From Pinnacle: Racing to the Top of Resuscitation Care

“Cardiac arrest is a survivable event.” A simple statement from a presentation at the Pinnacle EMS conference 10 years ago motivated Advanced Medical Transport, based in Peoria, IL, to launch a program colloquially dubbed “Race to the Top.”

Race to the Top represented an organizational change and shift in paradigm to raise rates of neurologically intact survival to discharge from OHCA to triple the national average, said Lauren Emanuelson, MS, MLS, RN, BSN, EMT-P, director of quality improvement and compliance for AMT. Emanuelson presented “Achieving Better Results in Resuscitative Care: Blue Skies or Reality” Wednesday afternoon August 14, during the 2024 Pinnacle EMS Conference in Marco Island, FL, and stressed to her attendees that they can drive similar improvements in their own systems.

Emanuelson began her talk by presenting AMT’s pillars of success:

• 9-1-1 activation—“first-care” hands-only CPR
• Community access to and utilization of AEDs
• Pit crew resuscitation by EMS providers—all new hires receive 8 hours of training and monthly trainings keep providers proficient
• Deployment of advanced practice providers
• Advanced biomedical tools
• Immediate provider feedback
• Community and caregiver recognition

The Bundle of Care

Perfusion is at the center of AMT’s bundle of care, said Emanuelson. While other components of the bundle include ZOLL X Series Monitor, LUCAS device, airway systems, ResQCPR, ACLS medication, head-up CPR and others, providers are taught that perfusion is the primary mission of all interventions.

The “why” is the most important part of the story, stressed Emanuelson, who showed a video of an 18-year-old man who suffered cardiac arrest and was resuscitated by his 12-year-old brother.

Lessons Learned

Emanuelson offered the following lessons learned for services looking to embark on a similar journey toward resuscitation success.

• Reduce variability between protocols. Keep it simple and practice the same things over and over again under variable circumstances. Maintain a team approach. Offer feedback on skills and quality.
• Things that get measured, get better. If you’re not measuring anything, start now. Emanuelson recommends participating in the CARES registry. “It can’t be the ‘me’ show, it has to be the ‘we’ show,” she said. Measurable data can include ROSC, estimated downtime, presumed etiology, underlying rhythm, pre-arrival bystander CPR, neurological recovery and others.
• Get granular. Drill data down. Patient outcomes aren’t the only measure of success. Crew performance and standardization are just some examples of “other” trackable benchmarks.
• Let your data tell your story. For instance, AMT demonstrated a 63% improvement in discharge against CARES database last year.
• Use your data to drive the change—this helps with your “why.” If all you do is collect data and don’t act on it, you’re wasting an opportunity, said Emanuelson.
• Practice what you preach. Use QI “near misses” to guide a training plan. Practice realistic scenarios with short, sporadic drills. Every Wednesday, a team reviews all cardiac arrest calls to AMT in the prior week. Purposeful remediation opportunities need to be non-punitive and recreate a real scenario.
• Integrate and collaborate. Medical directors, board chairs, partner agencies must collaborate, understand, and contribute to the shared mission.
• Be vulnerable. You won’t get everything right every time. It’s OK to discuss and learn from failures, said Emanuelson.

For a 2019 EMS World e-book outlining the Race to the Top program in detail click here.