Cardiac arrest outcomes at the Melbourne Cricket Ground and Shrine of Remembrance using a tiered response strategy-a forerunner to public access defibrillation1
Introduction
The attainment of maximal survival from cardiac arrest is a major challenge for health care systems and in particular for out-of-hospital emergency provider services. Two major changes have prompted a renewed form of interest in cardiac arrest. The first is the finding that time to successful defibrillation is the major determinant of survival [1], [2], [3]. The second is the advancement in technology of electrical circuitry and computerisation with the consequent development of reliable lunch box sized shock advisory external defibrillators or semi-automated external defibrillators (SAEDs). The most significant impact of this development is the ability of lay trained first aiders and other first responders to use these machines proficiently, time efficiently and safely [4], [5], [7]. For these reasons the capacity for organisations providing first aid services at major public events to respond in a timely way to collapsed members of the public is an important contemporary consideration [5].
St John Ambulance Australia (SJAA) is a major national organisation concerned with the provision and teaching of first aid, domiciliary level patient care and community health care. St John activities form an integral part of State and National counter disaster strategies and activation plans. The SJAA Operations Branch is a volunteer community first aid provider organisation composed almost entirely of lay (non-health care professional) personnel trained in first aid.
For many years the SJAA Operations Branch in Victoria has provided first aid services at the Melbourne Cricket Ground (MCG) and at ANZAC Remembrance Day marches. At the MCG, St John, for approximately 3 decades, has complemented first aid coverage with Advanced Life Support services of various levels of training and skill at major public events such as football finals, international cricket and other large gatherings. Since the late 1980s, similar activities have been progressively developed at the Shrine of Remembrance on ANZAC Day.
In 1990, the Chief Medical Officer of SJAA, one of the authors, (JFL) implemented an Australia-wide program of mandatory reporting of all out-of-hospital cardiac arrests managed by St John Ambulance Operations Branch personnel, whether on or off duty. In 1995 the data from the MCG and Shrine of Remembrance was specifically reviewed, as it was apparent that the survival from cardiac arrest at these venues was clearly different to the trend in reported episodes from other event locations (Personal communication).
Section snippets
Response structure
In 1989, the response structure for dealing with collapsed persons was reconsidered in light of the Chain-of-Survival concept and sequence of resuscitation [6]. This sequence was adopted and implemented at the MCG and Shrine of Remembrance by means of a three-tier response structure. The first tier consisted of a basic life support (BLS) response. The second tier, cardiopulmonary resuscitation-defibrillation (CPR-D), is focused on providing early response defibrillation to a pulseless patient
Results
Twenty-eight cardiac arrests occurred between December 1989 and January 1998. Of these, 25 episodes were situated at the MCG and three at the Shrine of Remembrance. The incidence of cardiac arrest at the MCG site was 1:500 000 patron admissions.
Of the 28 patients, 24 (85.7%) were successfully resuscitated at the venue. Subsequently, 20 (71.4%) were discharged home from hospital.
Age ranged from 23 to 83 years (Mean: 64.57. SD: 10.86. Fig. 1). CPR was commenced on 26 patients (92.1%) within 2 min
Discussion
Cardiopulmonary resuscitation is an integral part of every first aid course curriculum. The ability to provide a timely and effective response to a collapsed person, who may have a cardiac arrest, is a major concern for organisations regularly providing first aid coverage at large public events and venues. Despite this, very little research on the effectiveness of response strategies and consequent outcome after cardiac arrest in such places has been documented in the published literature.
In
Conclusion
This study reports consecutive cardiac arrest outcomes at the MCG and Shrine of Remembrance on ANZAC Day using a graded three tiered response strategy to compress the Chain-of-Survival.
The timely provision of cardiopulmonary resuscitation and early defibrillation to arrested patients in VF and or VT promotes both ‘at scene’ and overall survival rates higher than previously predicted and reported for out of hospital cardiac arrest. It is recommended that first aid and first responder systems be
Acknowledgements
The authors would wish to acknowledge the support of the Operations Branch volunteers in Victoria who committed themselves to both the concept and training in order to achieve an improved response to out-of-hospital cardiac arrest.
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Attributed to: St. John Ambulance Australia (Victoria), Operations Branch, St. John Ambulance Australia (National Headquarters).