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Final Case Audit

After all the available information has been received and reviewed we attempt to define the reason for the failure of resuscitation. We complete this form for every unsuccessful witnessed VF event. Our assumption is that every patient in VF should survive and when the patient does not survive we want to define the reasons why. We think of this as our system audit. Why did the patient die? The following is our analysis sheet for defining the reasons why the patient with witnessed VF died. Even though the patient may have died for reasons unrelated to the system we do the analysis to see if system factors can be identified. Clearly the reason for this system post-mortem is to see if the system can be improved.

We have found that interviewing the patient (if s/he survives) or family members is very useful in defining the events prior to EMS arrival. Examples of information that is often best defined by witnesses include: Was the collapse witnessed? Was there a delay in recognizing the cardiac arrest? Was there a delay in reaching the dispatch center? Was bystander CPR offered and administered? Did the collapsing position preclude bystander CPR?

Links to Data collection forms

• Cardiac arrest - basic registry information
• Cardiac arrest - detailed registry information
• Dispatcher Assisted Telephone CPR registry
• EMT - defibrillation registry
• Interview form for patient or surviving spouse or partner

Factors contributing to death:

Patient Factors

1. Expected death or DNR papers
2. Compelling co-morbidity
3. Age > 80
4. morbid obesity
5. Symptom denial

Event Factors

1. Lack of bystander CPR
2. Compromised bystander CPR
3. Delay in RP reaching 911
4. Remote location or delay in gaining access to patient
5. Language barrier

System Factors

1. Delay in dispatch
2. Lack of or delay in dispatcher-assisted CPR
3. Long BLS rollout time (dispatch to enroute)
4. Long ALS rollout time (dispatch to enroute)
5. Delay in BLS response time (enroute to arrival)
6. Delay in ALS response time (enroute to arrival)

Therapy Factors

1. Airway issues
2. IV access issues
3. Lack of hypothermia