BC Ambulance Service part of the Resuscitation Outcomes Consortium North American Study

A young woman lays unconscious on the roadside following a highway accident. A player clutches his chest and falls to the ice during an old-timers hockey game. A father suffers a cardiac arrest as he gets ready for work.

“Cardiovascular disease is the second leading cause of death and accounts for more than one fifth of all deaths in British Columbia (BC),” says Dr. Karen Wanger, Acting VP Medical Programs for (BCAS), operated by the Provincial Health Services Authority. “Major trauma is the leading cause of death in adolescents and young adults.”

BCAS – the province-wide ambulance organization serving more than four million residents — is investigating promising new interventions and approaches to pre-hospital management of cardiac arrest and life-threatening trauma through the Consortium (ROC). Now in its sixth year, the ROC research network brings together 260 EMS and fire agencies from across North America and is the first large scale effort of its kind in the world.

Earlier this year, BCAS representatives met ROC partners to discuss observations from the studies in Vancouver. The session delegates included paramedics, BCAS leaders, First Responders, Fire Chiefs, representatives from the National Institutes of Health, EMS physicians, clinician scientists, academics and guests from the Seattle ROC site and from the ROC Data Coordinating Center in the University of Washington.

“The conference provided an important chance for partners to share perspectives on upcoming trials and challenge ourselves to greater achievements,” explains Dr. Jim Christenson, Principal Investigator and Head, University of British Columbia Department of Emergency Medicine. “Through ROC research, we have learned much about trauma and interactions, how particular interventions work in the field and what other interventions might be effective, but this is just the tip of the iceberg. There is still much to learn about resuscitation and while we have seen relatively promising results in the control and intervention arms of the trials we are still working to achieve the best possible survival rates.”

As part of ROC, BCAS paramedics are playing an important role in supporting evidence-informed care by complying with study protocols and documenting in detail exactly what is done in the pre-hospital setting on every case of cardiac arrest. In doing so, the ROC study can help to integrate pre-hospital information with post-resuscitation phase in-hospital information and survival.

In the ROC sites in BC, this focus on quality CPR and the effort of paramedics, dispatchers, first responders, clinical education and quality improvement staff has resulted in an increase in survival to discharge for all attempted resuscitations from six per cent to more than 10 per cent.

Also key to saving lives is taking advantage of opportunities to hone and improve on CPR skills. BCAS offers CPR refresher courses as a chance for paramedics to refine this life-saving skill. “We know that CPR is a skill that requires continuous upgrading no matter how often you treat cardiac arrest patients,” says Dr. Wanger. “We are learning that the best survival comes from optimal timing and depth of compressions, optimum delivery of defibrillation, and the optimum choreography of the scene. We are encouraging all paramedics to visit the BCAS Learning Centre and sign up for CPR refresher courses.”

The ROC research study presently involves a limited number of BCAS stations but the service hopes there will be opportunities for paramedics from across the province to get involved in future ROC trials, looking into areas such as the comparison of continuous compressions with interrupting for ventilations (30:2 ratio), amiodarone vs. lidocaine vs. placebo for recurrent VF, and permissive hypotension for life-threatening trauma, to name a few.