Any delay can be fatal
Suffolk County may be one of the more affluent places in the nation, but it's not a very good place to have a heart attack, a new analysis suggests.
Out of 3,424 people who collapsed in cardiac arrest in Suffolk over the last four years, only 71 were resuscitated and lived long enough to be released from the hospital, according to an analysis prepared for the county by Stony Brook University.
That is less than half the 5 percent odds of survival that the American Heart Association estimates as the national average.
Because speedy intervention is accepted as the most important factor in saving a cardiac arrest patient, experts say Suffolk's poor survival rates highlight the human cost of its relatively slow emergency medical response, which has been a longtime target of reform efforts.
The nation's best systems, such as Seattle, average survival rates as high as 25 percent. But of other U.S. areas for which studies have been published, only New York and Chicago fared as poorly as Suffolk County, said Edward Stapleton, a professor of clinical emergency medicine at the university who co-authored the heart association's emergency cardiac-care manuals and guidelines.
Only 1.4 percent of New York's cardiac arrest victims survived 10 years ago, but that average has improved to 2.2 percent since firefighters began carrying defibrillators on their engines, a new study has shown. Chicago's survival rate is 1.8 percent.
"We're doing as well as the worst systems in the country," Stapleton said. "We're simply not getting there soon enough."
Dr. Jeanne Alicandro, emergency medical director for the county health department, said the study is the first step to improving care.
"One thing we do have going for us is that we're looking, because there are a lot of areas that aren't looking, that don't keep data at all," she said. "I think we're moving in the right direction."
No comparable review has been performed in Nassau County, because Nassau does not provide significant funding for medical supervision and quality improvement of emergency care, said John Hassett, who heads Nassau's regional EMS council.
A rule of thumb published by the heart association holds that every minute that passes without intervention after cardiac arrest reduces the chances of survival by 7 to 10 percent.
But newer studies have refined that understanding, showing dramatically higher survival rates among those who get defibrillation within four minutes and rapidly worsening hopes thereafter, said Dr. Robert Silverman, research director for the department of emergency medicine at Long Island Jewish Medical Center in New Hyde Park.
"Optimally, you want to get defibrillation within four minutes or as close to four minutes as possible," he said. "The further out you go, the poorer the patient's chances."
That may be why survival rates as high as 60 percent are found in some airports and casinos, where defibrillators and trained staff are close at hand and visitors are constantly monitored.
The cities of New York and Chicago appear to suffer poor survival rates because it can take so long to get through lobbies, stairs and elevators from the street to the patient's side, researchers believe.
Last year, Suffolk agencies took an average of 7 minutes, 13 seconds to deliver the first help of any kind to the doorstep of patients, even after being warned by dispatchers that they were responding to the most urgent cardiac and/or respiratory arrest calls, according to county records.
And that average did not include the time spent processing the 911 call before the dispatchers summoned help, or the time it took crews to actually deliver a shock to the heart, Silverman noted.
"That is a long response time, and I would say that if there was one system intervention likely to improve the outcome from cardiac arrest, it would be to reduce those response times," said Dr. Tom Aufderheide, a professor of emergency medicine at the Medical College of Wisconsin and a national authority on emergency cardiac care.
In Milwaukee County, for example, fire department first responders arrive within 2 to 3 minutes, Aufderheide said, and 10 to 11 percent of cardiac arrest patients survive.
Stapleton said Suffolk is about to launch a campaign to teach volunteers new techniques in CPR because recent studies suggest it is key to survival for people who don't get emergency defibrillation within the first 5 minutes.
"It really boils down to time: time from collapse to CPR and defibrillation," Stapleton said.
