Performance trends

Why is this measure important?

Montgomery County experiences approximately 50 out-of-hospital sudden cardiac arrests each month. The goal is to have these patients walk out of the hospital with all their faculties intact. Measuring return of spontaneous circulation (ROSC) is the first step in this process. MCFRS hopes to measure ultimate outcomes in the future, but this is dependent upon coordination with and cooperation from our hospital partners.

Factors contributing to current performance

  • Implementation of high performance CPR and treating patient on scene.
  • Provision of Lucas devices (automatic CPR machines) for use during patient transport. The primary objectives for using Lucas devices are over-the-road CPR effectiveness and safety of MCFRS personnel, as these devices perform over-the-road CPR more effectively than would a standing EMS provider (who would be adversely impacted by the physical forces exerted by a vehicle in motion) and with minimal risk to EMS providers.
  • Quality improvement (QI) feedback loop within the department.

Factors restricting performance improvement

  • Lack of lay person CPR being performed prior to arrival of MCFRS
  • Lack of sufficient number of Lucas devices on MCFRS apparatus. [These devices are costly to purchase and maintain; thus, in view of budget limitations, it will take several years to purchase a sufficient quantity of devices to achieve the goal whereby a unit will be present in each station.]

Performance improvement plan

  • EMS providers will be attempting resuscitation for longer periods of time in accordance with a FY2019 change in the Maryland Medical Protocols. [MCFRS was instrumental in effecting this change and provided data and research to the State regulatory agency showing why this was a needed change.]
  • MCFRS will continue offering hands-free CPR training for the public during the County Agricultural Fair, various community events and special events, and during CERT classes/events.
  • MCFRS will continue use of EMD protocols at the ECC designed for rapid recognition of patients in cardiac arrest and rapid delivery of pre-arrival instructions that guide the 911 caller in performance of appropriate CPR.
  • MCFRS will continue building out its fleet of Lucas devices (approximately two devices per fiscal year) so that eventually one unit in each station will carry this device.
  • MCFRS will continue its participation with MIEMSS and all in-county hospitals in "CARES" - a national project administered by Emory University which seeks to improve out-of-hospital cardiac arrest care.
  • County Police officers will continue to respond to cardiac arrest incidents if nearby and if their vehicle is equipped with an AED. This capability should improve the provision of early CPR and defibrillation.