Patient satisfaction and outcome using emergency care practitioners in New Zealand.

OBJECTIVE: A patient satisfaction survey was undertaken in the Kapiti District of the Wellington Region to ascertain patients' experience and opinions of New Zealand's first extended care paramedic (ECP) service before consideration is given to extending it to other locations within the region. Patient outcomes were also analysed for 1 week following ECP care. METHODS: One hundred patients, 50 attended by ECPs and 50 by standard emergency ambulance service paramedics, were interviewed by an independent assessor, either in person or by phone according to patient preference. The questionnaire was aimed at comparing the experience of both groups of patients, dividing them into those treated at home and those transferred to the ED. ED and general practice records were then reviewed to determine whether the ECP-treated patients attended either facility within 7 days and why. RESULTS: Patients were very satisfied with their experience of both groups of paramedics but expressed a clear desire to be treated at home if possible. Of the 50 ECP-treated patients, 11 were transferred directly to the ED. Only one clinical complication arose over the next 7 days in those treated in the community: a seizure in a patient with refractory epilepsy. CONCLUSION: The avoidance of unnecessary transfers to hospital is beneficial to patients, the ambulance service and the ED. This study demonstrates that patients are very satisfied with their assessment and treatment by ECPs, endorsing the proposal that the scheme should be extended across the Wellington Region, and perhaps New Zealand.

Outcomes from out-of-hospital cardiac arrest in the Wellington region of New Zealand. Does use of the Fire Service make a difference?

AIMS: Survival from community cardiac arrest in the Wellington region was analysed and compared with similar data reported nationally and internationally. In particular, the impact of a dual fire and ambulance service response was studied. METHOD: A retrospective comparative study was undertaken of out-of-hospital cardiac arrests in the Wellington region between 1 July 2007 and 31 December 2009. Data was collected from Wellington Free Ambulance and hospital records in accordance with the Utstein template. The New Zealand Fire Service provided details of firefighter attendance and timings. The primary outcome measure was survival to hospital discharge. RESULTS: Overall survival to hospital discharge was 11% (37/339) whilst survival from initial ventricular fibrillation or tachycardia (VF/VT) was 21% (34/161). Initial VF/VT was more common in witnessed than unwitnessed arrests (57% v. 35%, p=0.001) and this mirrored survival in these groups (15% vs 6%, p=0.01). Survival to hospital discharge was also associated with younger age and shorter emergency service response time. Bystanders attempted CPR in 55% and the fire service in 50% but neither intervention influenced outcome. Although, when activated, the fire service arrived on average 1-2 minutes ahead of the ambulance, the dual response did not influence survival to hospital admission or discharge. CONCLUSION: Survival from out-of-hospital cardiac arrest in Wellington is similar to that of other New Zealand cities and better than that reported from several large centres overseas. The combined fire and ambulance response was not shown to have any beneficial impact on survival over and above that achieved by the ambulance service alone. System changes are proposed to try and improve survival from community cardiac arrest in Wellington.

Survival from out-of-hospital cardiac arrest in New Zealand following the 2005 resuscitation guideline changes.

AIMS: The effect of cardiopulmonary resuscitation guideline changes on out-of-hospital survival rates and defibrillation efficacy was investigated. The guideline changes were those recommended by the International Liaison Committee on Resuscitation in 2005. METHODS: A retrospective comparative study was undertaken of out-of-hospital cardiac arrests in the Wellington region. The effect of guideline changes between the periods of 1st July 2005-30th June 2006 and 1st June 2007-31st May 2008 was examined. Data was collected from Wellington Free Ambulance and hospital records in accordance with the Utstein template. The primary outcome measure was survival to hospital discharge. Additional end points included individual shock success, return of spontaneous circulation (ROSC) and survival to hospital admission. RESULTS: There was no significant increase in survival to hospital discharge with 11% (18/162) pre-change and 12% (20/170) post-change (p=0.5). First-shock efficacy decreased from 68% (65/96) to 62% (57/92) (p=0.75). Second shock efficacy decreased from 47% (14/30) to 27% (9/33) (p=0.12). The proportion of patients with ROSC increased from 34% (55/162) to 42% (72/170) (p=0.07, Chi squared). The proportion surviving to hospital increased significantly from 22% (36/162) to 36% (61/170) (p=0.006). Withdrawal of atropine in 2005 had no adverse effect on the outcome. CONCLUSION: This study suggests that in the Wellington Region of New Zealand, the new guidelines have improved survival to hospital but not to discharge. Whilst the guideline changes have resulted in a trend towards decreased shock success rates, ROSC and survival to hospital admission have both increased.