In a Canadian retro-review of 1240 heart attack cases only 3% (41 patients) survived after efforts to restart a heart through CPR, electric shock and transport to hospital, discouraging results to be sure.

Lead researcher Dr. Laurie J. Morrison of the University of Toronto then isolated three criteria to help rural paramedics determine when to cease resuccitation efforts in the field and avoid additional measures that can severely strain healthcare delivery systems and that pose unique hazards of their own.  ”Taking such lost causes to the hospital ties up ambulances and emergency departments, and the race to get there is hazardous for rescue workers and other motorists,” the researchers said.

The team’s recommendations specified that paramedics terminate CPR if a pulse couldn’t be restored, if the defibrillator determined that an electric shock shouldn’t be given and if the cardiac arrest wasn’t witnessed by a rescue worker.  The criteria were applied in the course of ongoing emergency responses. Researchers say that the test closely predicted throughout the study who was likely to die. Overall, 776 patients met all three criteria, and all except four died, a survival rate of 0.5 percent (1 in 200).

“If the test were applied,” said the article, “it would reduce by about two-thirds the number of patients taken to the hospital, the researchers said. When two more criteria were added — paramedic arrival time of more than eight minutes and an attack not witnessed by a bystander — the test worked even better.”

For Feedback:

1) What level of payoff is insignificant for emergency care? 1 in 200? 1 in 400?…

2) Are you comfortable allowing a rural paramedic with 2 years or less of training to decide whether you live or die?

One Response to “Acceptable Medical Losses?”

1. Dave N says:

   March 19, 2009 at 9:16 am

   There is obviously a lot to know about this. I think you made some good points in Features also.

   Reply