Multnomah County Medical Directors Report 2007

Jon Jui MD, MPH

RSI (AMR data): January – October 2007

Success Total Percent

Medical 65 74 88 %

Trauma 25 32 78%

Total 90 106 85 %

RSI : Success by Primary Impression

Number Success PercentCardiac 8 8 100%

Neurologic

25 20 80%

Respiratory

24 22 92%

Toxicology

12 11 92%

Trauma 36 28 77%

Burns 1 1 100%

Total 106 90 85%

Cardiac Arrest (AMR data): January 1 – October 31, 2007

Treatment Number Percent

No resuscitation 156 26 %

Treated : Resuscitation Terminated

126 22 %

Transported 309 52 %

Total 591 100 %

Cardiac Arrest : ROSCROSC Number Percent

NO 301 70 %

YES 134 30 %

Total 435 100 %

Cardiac Arrest : EZIO vs ROSCROSC : YES

ROSC : NO

Total Percent

EZIO : YES

41 75 116 35 %

EZIO : NO

93 226 319 29 %

Total 134 231 365

ROC Cardiac Outcomes12/01/05 – 5/30/07 - Total Cases

Multnomah

All others

All 951 942

Treated 555 (58%) 576 (61%)

ROC Cardiac OutcomePortland ROC

2nd amongst all ROC sites in survival of cardiac arrest patients.

Guess who is number 1?

ROC Cardiac OutcomesLocation of Arrest

Multnomah

Others

Public 114 (20%) 90 (16%)

Private 441 (80%) 486 (84%)

Total 555 576

ROC Cardiac OutcomesWitness & Bystander CPR

Multnomah

Other

Bystander Witnessed

50% 48%

EMS 3.8% 3.3%

Bystander CPR

44% 48%

ROC Cardiac OutcomesPresenting Rhythm

Multnomah Other

VF or VT 174 (31%) 195 (33%)

PEA 130 (23%) 111 (19%)

Asystole 238 (43%) 257 (45%)

AED No shock

0 4 (0.7%)

Cannot determine

13 (2%) 9 (1.5%)

ROC Cardiac Outcomes Field ROSC

Multnomah

Others

Any Field ROSC

43% 33%

ROC Cardiac OutcomesTransported

Multnomah Others

Died at scene 208 (37%) 266 (46%)

Transported 347 (63%) 310 (54%)

ROC Cardiac OutcomesOutcome

Multnomah Others

Died at scene 208 (37%) 266 (46%)

Died in ED 197 (35%) 145 (25%)

Died after admission

80 (14%) 84 (15%)

DC Alive 62 (11.2%) 62 (10.7%)

Outcome unknown

8 (1.4%) 19 (3.3%)

Multnomah County EMS12 Lead ProceduresJanuary 1 – October 31, 2007

Patients ECG STEMI

4965 5812 156 (3%)

Multnomah County STEMI’s

12 Lead ECG : Scene Time YR 2005 vs Year 2006

12 Lead ECG : Scene TimeSTEMI vs NON STEMI 2006

EZ IOSuccessful by PatientSuccessful 159 93%

Unsuccessful

12 7%

Total 171

MCEMS : EZIO by AgencyNumber of procedures

Fire 58 (34%)

AMR 113 (66%)

Total 171

MCEMS: EZIO by IndicationCardiac Arrest 119 70%

Trauma Arrest 2 1%

Trauma System Entry (Mandatory)

9 5%

Respiratory 13 8%

Neurologic 8 5%

Toxicologic 6 4%

Shock (GI bleed)

4 2%

MCEMS Trauma System EntriesScene Times : All vs. RSI

2007 All 2007 RSI

Mean 14.34 18.11

Median 12.57 14.05

75% 17.41 19.59

MCEMS Trauma System EntriesRSI Scene Times 2006 vs 2007

2006 RSI Pt Side to Transport

2007 RSI Pt Side to Transport

Mean 20.29 18.11

Median 17.18 14.05

75% 25.51 19.59

Trauma Scene Time Impact of RSI : Conclusions

Dramatic decrease! 2006 5-7 minutes increase

2007 1-3 minutes increase