In response to the article written July 24 regarding EMS and pre-hospital hypothermia protocol, I would like to present a different viewpoint from Dr. Chuck Burnell.
The issue is that only one of 35 to 45 patients who suffer sudden death syndrome will survive with no significant neurologic impairment.
Extensive research regarding mild therapeutic hypothermia results in improved six-month survival and neurologic outcomes in selected patients.
The evidence has led the American Heart Association to stipulate hypothermia therapy a Class I recommendation. The majority of the current literature in reference to pre-hospital administration of iced fluids comes from feasibility and safety studies.
The studies are not powered for survivability; thus, one cannot say this therapy does or does not work in the pre-hospital setting. One of the four key factors identified which determines success of mild hypothermia’s protective effect is the speed at which targeted temperature is achieved: the faster the better.
Ongoing research includes giving cold fluids during CPR. Pre-hospital institution of hypothermia allows patients to be cooled faster and allows the receiving hospital time to prepare.
Research also supports delaying hypothermia is associated with worsened clinical outcome.
This protocol was developed by East Baton Rouge Parish EMS Assistant Training Director and CQI Officer Susan Bailey, AA, NCEE, NREMT-P.
This protocol was advanced to the EBRP Medical Society for its review and acceptance. EMT staff education was completed. The hypothermia protocol was deployed in April. Cooling intravenous fluids require an elaborate array of equipment which had to be purchased.
This included an ice machine for each EMS station and a small ice chest for each truck.
Funding was provided by the Metro Council and Mayor Kip Holden, both have been very supportive of EBRP EMS.
Soon after deployment, an 18-year-old man suffered a cardiac arrest while playing basketball. EMS revived the patient and instituted hypothermia.
The patient was transferred to Baton Rouge General Hospital Mid-City where physicians continued appropriate hypothermia.
That young man was discharged to home without significant neurologic impairment.
Since April, EBRP EMS has initiated pre-hospital hypothermia protocol in seven patients, according to EMS statistics. Four patients were transported to Our Lady of the Lake Regional Medical Center, two were transported to Baton Rouge General Health System and one was transported to Earl K. Long Medical Center.
Of the four transported to OLOL, three were discharged with no neurologic impairment and one was sent directly to surgery.
Considering the above historical data and the results we have experienced thus far, one realizes that something “good” is occurring.
That “good” is resulting in better patient survival and neurologic outcomes, although we are early in our process.
We believe this has been an impressive start — one that deserves the term “Strong Work Baton Rouge!” Thank you for your support goes to everyone involved: Mayor Holden, the Metro Council, EBRP EMS administration, EBRP EMTs, the local hospitals and their medical staff, as well as the people of Baton Rouge (Their taxes at work!).