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GCRAC “ICE” PROPOSAL

GCRAC “ICE” PROPOSAL. (Induced Cooling by EMS). By : Walter Morrow PHI Air Medical. The Idea of “ICE”. Sudden Cardiac Death Out of hospital cardiac arrest is a common disease 600-1000 Americans have a OOHCA daily 47% never make it to the hospital CHANCE OF SURVIVAL 1:20.

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GCRAC “ICE” PROPOSAL

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  1. GCRAC “ICE” PROPOSAL (Induced Cooling by EMS) By : Walter Morrow PHI Air Medical

  2. The Idea of “ICE” • Sudden Cardiac Death • Out of hospital cardiac arrest is a common disease • 600-1000 Americans have a OOHCA daily • 47% never make it to the hospital • CHANCE OF SURVIVAL 1:20

  3. The Idea of “ICE” • There has been no significant decline over the past few decades despite advances in medications and early defibrillation • Return Of Spontaneous Circulation (ROSC) • Many pt’s continue to have poor outcomes after hospitalization • Neurologic impairment often remains a lasting morbidity

  4. The Idea of “ICE” • Causes of Death in ROSC pt’s • 10% refractory dysrhythmias • 30% poor cardiac output states • 40% post resuscitation encephalopathy • (neurologic injury) • Caused by cell death (multiple factors)

  5. Idea of “ICE” • Induced hypothermia is considered a Class IIA procedure according to the AHA. • Epi is considered a Class IIB

  6. Success: Bernard Study Group Outcome Hypot. (N=43) Normot. (N=34) Normal or minimal disability (discharged directly home) 15 7 Moderate Disability (to rehab facility) 6 2 Severe Disability but awake (long term Nsg facility) 0 1 Severe Disability, unconscious (long term Nsg facility) 0 1 Death 22 23 NOTE: “bad” outcomes = 13% for hypot vs 17% for normo RISK : BENEFIT

  7. The Idea of “ICE” • Induce hypothermia in ROSC pt’s to bring pt temperature down to the 32-34 degree Celsius range (89.6-93.2 degree F) • Bolus of cooled normal saline • Ice pack application

  8. GCRAC “ICE” GOALS • Improve outcomes of post cardiac arrest patients . • Comply with AHA’s ECC current guidelines (2005) • Lead the south Texas in advanced cardiac care • Promote awareness of GCRAC, Hospitals and local EMS services

  9. Sample Protocol

  10. “ICE” Plan • EMS support • Hospital Support (with cardiac services) • DeTar Hospital and Citizen’s Medical Center are on both on board • Community Hospitals to follow EMS plan • GCRAC support

  11. GCRAC • Request GCRAC to purchase cooling units for primary response ambulances in RAC. • Develop RAC wide protocols for both EMS and hospitals. • Provide oversight of program through the Acute Care Committee

  12. Training of EMS • PHI Air Medical has offered to provide the hypothermia training to all EMS agencies at no cost.

  13. Costs • Cooling units – GCRAC funding? • Normal Saline – EMS units / Hospital • Ice Packs – EMS Units / Hospital • Training • Class is provided by PHI Air Medical • Staff payment during training – EMS agency / Hospital

  14. Cooling Units • Refrigerators • Cost effective • Very large – space limited • Hard to secure in ambulance • Cooling Units – designed for EMS use • Chillcore case by Thomas EMS • Engle EMS Unit cooler by Engle USA

  15. Engle EMS Unit • Some what mobile • Requires mounting hardware • Requires thermometer • Adjust temperature using dial like home fridge • Lower cost $600

  16. Chillcore Case • Mobile • Cools at constant temp • As low as 20 degrees C • Battery pack • 12V or 110V • Cost $799

  17. GCRAC Staffed EMS Units • Victoria FD 4 • Calhoun Co EMS 3 • Edna EMS 2 • Ganado EMS / Jackson Co ESD ? • Yoakum EMS 2 • Lavaca Co. Rescue 2 • Cuero EMS 2 • Goliad EMS 2 • Yorktown EMS? (BLS service) ? • PHI Air Medical 0 Total 17-20 units

  18. Costs • Chillcore Unit • 17-20 x $799 = $13583 - $15980 • Engel EMS Unit • 17-20 x $600 = $10200 - $12000

  19. Thank you for your time! Find out more info at: JEMS online web casts MCHD EMS – hypothermia Wake Co. EMS

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