Cardiac Arrest – Response Times – Part I

It’s been over 6 years since the USA Today published Bob Davis’ series Six Minutes to Live or Die. If you’ve never read it, you need to, because it’s one of the most important EMS-related publications of our lifetime.

Consider this excerpt:

When baggage handler Andrew Redyk, 64, collapsed on the job at Los Angeles International Airport, his co-workers leaped into action. One called for help. Another did CPR.

The Los Angeles Fire Department sent a nearby fire engine and an ambulance, which arrived at the airport in six and seven minutes, respectively. Officially, their response time was quick enough to save Redyk.

In truth, almost half an hour passed before rescuers actually reached Redyk. He died.

This official deception is not unusual. Los Angeles is one of many cities that routinely lie to themselves about their true response times to medical emergencies. The result is needless deaths.

There is no nationwide standard for measuring emergency response times. A USA TODAY study of the 50 biggest U.S. cities found that most report only the slice of the response that looks most favorable: the time it takes for the emergency crew to drive to the scene. On many emergency runs, that is just a fraction of the time that passes between the call for help and the arrival of rescuers.

Yet most cities base quality-control decisions on these official response times, which are misleading and incomplete. As a result, people die, and attempts to improve survival rates fail.

This official deception is not unusual … Yet most cities base quality-control decisions on these official response times.

There must be some mistake. How could a misunderstanding like this happen?

Consider Bruce J. Moeller, PhD, Obstacles to Measuring Emergency Medical System Performance, EMS Management Journal, Vol 1, Number 3, April-June 2004.

“[P]aramedic agencies continue to use various definitions of response time. More importantly, the response time definition employed by agencies provided a more favorable image of agency performance than may otherwise be deserved. There was no effort being made by agencies to establish a shared meaning with others or to communicate their definition of this key performance measure. These obstacles, therefore, limit the ability of providers to benchmark their performance against other systems and to engage in meaningful outcomes based research.

Obstacles to measuring performance in EMS systems were hypothesized to include both definitional ambiguity and conscious errors…”

Every good researcher knows that a scientist must observe the “fact/value” distinction. A good researcher does not make “value judgments.” So how does a social scientist call someone a liar? He says that the liar makes conscious errors.

To someone like me, who prefers classical philosophy to modern science, a liar by any other name is still a liar.

Moeller explains in his paper why someone might make a conscious error.

“Juran characterized one of the more significant problems in performance measurement as conscious errors. Such conscious errors result in ‘a deliberate distortion of the sensed data, for a variety of (usually) self-serving human purposes: reduction of workload, avoidance of unpleasant tasks, self-aggrandizement, fear of being punished as the bearer of bad news (Juran [1992]).’”

But isn’t the failure to save people the worst possible news of all?

Not if you don’t measure it.

I suspect this is the reason so many EMS chiefs become impatient with discussions about cardiac arrest survival and claim that it doesn’t really measure an EMS system’s performance.

In South Carolina, the Attorney General’s office recently said that details on EMS operations, including ambulance response times, can’t be released to the public. Apparently doing so could compromise patient privacy.

The opinion was an interpretation of a law, the wording of which was composed by the Department of Health and Environmental Control (DHEC), which oversees EMS in South Carolina.

Beaufort County Administrator Gary Kubic was pleased with the opinion. He said it was unnecessary for information about EMS operations to be accessible because “we have people — professionals — in positions to make sure the level of service provided is commensurate with the demands of the community.”

One thing is certain. As long as EMS leaders believe they are not accountable to the public, then tens of thousands of cardiac arrest patients will continue to die needlessly every year in the United States.