GP response to cardiac arrest: an innovative response strategy

Problem

Out of hospital cardiac arrest (OHCA) is a key health issue. In Ireland 2,000 OHCAs are dealt with by the ambulance services annually with only 6% leaving hospital alive.Ireland’s 2,600 GPs live and work in the communities for which they provide comprehensive primary care and as a result are well placed to deliver early care in an emergency in the community. The MERIT project recruited more than 500 Irish general practices to receive AEDs and training in OHCA management; 18% of patients who suffered an OHCA and were treated by a participating GP, survived to hospital discharge, mainly because of timely access. To date GPs have encountered OHCA via their day to day practice and have not been linked formally with the 999 system of emergency ambulance dispatch.New technology allows real-time text alerts to be sent to GPs’ phones from ambulance control when a nearby OHCA occurs. This project examines the feasibility and outcomes of recruiting GP volunteers to be alerted to nearby incidents of OHCA via text message.

Approach

Initially, only GPs participating in the MERIT project have been invited to participate. Structures to address governance, equipment, training, indemnity and data management have been developed and implemented, in liaison with the National Ambulance Service and national OHCA Registry. GPs provide monthly reports on alerts and clinical data on individual cases. Data on alerts, responses, OHCA incidents and outcomes are gathered in the overall project. This report addresses recruitment and set-up data.

Findings

Around 400 MERIT GPs based in rural areas or small towns were invited to participate; 25% have volunteered to take part. The majority are from rural practices and many have reported prior incidents of OHCA managed in the practice. Monthly reporting from participants has been 90-100%. In the period May 2015 to Jan 2016, 35% of the participating GPs have been alerted to at least one OHCA incident, involving more than 100 OHCAs. Initial data suggest that GPs have responded in around 30% of cases. Clinical and outcome data are currently being collated.

Consequences

GPs in Britain and Ireland are said to be under significant financial, workload and morale pressures. It is noteworthy that in such circumstances, up to 25% of GPs are prepared to re-affirm their commitment to the communities they serve by volunteering for a project such as this. The recruitment and alerting process has proved to be feasible and effective. Clinical and outcome data will indicate the overall contribution of this novel role for GPs in life-threatening emergencies.