The Ultimate Lifesaver – EMS in the Wall Street Journal

I got a strange voice mail from the Secretary of the Chief of Department asking if I could talk to a reporter about our advancements in cardiac arrest survival.

Um…yes please?


Laura Landro from the Wall Street Journal asked the kind of questions I wish more reporters asked.  Not just asking for our survival rate, but the more important question:

“Why is your number improving?”

We discussed continuous chest compressions, training the entire department to AHA standards and ensuring our BLS fleet can anticipate ALS interventions.  We discussed esophogeal airways, CPAP, see through CPR (from ZOLL), end tidal capnography, so many different tools that come together to make a 9% into a 23%.  And that was all before I got my job at HQ.  It’s nice to highlight the work of those who came before including Jeff Myers, Seb Wong, Brett Powell, Pete Howes.

Hopefully this is just the beginning of a conversation with the public about how EMS impacts their daily lives, not just when they, for lack of a better term, drop dead.


The Ultimate Lifesaver


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4 thoughts on “The Ultimate Lifesaver – EMS in the Wall Street Journal”

  1. Justin, Nice of you for the mention in your Blog but the real credit goes to the Medical and Command Leadership of the Department.  When I started as the EMS Operations Chief, I asked your pre-predecessor before Captain Powell, why we weren’t monitoring cardiac arrest as a benchmark in our quality improvement program.  He dismissively waved his hand and said, “Because Seb, we don’t waste time on dead people.”  As you can imagine, I was rather perturbed by such a cavalier position.

    After we replaced him with Captain Powell, Chief Howes and I made it a priority to improve the SFFD performance in cardiac arrest survival and the Chief of Department gave us latitude to work on that issue.  Dr. Karl Sporer made it a very succinct and clear point that we needed to have a clear metric and benchmark against which to compare our performance and how different changes implemented affected survival.  We tried to implement mechanical CPR devices but were stymied by funding.  In its stead, we utilized the new AHA BCLS guidelines that emphasized compression and changed ABC to CAB.  Dr. Sporer and I debated the use of the Pit Crew concept in handling cardiac arrests.

    Every single resuscitation or 9-Echo-1 was reviewed by Dr. Sporer and dissected to ensure that the units in the system on that response met response time recommendations.  We tried vigorously to ensure sufficient supply to meet the demand suing deployment plans developed by our Planning and Research Department.  Captain Powell worked religiously to ensure that the data being sent to Emory and CARES was accurate and timely.  He spent many a day off to ensure timely reporting for our Utstein reports.

    The Chief of Department allowed me to host to date two Cardiac  Arrest Summits to bring state of the art evidence based medical research to the San Francisco prehospital and medical community.  We have tried our best to lay a foundation for the next team to build and improve upon what we started.  The next step is to work on the system as a whole.  STEMI/CARDIAC RESUSCITATION Centers akin to Trauma Centers need to be designated in San Francisco.  We need to look at pre-hospital hypothermia to see if we can start that for all our ROSC patients.  And we need to continue reviewing all the resuscitation events and passing the information to CARES to measure how we are doing.

    Above all else, the greatest credit goes to the men and women who respond to the person down, or person not breathing and give their all to hopefully bring the patient back from clinical death.  The 23% (and hopefully a higher number) deserve the chance to see more of their lives and families.

  2. Justin, 

    Please indulge me once more as I thank publicly, Dr. Bryan McNally of Emory/CARES, Dr. Gordon Ewy of the University of Arizona, Dr. Ben Bobrow of the Arizona State EMS Office, Dr. Keith Lurie of the University of Minnesota, Dr. James Pointer ( a Medical Director that needs no introduction or appelation), Dr. Zian Tseng of the University of California-San Francisco, Dr. Claude Hemphill of UCSF, Dr. John MacGregor of San Francisco General Hospital, and Mr. Michael Jacobs of the Alameda County EMS Agency.All these wonderful people have been good friends and teachers during my time working in the EMS Administration of the SFFD to help improve Cardiac Arrest Survival in San Francisco.

    Anyone that wants to do the same just has to get a copy of the bible of cardiac resuscitation written by Dr. Mickey Eisenberg of the University of Washington in Seattle; “Resuscitate!: How Your Community Can Improve Survival from Sudden Cardiac Arrest” ISBN  9780295988894

  3. “why we weren’t monitoring cardiac arrest as a benchmark in our quality improvement program.  He dismissively waved his hand and said, ‘Because Seb, we don’t waste time on dead people.'”
    Of course, that kind of comment means – “When we do treat cardiac arrest, we ARE wasting our time, because we are not keeping track of what we are doing.”

    Nice work ending that archaic attitude.


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