need, Fire Chief Bill Stoner lobbied for his firefighters to improve their pre-hospital emergency skills and training.  As a result of his efforts, Sun Peaks was one of two B.C. fire departments chosen for a pilot project allowing firefighters to use the Emergency Medical Response (EMR) protocols.  SPFR then embarked on the process of upgrading their training of their firefighters to the EMR level. 

Having completed the EMR upgrade and with the assistance of Iridia, Sun Peaks Fire Rescue entered into a pre-hospital care consultation process. Included in this consultation process were the Emergency Health Services Commission, the BC Ambulance Service, BC Ambulance paramedics and emergency room physicians. Through this collaboration, a defined framework was established within which EMR skills could be utilized by the Sun Peaks firefighters. 

Emergency Medical Responder protocols outline the roles and responsibilities of firefighters and paramedics who respond to a medical emergency on-scene. The goal of the protocols is to quickly identify and respond to any potential life threatening medical emergency.

Using the EMR protocols provides firefighters with better tools to attend to a patient’s needs. It allows firefighters to use additional pain relief as well as immobilization tools when responding to emergency situations.

The EMR pilot is an ongoing effort. At this point, the pilot has improved documentation on patient care and interaction between Sun Peaks firefighters, paramedics and physicians. Further improvements in this pre-hospital care will be made throughout the duration of the project and the citizens of Sun Peaks will enjoy the benefits of collaboration and innovation that this pilot project brings.

Comments from Sun Peaks Fire Chief Bill Stoner:

“Sun Peaks Mountain Resort Municipality is a world class resort town which enjoys a number of outstanding facilities.  One facility that the town is lacking however is a British Colombia Ambulance Station.  As such, Sun Peaks depends on ambulance service from the neighbouring community of Kamloops.  Because of this lengthy wait for emergency transport, Sun Peaks Fire undertook a pilot project in 2011 which allows firefighters to operate at the level of Emergency Medical Responder (EMR).  It is believed that using EMR protocol will improve the level of pre-ambulance care that Sun Peaks Fire can offer its patients.
When Sun Peaks began utilizing EMR protocols its members recognized a number of significant benefits; firefighter’s patient assessment skills improved, so they were able to deliver better information to ambulance personnel; the ability to provide Nitro and ASA to patients showing the signs and symptoms of a heart attack was also unquestionably beneficial.   The benefit that provided the most profound impact however, was the ability to provide pain relief with Entonox.
 Although most patients who complain of severe pain are not suffering life threatening conditions, they are experiencing a situation that is distressing, not only to themselves but also to their families and friends, as well as to the first responders who attend the scene; it’s tough to watch someone suffer without being able to help.  Due to the 45 minute wait for an ambulance, Sun Peaks Fire’s patients have had to endure this pain.  With EMR protocol however, fire department members can use Entonox to assist with pain relief.  This relief makes the patient more comfortable and alleviates the stress suffered by friends, family and first responders. 
As Sun Peaks gathers its ongoing statistical data on the EMR Pilot and the potential effects and benefits in saving lives; one thing is for sure, delivering enhanced pre hospital care has allowed its members to provide much better service to the people in the community and great customer service is what Sun Peaks Fire strives to deliver.”

For more information on our service offerings for At Iridia we are thrilled to have the opportunity to have worked with Fire Chief Bill Stoner and Sun Peaks Fire Rescue in the development of the EMR program. We believe the EMR pilot is just the beginning. There is a bright future for BC fire departments and the delivery of pre-hospital care.