St John aims to save more heart cases

Gym instructor Suyash Pawar, St John paramedic Matt Schultz, Constable Jason Gordon and cardiac arrest survivor Gary Deuchrass. Photo / David Russell, Southern Exposures

Emergency responder finds survival rate low in comparison with Wellington service.

Cardiac arrest patients cared for by New Zealand's largest ambulance provider have a markedly lower chance of surviving than those under the service covering Wellington and the Wairarapa.

St John's patient survival rate at hospital discharge is 15 per cent of the 1996 patients on whom resuscitation was attempted. This contrasts with 20 per cent for the Wellington Free Ambulance service, a study by St John for the year to June 30 found.

The report also compares performance with overseas ambulance services, whose survival rates ranged from 9 to 19 per cent. St John says "numbers to survive a cardiac arrest are universally low".

Of the more than 4000 out-of-hospital cardiac arrests covered by the study, the leading cause was heart disease, with much smaller contributions from other causes including asthma, trauma, hanging, drowning and poisoning.

The average age of patients was in the mid-60s, 67 per cent were male and Maori had a 36 per cent higher incidence of cardiac arrest than non-Maori.

St John's medical director Dr Tony Smith said, "I have contacted Wellington Free Ambulance to congratulate them and to say I'm keen to see what they are doing differently that may be leading to improved outcomes."

One of the reasons for its better performance might be its lower use of single-crewing.

"We continue to have around 10 per cent of our emergency responses crewed by a single ambulance officer rather than a pair. That's something we are trying hard to eliminate because we think it's unsafe for the patients and we think it's unsafe for the crew.

"Our provisional cardiac data strongly suggests survival is reduced if the first arriving ambulance is single-crewed. That's no surprise as there are a number of things that need to be done in the first minutes, including CPR," Dr Smith said.

He said single-crewing resulted from having insufficient funding and available staff.

"In some areas of New Zealand we turn out a single crew or we don't turn out at all."

The Wellington service's medical director, Dr Andy Swain, said its ambulances were all double-crewed.

"There has been a lot of training focus on how paramedics work together in critical situations, how they interact with each other, who is in charge and who does what. I think that training is starting to bear fruit."

Team effort and defibrillator save life

Heart attack survivor Gary Deuchrass owes his life to a chain of amateur and professional health workers.

The 52-year-old Invercargill power systems technician and married father of three young men collapsed on a cross-trainer at his gym in August.

This was despite being fit, controlling his high cholesterol with diet changes and taking medication for high blood pressure.

Just moments after Mr Deuchrass' heart had stopped beating, a quick-thinking off-duty policeman, Constable Jason Gordon, began CPR. He told a gym instructor to bring the defibrillator installed at the YMCA by the local council and another gym patron called 111.

Mr Deuchrass had to be shocked twice before he came round properly. He was taken to Invercargill Hospital and later choppered to Dunedin Hospital, where blockages were diagnosed in three heart arteries. Bypass surgery ensued.

"[Defibrillators] are a life-saver," he says. "The more that can be around the better."

Cardiac arrest survival

St John ambulance service data for the year to June 30
• St John attended to 1996 adults on whom resuscitation was attempted.
• 31% per cent survived at least until hospital.
• 15% survived at least to hospital discharge.

Wellington Free Ambulance

• 199 patients.
• 41% survived at least until hospital.
• 20% survived at least to hospital discharge.