Trust in partnership implements an app to link a qualified lifesaver with a patient in cardiac arrest, facilitating timely cardiopulmonary resuscitation and saving lives

Outline:

The chances of surviving an out of hospital cardiac arrest in the East Midlands was extremely poor <3%, we wanted to connect people willing to perform CPR with patients who needed it and our current community response strategies were not effective.

Our response time to a cardiac arrest for a conventional ambulance vehicle is over 7 minutes, the body can only survive without oxygen for 4 minutes and therefore a radical approach was required. We worked with GoodSAM app to implement crowd source technology into the 999-response model, when a cardiac arrest is received the app alerts the nearest 5 people trained in CPR to the patient.

Starting CPR as early as possible saves lives. There are over 2000 people registered on the application within the East Midlands and in the last 18 months we have issued 22,000 alerts with over 16,000 finding a responder and that responder providing treatment to the patient. We have seen over 40 patients where spontaneous circulation has been achieved at the scene and 7 patients have survived to be discharged from hospital and lead healthy lives. We have also been able reduce the time to arrive from 7 minutes to under 3 minutes.

Challenges:

This was a challenging project to implement as it was a disruptive approach and something the ambulance service or NHS had not previously encountered. It required a complete rethink of our appetite to risk and clinical governance particularly when tasking individuals who had downloaded the app without undertaking NHS background checks.

Our goal was clear to improve the chances of survival to patients in cardiac arrest where there was a less than 10% chance of surviving, We aimed to improve access to CPR training and encourage groups and communities to respond in times of need. We were clear that the purpose of the project and the application was to improve patient experience and not Trust key performance indicators therefore the results of the app do not effect ambulance response times.

This is about quality so as to lead to improving patient care. This element was a challenging sell to the organisation who had been very focused on achieving national NHS response standards. Our service is particularly challenged in regard to response standards due to the rural communities we serve, being able to provide a safe and effective service still remains a challenge particularly in Lincolnshire.

Our goal through this technology is to turn the community response model on its head and encourage communities to support each other until the ambulance can arrive. Evidence already existed from European communities that a crowd-sourced approach to CPR worked and therefore this was our drive to demonstrate it could benefit the East Midlands.

Our ultimate goal was to be an innovator in emergency care, disrupt the typical ambulance response approach to cardiac arrest and provide better services to the communities and patients we serve.

Outcomes:

Over the course of 18 months we have seen; over 16,000 patients benefit from a response via a GoodSAM alert over 2000 people have registered for the application in the East Midlands. We have seen 40 return of spontaneous circulation events, patients who have started breathing and their hearts beating following cardiac arrest.

We have seen 7 patients survive to discharge to the hospital and return to families and ultimately work we have created a community of responders by working with partner agencies and aim to increase this over coming years we have begun using the App in wider settings such as working with the police forces to respond to critical haemhorrages caused by violent assaults and by using geolocation to task volunteers to help with non clinical tasks such as 4x4 drivers for winter.

We have faced a challenge working collaboratively with hospitals on survivor data, sharing patient data without patient consent remains a considerable challenge for the NHS therefore of all of the alerts we have issued we cannot accurately track the outcome for the patient. However, because of the positive engagement the GoodSAM app has found, we have seen responders posting their outcomes on social media. This has allowed us to track progress in a way not previously envisaged.

Spread:

Through our work with GoodSAM app, we have built a region-wide partnership of responder organisations that encourage their staff and volunteers to register with the application.

Typically these are other emergency services and aid agencies but we are working with corporate organisations to build the responder pool further. We have shared our work, experience and methods with other ambulance services both in the UK and around the world. We held a webcast event with over 40 ambulance services from as far wide as Australia and Brazil.

In the UK we have assisted North West Ambulance Service, Welsh Ambulance Service and South West Ambulance Service follow our best practice and adopt the application into their response models.

Value:

Benefits have been a mix of financial and patient experience; - With the introduction of a smartphone app our approach to community response through text messaging has reduced. We have seen a reduction in spend with our text messaging provider (£270,000) as the technology has allowed us to use geo-location information to target a request to those near the patient.

- our response to Cardiac Arrest patients has improved with time to start CPR and defibrillation now commencing in under 3 minutes from the 999 call being made down from around 7 minutes before the app was introduced.

- Chances of survival have improved with 7 patients surviving from discharge to hospital since the app was introduced.

- Community experience and staff engagement has markedly improved with campaigns such as defib for sam allowing the local communities to upload their defibrillators.

- The application has allowed for more wider use in the organisation driving efficiencies such as the use of video triage and using the response element for winter pressures

- locating and tasking 4x4 drivers to collect staff or provide services to patients.

Involvement:

We engaged with staff and patients through our conversation cafe events. This allowed us to understand how people would react to a crowd-sourced approach. This was invaluable as it allowed us to relieve any concerns about risk our staff held. We also ensured that a patient and staff representative joined the project board to ensure that the project and implementation continued to reflect on the ground views. We experienced challenge engaging with IT colleagues around the integration of an app to the 999 command and control software.

Initial meetings were met with resistance but once GoodSAM developers worked with us to ensure appropriate security the project ran more smoothly. A key lesson learned was to ensure the technical experts were engaged as early as possible.

Our relationship with GoodSAM was a partnership with GoodSAM built on an open relationship. The GoodSAM app was funded by the Cabinet Office through innovation funding routes and EMAS received grant funding to assist with the implementation. Our procurement and finance colleagues were members of the project board and engaged throughout the process to ensure the supply relationship was appropriately managed.