Why Edinburgh leads way in treating cardiac arrests

Paramedic Donald McPhail at the back of a rapid response vehicle. Picture: Toby Williams
Paramedic Donald McPhail at the back of a rapid response vehicle. Picture: Toby Williams
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EDINBURGH is world-famous for its festivals but there is less recognition for one of its most vital achievements – treating cardiac arrests.

A team of Lothian paramedics are part of a pioneering re-think on how to save hundreds of lives.

Known as the Resuscitation Rapid Response Unit (3RU), the team was set up three years ago to trial a new approach in the Capital that would lead the way and drag Scotland from its place at the bottom of the table in terms of survival rates.

Working with emergency medical consultants from the award-winning Resuscitation Research Group, based at Edinburgh Royal Infirmary, the paramedics receive fortnightly training to ensure they are working at the forefront of critical care.

And it seems to be working, as the chances of surviving a cardiac arrest in Edinburgh are now among the highest in the world.

Someone having an arrest, when the heart suddenly stops pumping blood, has a 17 per cent chance of surviving if it happens in Edinburgh.

The figures might seem low but it is impressive when compared to the UK average of nine per cent and the European average of ten per cent.

The Evening News joined the squad on the road for a morning to shed light on how they are using the whole chain of survival to transform critical care.

Call handlers at the centre in South Queensferry are told to mark any potential cardiac arrest call as quickly as possible and to dispatch a 3RU unit alongside a normal ambulance.

This can be a motorbike or a car manned by one of the 3RU team, which ensures there are always three paramedics at every call instead of the usual two. There are plans to roll this out across the whole of Scotland.

Team leader Donald McPhail revealed the extensive kit the paramedics take with them, including ultrasound machines and a mechanical CPR device that can deliver chest compressions to a casualty without aid.

The device allows paramedics to carry a casualty down stairs while still delivering compressions.

The squad can even conduct an electrocardiogram (ECG) on any patient suspected of having an episode, which measures the electrical function of the heart.

This is sent on to the ERI ahead of the ambulance so medics can be ready to kickstart treatment immediately.

Despite being on high alert for these calls, Donald also responds to other emergency alerts, including a two-year-old girl, who might have suffered a seizure and a man in his 50s, who was presenting signs of having a stroke.

He said: “Survival rates in Edinburgh are now among the best in the world thanks to this collaborative working between the Scottish Ambulance Service and the research groups. One of the things we have found is having a third person at the scene means the quality of response is materially better than when you don’t.”

Data from the defibrillator is recorded to build a better picture of responses and the squad is also believed to be the first place in the world to create a video audit, where paramedics wear a camera to record video footage to help improve their response.

The footage is encrypted for viewing on only one computer and it is destroyed afterwards.

The 3RU initiative has raised the standard of response across the whole ambulance service, Donald added.

Dr Gareth Clegg, one of the leaders of the Resuscitation Research Group, said: “Most paramedics might see three cardiac arrests in a year but the guys in this team see about three a week.

“So they are focused on what needs to be done and completely up to speed with the latest techniques.”

Quick delivery of CPR from bystanders is one of the most important factors in the chain of survival, something the 3RU team is hoping will increase among the public as it is currently only delivered in half of the cases.

Dr Clegg, who is also an honorary consultant at the ERI, said: “I prefer to think of it as relay race, so the chain of survival will fall apart if the baton is dropped between any of the stages.

“From the initial ambulance call, to bystander CPR and defibrillation, on to hospital care and afterwards.

“But the majority of out-of-hospital cardiac arrests will have no chance without bystander CPR.”

Dr Clegg praised the ambulance service for their enthusiasm and openness for the project, which he said might not have been possible elsewhere. He said: “One of the major things that has made this a success is the willingness of the ambulance service to examine their data and look for improvements.”

The Scottish Government collaborated extensively with the team for its new cardiac arrest strategy, which was published earlier this year.

It aims to save 1000 additional lives across the country by 2020.