gcrac “ice” proposal (induced cooling by ems) by : walter morrow phi air medical
TRANSCRIPT
GCRAC “ICE” PROPOSAL
(Induced Cooling by EMS)
By : Walter Morrow
PHI Air Medical
The Idea of “ICE”
• Sudden Cardiac Death– Out of hospital cardiac arrest is a common disease
• 600-1000 Americans have a OOHCA daily• 47% never make it to the hospital• CHANCE OF SURVIVAL 1:20
The Idea of “ICE”
• There has been no significant decline over the past few decades despite advances in medications and early defibrillation
• Return Of Spontaneous Circulation (ROSC)– Many pt’s continue to have poor outcomes after
hospitalization– Neurologic impairment often remains a lasting
morbidity
The Idea of “ICE”
• Causes of Death in ROSC pt’s– 10% refractory dysrhythmias– 30% poor cardiac output states– 40% post resuscitation encephalopathy
• (neurologic injury) • Caused by cell death (multiple factors)
Idea of “ICE”
• Induced hypothermia is considered a Class IIA procedure according to the AHA.
• Epi is considered a Class IIB
Success: Bernard Study Group
RISK : BENEFIT
Outcome Hypot. (N=43) Normot. (N=34)
Normal or minimal disability (discharged directly home)
15 7
Moderate Disability (to rehab facility) 6 2
Severe Disability but awake (long term Nsg facility)
0 1
Severe Disability, unconscious (long term Nsg facility)
0 1
Death 22 23
NOTE: “bad” outcomes = 13% for hypot vs 17% for normo
The Idea of “ICE”
• Induce hypothermia in ROSC pt’s to bring pt temperature down to the 32-34 degree Celsius range (89.6-93.2 degree F)
• Bolus of cooled normal saline • Ice pack application
GCRAC “ICE” GOALS
• Improve outcomes of post cardiac arrest patients .
• Comply with AHA’s ECC current guidelines (2005)
• Lead the south Texas in advanced cardiac care
• Promote awareness of GCRAC, Hospitals and local EMS services
Sample Protocol
“ICE” Plan
• EMS support • Hospital Support (with cardiac services)
– DeTar Hospital and Citizen’s Medical Center are on both on board
– Community Hospitals to follow EMS plan
• GCRAC support
GCRAC
• Request GCRAC to purchase cooling units for primary response ambulances in RAC.
• Develop RAC wide protocols for both EMS and hospitals.
• Provide oversight of program through the Acute Care Committee
Training of EMS
• PHI Air Medical has offered to provide the hypothermia training to all EMS agencies at no cost.
Costs
• Cooling units – GCRAC funding?• Normal Saline – EMS units / Hospital • Ice Packs – EMS Units / Hospital• Training
– Class is provided by PHI Air Medical– Staff payment during training – EMS agency /
Hospital
Cooling Units
• Refrigerators – Cost effective– Very large – space limited– Hard to secure in ambulance
• Cooling Units – designed for EMS use– Chillcore case by Thomas EMS– Engle EMS Unit cooler by Engle USA
Engle EMS Unit
• Some what mobile• Requires mounting hardware• Requires thermometer• Adjust temperature using dial like home fridge• Lower cost $600
Chillcore Case
• Mobile • Cools at constant temp
– As low as 20 degrees C
• Battery pack• 12V or 110V• Cost $799
GCRAC Staffed EMS Units
• Victoria FD 4• Calhoun Co EMS 3• Edna EMS 2• Ganado EMS / Jackson Co ESD ?• Yoakum EMS 2• Lavaca Co. Rescue 2• Cuero EMS 2• Goliad EMS 2• Yorktown EMS? (BLS service) ?• PHI Air Medical 0
Total 17-20 units
Costs
• Chillcore Unit• 17-20 x $799 = $13583 - $15980
• Engel EMS Unit• 17-20 x $600 = $10200 - $12000
Thank you for your time!
Find out more info at:
JEMS online web casts
MCHD EMS – hypothermia
Wake Co. EMS