Legislating the entire "Chain of Survival"

The potential to improve outcomes for patients suffering cardiac arrest, heart attack and stroke is enormous. Survival rates and outcomes in communities that are amongst the leaders in implementing the latest evidence based practices in pre-hospital cardiovascular emergency management can be three hundred to four hundred per cent better than in communities that are stuck in the 20th century.

Since the 1990 conference at the Utstein Abbey in Norway an avalanche of excellent scientific research has created a strong evidence base that provides clear direction for implementing best practice in community cardiac response. The evidence indicates that there is not one but several pillars on which a community cardiac response program must be built.

• AED's. Everybody loves to advocate for AED's. Not one life has ever been saved by an AED. Someone had to take the device off the wall, place the pads and deliver the shock (and then perform effective CPR). Of course we need them, but to begin and end with a law that promotes more AED's in the community will not produce the hoped for results
• CPR. I find it bizarre when the AED lobby is distinct and seperate from the CPR lobby. Different people and organizations approaching different legislators with different proposals, both groups claiming that their way is the true path to improved survival rates. The two therapies are inseperable. I am also very concerned about the love affair many advocates have with teaching CPR to teenagers, with little or no thought given to the importance of teaching CPR to adults including educators, coaches, trainers, youth leaders, adult athletes, in fact just about everybody.
• Early Recognition. Raising community wide awareness of the warning signs of heart attack, stroke and arrhythmia and how to respond to them is the most undervalued link in the chain. It is also the link with the greatest potential to deliver significant and measurable economic return. Rehabilitating survivors whose MI and Stroke symptoms evolve over several hours is expensive.  If everyone made it the hospital within and hour of the onset of symptoms imagine the cost savings, billions.
• 9-1-1 and Dispatch. Investing in the best dispatch technologies to reduce EMS response times will always have benefits. Dispatcher coached CPR is proving to be a very simple and cost effective way to improve survival rates. The abilty for all dispatch centres to perform instant GPS locate on cell phones is critical and long overdue in many Canadian communities.
• Early Advanced Care including Induced Hypothermia. If all qualifying patients are not cooled half of the money invested in acheiving ROSC in the pre-hospital setting is wasted, along with the corresponding number of lives.

Ontario where I live, work and play is far from a leader in legislating policies that strengthen the cardiac chain of survival. However there are a number of individuals and organizations lobbying both the provincial and municipal governments to enact laws that promote their "pet" link in the chain. Legislators are busy and the number of issues that they must contemplate is immense. Presenting them with a tidy, gift wrapped, inclusive policy package makes their life easier and is the best way to earn their respect and their ear. I hope that advocates and law makers in Ontario and in all jurisdictions work together with all stakeholders that have an interest in pre-hospital cardiac emergency response to develop a comprehensive strategy for improving survival rates and outcomes. The links in the Chain of Survival are co-dependant and the whole will always be greater than the sum of the parts.