Cardiac Arrest Guidelines - Case Study Example

TOPIC: REVIEW OF CARDIAC ARREST GUIDELINES By student’s Name: Code+ Course: Instructor’s Name: University Name: City, State: Date of submission: Introduction In the recent past, cardiovascular disease has been rated as one of the major root of premature death in Australia. Stroke, heart as well as the vascular disease has posed a great threat as far as the health matters in Australia are concerned. For instance in year 2005 the disease claimed 46,134 lives which translated to 3.5% of all deaths in Australia which affected approximately 3.7 million people in Australia (Lerner, Maio , Garrison, Spaite, Nichol, 2006:pp.515-524). Therefore the Australian Government has prioritized to invest in National Health regarding the improvement of health outcomes due to cardiovascular disease. Death resulting from sudden cardiac arrest is estimated to account for at least half of the deaths that are associated with cardiovascular causes. It occurs when the heart ceases to function all over sudden due to electrical malfunctioning thereby disrupting the normal rhythm of the muscle. Recent studies have shown that there are minimal chances of survival from cardiac arrest especially from patients who are not within the hospital premises. Cardiopulmonary Resuscitation (CPR) as well as the early defibrillation is the only major cardiac arrest solutions that can help arrest the condition and that forms a part of emergency sequence of survival (Bernard, 1998: pp.25-29). Therefore early defibrillation has been considered as the most efficient method of treatment to re-start the functioning of the heart of an individual suffering from cardiac arrest. However the defibrillation time has been considered as one of the determinant of survival to cardiac arrest patient. This has thereby led to the automated external defibrillators (AED) development that has created a chance for community to respond to early cases of defibrillation in public places. Therefore the Australian Resuscitation Council guidelines categorize and identify the cases of early defibrillation as follows; Emergency medical services: whereby defibrillation is undertaken by ambulance service personnel; First responder: the defibrillation is undertaken by thoroughly trained persons whose core duty is to respond to emergencies pertaining to medical cases; and Public access defibrillation (PAD): a situation where defibrillation can be carried out by anyone regardless he/she is trained or not. Review on Public Access Defibrillation (PAD). The automated external defibrillators (AED) under the guideline of the public access defibrillation demonstration are a perfect move adopted by New South Wales, Victoria and St John WA ambulance services. This was through an engagement by the Department of Health and Ageing of the Australian Government for the ambulance services to adequately implement a public demonstration on public access defibrillation. The main objective of this demonstration was to adequately reduce the mortality to Australians who occasionally experience the condition of cardiac arrest in comparison with other current emergency cases experienced day in day out in Australia. Currently there are several automated external defibrillators has been installed at various host organizations selected in all the states in Australia and those territories that manned by the PAD Demonstration funded department (Wasserstein, Keane, Fisher, Leditschke, 2000: pp. 97-104). These places comprises of airports, schools, sporting stadiums, tourist sites, clubs and train stations. The demonstration on public access defibrillation was adequately designed to help curb the cardiac arrest cases that mostly occur in public places. The objectives of this program are part and parcel of the major policies developed by the Australian Government regarding the health prevention. However this guideline encompasses; Duty to Rescue: by Volunteers and ‘Good Samaritans’ In this context a ‘Good Samaritan’ can be defined as an individual who willing assists another person without expecting any reward in return (Tuxon, Lane, 1984: pp.872-879).Volunteers or lay persons acting in the capacity of ‘Good Samaritan’ have a legal obligation to use automated external defibrillator to help a cardiac arrest patient in public places where AEDs have been installed. However in their capacity to assist cardiac arrest victims a standard care must be taken which is proportional to their training as well as lack of training in case of untrained individual. Good Samaritan are required act under the doctrine of ‘good faith’ where the carry their duty without recklessness. In New South Wales and Victoria a volunteer is supposed to exercise reasonable care in handling cardiac arrest victims however in St. John’s ambulance the case may be different since they usually emphasize that the defibrillation be carried by a trained personnel to minimize the death cases associated with the cardiac arrest (Finn , Jacobs, Holman , Oxer, 2001: pp. 247-255). A trained individual however must portray high standards of care as compared to untrained individuals in handling of the AEDs and some expertise is required in the way the individual carries himself/herself in the rescue process. Doctors and Healthcare Professionals: Doctors as well as trained workers on health are allowed to rescue cardiac arrest patients in New South Wales, Victoria as well as those at St. John‘s Ambulance services when they are on duty. Trained Volunteers: It is not very clear whether for example a St John Volunteer, a Victoria Volunteer or New South Wales volunteer has a legal obligation to rescue a cardiac arrest victim according to this guideline set by Australian Resuscitation Council although if the situation demands a rescuer can argue from an ethical view where life must be protected at whatever cost. However trained volunteers when not on duty they assume the role of ‘Good Samaritans’ (Groenevel, Owens, 2005:pp. 58-67). Rationale The AEDs programs should be encouraged and the Australian Resuscitation Council should more conservative in enacting guidelines that are meant to improve the health condition of the Australian citizens. Restrictions on trained and untrained personnel to handle urgent cases using AEDs as long as they are conversant with defibrillation procedures and take due care in the resuscitation process should be encouraged to minimize the death cases as a result of cardiac arrest. Review on Emergency Medical Services The Australian Resuscitation Council usually recommends the emergency defibrillation services especially for cardiac arrest patients to be undertaken by trained doctors who possesses great skills in rescue services and who may exercise great care while handling these patients. However even though that might be the case there are orders that may followed in the rescue process in the case of cardiac arrest victims. Orders such as ‘Do-Not-Attempt-Resuscitation’ (DNAR) or ‘Not for Resuscitation’ (NFR) ought to be documented. However the present legal status of these orders is not very clear and it’s normally void in institutions as well as in out-of-hospital if not verified by the victim or the person taking care of the particular victim (Burton & Champion, 1991: pp.470). In New South Wales, Victoria as well as the St John Ambulance services in the case of an out-of -hospital circumstances emergency services usually are activated to only those cases of cardiac arrest that seem critical that is to the patients who are termed as chronically ill or possesses a terminal illness. The probability of treating a victim who is incompetent may therefore be high unless there is existence of a directive from an attorney or the caretaker of the cardiac arrest victim. Therefore these three institutions that is the NSW, Victoria and St John’s ambulance services are in collaboration with the International Liaison Committee on Resuscitation which usually recommends that there should be use of ‘standardized out-of-hospital physician orders’ to those patients who are termed as chronically. There should also exist additional instructions as to whether or not the health care providers should undertake life-sustaining procedures for cardiac arrest patients as well as those in near arrest (Valenzuela, Criss , Spaite, Meislin, Wright, Clarke, 1990: pp.1407-1455). However some differences exists based on jurisdiction for example in Victoria the refusal of treatment may be a personal decision given ‘’Endurance Power of Attorney (medical treatment)’’ which is outlined under the Medical Treatment Act 1988, on the other hand the refusal of treatment in New South Wales might be a personal decision given ‘’Enduring Guardianship’’ outlined by Guardianship Act 1987(NSW). Rationale Standardized orders as per the limitations regarding life-sustaining treatments need to be put into consideration to reduce the occurrence of unsuccessful attempts on resuscitation and to make sure that the individual wishes are taken into consideration. Therefore there should exist specific as well as detailed instructions. Protocols ought to be developed that are in, line with the cultural norms as well as within the framework of legal limitations to allow the health care providers to the wishes of the patients on resuscitation efforts. St. John’s legislation however includes references to withholding or discontinuing treatment without consent. A person responsible has a right to refuse consent towards the commencement or the continuation of any treatment whatsoever as outlined by Guardianship and Administration Act 1990. References Bernard S (1998) ‘Outcome from pre-hospital cardiac arrest in Melbourne, Australia’, Emergency Medicine, 10(1):25-29. Wassertheil J, Keane G, Fisher N, Leditschke JF (2000) ‘Cardiac arrest outcomes at the Melbourne Cricket Ground and Shrine of Remembrance using a tiered response strategy- a forerunner to public access defibrillation’, Resuscitation. 44:97–104. Finn JC, Jacobs IG, Holman CD, Oxer HF (2001) ‘Outcomes of out-of-hospital cardiac arrest patients in Perth, Western Australia, 1996-1999’, Resuscitation. 51(3):247-55. Valenzuela TD, Criss EA, Spaite D, Meislin HW, Wright AL, Clarke L (1990) ‘Cost effectiveness analysis of paramedic emergency medical services in the treatment of pre- hospital cardiopulmonary arrest’, Annals of Emergency Medicine. 19:1407-1411. Burton A, Champion P.(1991). External chest compression in acute severe asthma. Anesthetic Intensive Care.19(3):470 Tuxon D, Lane S (1984). The Effects of Ventilatory Pattern on Hyperinflation, Airway Pressures,and Circulation in Mechanical Ventilation of Patients with Severe Air-Flow Obstruction.American Review of Respiratory Disease. 136(4):872-9. Lerner EB, Maio RF, Garrison HG, Spaite DW, Nichol G (2006).‘Economic value of out-of- hospital emergency care: a structured literature review’, Annals of Emergency Medicine, 47(6):515–524 Groeneveld PW, Owens DK (2005).‘Cost effectiveness of training unselected laypeople in cardiopulmonary resuscitation and defibrillation’, American Journal of Medicine. 118(1):58-67. Read More