By Mahshid Abir, M.D.
Associate Professor, University of Michigan, Department of Emergency Medicine
2017-2019 National Academy of Medicine ABEM Fellow
The Enhancing Pre-Hospital Outcomes for Cardiac Arrest (EPOC) is a four-year study conducted by Brahmajee Nallamothu, M.D., (University of Michigan, Department of Internal Medicine, Division of Cardiovascular Medicine) and me. The study is funded by the National Heart, Lung, and Blood Institute (NHLBI), operating in partnership between the University of Michigan, RAND Corporation, and SaveMiHeart.
The focus of the study is on out-of-hospital cardiac arrest (OHCA), a common life-threatening event that is associated with poor survival outcomes. Current evidence indicates that some communities have been consistently more successful in responding to and treating OHCA than others. While this is largely believed to be due to the adoption of key care processes by Emergency Medical Services (EMS) agencies in the pre-hospital setting, how these processes are actually used in routine practice and the underlying factors contributing to their successful implementation is largely unknown. Further, an integrative systems approach that examines the interaction of EMS system stakeholders (i.e., EMS agencies, 911 call takers/dispatch, police, fire, and receiving emergency departments) who provide care across the “chain of survival” has not been undertaken. A better understanding and dissemination of strategies to improve the care processes employed by high-survival EMS systems and communities across the system of care for OHCA is a critical yet unfulfilled step for improving outcomes.
Accordingly, the EPOC study will lay the foundation for future quality improvement efforts in OHCA through the following three aims: 1) identify variations in OHCA survival among EMS agencies and communities; 2) define system of care ‘best practices’ for OHCA survival; and 3) validate system of care factors associated with OHCA survival. These aims are accomplished using a novel stakeholder-based participatory research and sequential mixed-methods approach. Findings from this study include ‘best practices’ identified from the perspectives of EMS system stakeholders that are generated in partnership with the Michigan Department of Health and Human Services (MDHHS). These findings will be used to construct a toolkit of actionable ‘best practices’– the EPOC Toolkit – that will be disseminated to EMS system stakeholders through key state and national partners to improve OHCA outcomes in communities across the U.S.
Read an interview with Dr. Abir here.