Ebook Resuscitate (2nd edition): Part 2
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Ebook Resuscitate (2nd edition): Part 2
SIXLocation, Location, LocationBest Places to Have a Cardiac ArrestThe fire chief and the medical director from the City of D. spent the first day mee Ebook Resuscitate (2nd edition): Part 2eting with the Seattle Medic One battalion chief, visiting the alarm center, and riding all afternoon and into the evening with two paramedics. The second day they visited the quality improvement office to understand the data collection system and then had lunch with the Medic One medical director. Ebook Resuscitate (2nd edition): Part 2Eventually the discussion came around to the issue of what makes the Seattle system work so well. The D. fire chief asked directly. "What is the secreEbook Resuscitate (2nd edition): Part 2
t of Seattle’s success?” The Seattle medical director was not surprised by the question. Almost every visitor to the Medic One program asked it. The vSIXLocation, Location, LocationBest Places to Have a Cardiac ArrestThe fire chief and the medical director from the City of D. spent the first day mee Ebook Resuscitate (2nd edition): Part 2tle. So said 60 Minutes on a national TV broadcast in 1974- The claim was not just media hype —it happened to be accurate, and it remains accurate to this day. Seattle and the surrounding King County community, along with Rochester. Minnesota, have the nation’s highest survival rates for cardiac arr Ebook Resuscitate (2nd edition): Part 2est. The latest data from King County and Rochester indicate that 46 percent of patients who collapse with ventricular fibrillation in the presence ofEbook Resuscitate (2nd edition): Part 2
witnesses walk out of the hospital alive. The survival rate in Seattle, at 45 percent, is virtually identical.' So if you’re going to have a cardiac SIXLocation, Location, LocationBest Places to Have a Cardiac ArrestThe fire chief and the medical director from the City of D. spent the first day mee Ebook Resuscitate (2nd edition): Part 2ished survival rates for cardiac arrest involving ventricular fibrillation-7 percent, 5 percent, 3 percent, and 1 percent, respectively.What accounts for these drastically different survival rates? To begin to answer120this question, this chapter closely examines the communities with the highest sur Ebook Resuscitate (2nd edition): Part 2vival rates-Seattle, King County, and Rochester. What are the elements of success in these communities? Do their EMS systems have a secret ingredientEbook Resuscitate (2nd edition): Part 2
that is missing from the systems in other communities? Can successful systems like the ones in these communities be exported to other cities?THE SEATTSIXLocation, Location, LocationBest Places to Have a Cardiac ArrestThe fire chief and the medical director from the City of D. spent the first day mee Ebook Resuscitate (2nd edition): Part 2le one of the best places to have a cardiac arrest? I posed these questions to two individuals who are eminently qualified to answer it-Leonard Cobb (we met him in chapter 2), the cofounder of Seattle’s paramedic program, and Michael Copass, the program’s director of training for thirty-three years Ebook Resuscitate (2nd edition): Part 2and its current medical director.History: Two Leaders, One VisionLeonard Cobb and Michael Copass have different, contrasting leadership styles, but inEbook Resuscitate (2nd edition): Part 2
one area they are in total agreement-they refuse to accept anything less than full commitment to helping patients.Cobb and Copass, Copass and Cobb-thSIXLocation, Location, LocationBest Places to Have a Cardiac ArrestThe fire chief and the medical director from the City of D. spent the first day mee Ebook Resuscitate (2nd edition): Part 2intimately tied to the program. And their strengths and personalities are perfectly complementary-Cobb is the professor, the thoughtful investigator who wants to know what works and how to make things better, and Copass is the enforcer, the one who gives orders and demands nothing less than 100 perc Ebook Resuscitate (2nd edition): Part 2ent loyalty and effort.I’ve known Leonard Cobb since 1971, when I arrived in Seattle for an internship and residency in internal medicine.2 Cobb-he waEbook Resuscitate (2nd edition): Part 2
s “Dr. Cobb” to me at the time—was the attending physician on one of my first rotations, at Harborview Medical Center’s coronary care unit. 1 vividly SIXLocation, Location, LocationBest Places to Have a Cardiac ArrestThe fire chief and the medical director from the City of D. spent the first day mee Ebook Resuscitate (2nd edition): Part 2c One system and the role that paramedics played in resuscitation. At the time, I assumed that every hospital had a number of such patients; only later did I learn how unusual Harborview was.As for Michael Copass, his gruff demeanor is legendary. I have heard him described many times, and some of th Ebook Resuscitate (2nd edition): Part 2ose descriptions were less than kind, but my favorite saying about him is this one: “He’ll make you feel like you’re going to run out of ass before heEbook Resuscitate (2nd edition): Part 2
runs out of teeth." But beneath his harsh exterior shines a soft and caring soul.LOCATION, LOCATION, LOCATION: BEST PLACES TO HAVE A CARDIAC ARREST 1SIXLocation, Location, LocationBest Places to Have a Cardiac ArrestThe fire chief and the medical director from the City of D. spent the first day mee Ebook Resuscitate (2nd edition): Part 2or, often had interns or residents ride on the night shift with student paramedics and evaluate their work. 1 volunteered Io do this and enjoyed every minute of it. The students were a great group, eager Io learn and highly motivated to do well. 1 got Io see emergency medicine as it unfolded in peop Ebook Resuscitate (2nd edition): Part 2le’s homes and on the streets of Seattle. And it was a boyhood dream come true for me to be speeding along with the fire department’s medic unit as thEbook Resuscitate (2nd edition): Part 2
e lights flashed and the sirens wailed.As director of training. Copass taught every single paramedic in the Medic One program, and he left an indeliblSIXLocation, Location, LocationBest Places to Have a Cardiac ArrestThe fire chief and the medical director from the City of D. spent the first day mee Ebook Resuscitate (2nd edition): Part 2 befitting a health care professional. Copass demanded that every patient in every situation be treated with respect and dignity; he would accept nothing less. Once when I was meeting with Copass in his office, a student paramedic knocked at the door and sheepishly entered to say that he had followe Ebook Resuscitate (2nd edition): Part 2d up on a problematic situation by contacting the patient in question and explaining a medication error.Copass glared at the student. "You almost killEbook Resuscitate (2nd edition): Part 2
ed that little old lady,” he snapped. "Don’t you ever, ever make a mistake like that again!”The student left, no doubt grateful that anything at all rSIXLocation, Location, LocationBest Places to Have a Cardiac ArrestThe fire chief and the medical director from the City of D. spent the first day mee Ebook Resuscitate (2nd edition): Part 2wink, but what it showed me is that Copass’s “Billy Goat Gruff” behavior is mostly an act. It’s an effective one. though. That student was retained in the paramedic program, and I doubt that he will make any more medication errors for the rest of his career.Despite his fearsome reputation. Copass is Ebook Resuscitate (2nd edition): Part 2 a humble person, and he places great stock in others’ humility as well. He distrusts bravado and ostentatious displays of celebration; his motto coulEbook Resuscitate (2nd edition): Part 2
d very well be "When you gel Io the end zone, act like you’ve been there before.” He says of paramedics, “They are dealing with disease, terrible diseSIXLocation, Location, LocationBest Places to Have a Cardiac ArrestThe fire chief and the medical director from the City of D. spent the first day mee Ebook Resuscitate (2nd edition): Part 2ormous amount of work for an occasional splendorous moment."Foundation: The Medical Model and the Importance of Medical ControlWhen 1 asked Cobb and Copass what makes the programs in Seattle and King County work so well, they both unhesitatingly gave the same answer: “Medical control."’ From the sys Ebook Resuscitate (2nd edition): Part 2tem’s earliest beginnings. Cobb has viewed its paramedics as extensions of physicians, serving as their eyes. ears, and hands out in the community. ThEbook Resuscitate (2nd edition): Part 2
ough physically separated from physicians, the paramedics are connected to them by radio and122 LOCATION, LOCATION, LOCATION: BEST PLACES TO HAVE A CASIXLocation, Location, LocationBest Places to Have a Cardiac ArrestThe fire chief and the medical director from the City of D. spent the first day mee Ebook Resuscitate (2nd edition): Part 2 they authorize paramedics to administer medications and perform other medical procedures on their behalf.Cobb feels very strongly that the medical model of the Seattle and King County programs is a major key to (heir success, just as he believes that the paramedics’ accountability to authorizing ph Ebook Resuscitate (2nd edition): Part 2ysicians makes for excellent care. Virtually even' EMS system everywhere in the country has a medical director, of course. But, as Cobb might say, theEbook Resuscitate (2nd edition): Part 2
re are medical directors and there are medical directors. That might sound like a glib remark, but it hints at the core of the Seattle and King CountySIXLocation, Location, LocationBest Places to Have a Cardiac ArrestThe fire chief and the medical director from the City of D. spent the first day mee Ebook Resuscitate (2nd edition): Part 2everyone else delivering care (0 patients. The medical director reviews every medical incident report, and if something is lacking or less than perfect, (he person responsible for the shortcoming is going to hear about it.4Copass’s views are very similar to Cobb’s. Like Cobb, he sees the role of the Ebook Resuscitate (2nd edition): Part 2 medical director as paramount. “A doctor and the people he supervises have personal responsibility for every patient," Copass says. “There is no margEbook Resuscitate (2nd edition): Part 2
in for error.” For Copass, shared responsibility is most effective when it is accompanied by (he element of face-to-face accountability, without adminGọi ngay
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