Implementation of a National 5‐Year Plan for Prehospital Emergency Care in Singapore and Impact on Out‐of‐Hospital Cardiac Arrest Outcomes From 2011 to 2016

Abstract

Background Outcomes of patients from out‐of‐hospital cardiac arrest (OHCA) vary widely globally because of differences in prehospital systems of emergency care. National efforts had gone into improving OHCA outcomes in Singapore in recent years including community and prehospital initiatives. We aimed to document the impact of implementation of a national 5‐year Plan for prehospital emergency care in Singapore on OHCA outcomes from 2011 to 2016. Methods and Results Prospective, population‐based data of OHCA brought to Emergency Departments were obtained from the Pan‐Asian Resuscitation Outcomes Study cohort. The primary outcome was Utstein (bystander witnessed, shockable rhythm) survival‐to‐discharge or 30‐day postarrest. Mid‐year population estimates were used to calculate age‐standardized incidence. Multivariable logistic regression was performed to identify prehospital characteristics associated with survival‐to‐discharge across time. A total of 11 465 cases qualified for analysis. Age‐standardized incidence increased from 26.1 per 100 000 in 2011 to 39.2 per 100 000 in 2016. From 2011 to 2016, Utstein survival rates nearly doubled from 11.6% to 23.1% ( P =0.006). Overall survival rates improved from 3.6% to 6.5% ( P <0.001). Bystander cardiopulmonary resuscitation rates more than doubled from 21.9% to 56.3% and bystander automated external defibrillation rates also increased from 1.8% to 4.6%. Age ≤65 years, nonresidential location, witnessed arrest, shockable rhythm, bystander automated external defibrillation, and year 2016 were independently associated with improved survival. Conclusions Implementation of a national prehospital strategy doubled OHCA survival in Singapore from 2011 to 2016, along with corresponding increases in bystander cardiopulmonary resuscitation and bystander automated external defibrillation. This can be an implementation model for other systems trying to improve OHCA outcomes.

Improve Cardiac Emergency Preparedness by Building a Team-Based Cardiopulmonary Resuscitation Educational Plan

“…TeamSTEPPS is a teamwork and communication systems model that has the potential to increase the effectiveness of team members with regard to leadership, communication, situation monitoring, and mutual support ( 15 ). As shown in Figure 1 , the team-based CPR protocol divided the team-based CPR process into five parts, namely, ( 1 ) identification of cardiac arrest, ( 2 ) organization of a team (role distribution), ( 3 ) resuscitation before the AED arrives (Role A and Role B), ( 4 ) resuscitation after the AED arrives (Role A, Role B, and Role C), and ( 5 ) arrival of the ambulance. It concisely defined the roles and responsibilities of each member and emphasized the methods and importance of reasonable task allocation, leadership, and closed-loop communication within the resuscitation team.…”

“…Health literacy is widely regarded as essential for achieving health and well-being ( 1 , 2 ). As an essential part of health literacy, governments worldwide have adopted national strategies and targets to improve emergency preparedness ( 3 , 4 ). It is noted that out-of-hospital cardiac arrest (OHCA) is one of the most critical medical emergencies.…”

SRFAC: resuscitation and saving lives in the COVID-19 era and beyond

“…Swee Han Lim 1 , FRCSEd, FRCPEd, Kee Chong Ng 2 , MBBS, MMed, Chi Keong Ching 3 , MBBS, MRCP, Gene Yong-Kwang Ong 2 , MBBS, MRCPCH, Yew Woon Chia 4 , FRCP, EDIC, Agnihotri Biswas 5 , MBBS, MRCPCH, Janice Hui Hong Oh 6 , BSc, Jia Hao Lim 1 , MBBS, MMed, Faraz Zarisfi 1 , MRCSEd, FRCEM, Jun Hao Loke 7 , BSc, Benjamin Sieu-Hon Leong 8 , MBBS, MRCSEd…”

“…Bystander CPR rates more than doubled from 21.9% to 56.3%, and bystander AED rates also increased from 1.8% to 4.6%. (6) Before April 2018, there were two councils overseeing the conduct of resuscitation and first aid courses in Singapore. The National Resuscitation Council (NRC) was established in 1988 and promoted the teaching of basic resuscitation skills to the public, such as CPR and use of AEDs, while providing guidelines for advanced resuscitation courses such as Advanced Cardiac Life Support (ACLS), Life Support Course for Nurses (LSCN), and Paediatric and Neonatal Life Support courses.…”

Transportation during and after cardiac arrest: who, when, how and where?

“…In a condition, such as OHCA where prehospital interventions confer larger survival impact relative to advanced hospital-based interventions, and where the benefits of the latter are confined to those who had received timely prehospital interventions, the focus of care should be on the out-of-hospital setting. Along with the role of the community [6,7] (in recognizing OHCA, activation of EMS, provision of bystander CPR and public access defibrillation), the transport process for OHCA is also key to favorable outcomes. This involves important decisions in identifying patients in whom further resuscitation and transport is futile, continuing uninterrupted high-quality resuscitation despite logistical challenges, commencement of proven advanced interventions in challenging environments as well as transfer of the appropriate patient to specialized centers suitable to receive them.…”