1. GCRAC “ICE” PROPOSAL (Induced Cooling by EMS) By : Walter Morrow PHI Air Medical

2. The Idea of “ICE” Sudden Cardiac Death –Out of hospital cardiac arrest is a common disease 600-1000 Americans have a OOHCA daily 47% never make it to the hospital CHANCE OF SURVIVAL 1:20

3. The Idea of “ICE” There has been no significant decline over the past few decades despite advances in medications and early defibrillation Return Of Spontaneous Circulation (ROSC) –Many pt’s continue to have poor outcomes after hospitalization –Neurologic impairment often remains a lasting morbidity

4. The Idea of “ICE” Causes of Death in ROSC pt’s –10% refractory dysrhythmias –30% poor cardiac output states –40% post resuscitation encephalopathy (neurologic injury) Caused by cell death (multiple factors)

5. Idea of “ICE” Induced hypothermia is considered a Class IIA procedure according to the AHA. Epi is considered a Class IIB

6. Success: Bernard Study Group RISK : BENEFIT OutcomeHypot. (N=43)Normot. (N=34) Normal or minimal disability (discharged directly home) 157 Moderate Disability (to rehab facility) 62 Severe Disability but awake (long term Nsg facility) 01 Severe Disability, unconscious (long term Nsg facility) 01 Death 2223 NOTE: “bad” outcomes = 13% for hypot vs 17% for normo

7. The Idea of “ICE” Induce hypothermia in ROSC pt’s to bring pt temperature down to the 32-34 degree Celsius range (89.6-93.2 degree F) Bolus of cooled normal saline Ice pack application

8. GCRAC “ICE” GOALS Improve outcomes of post cardiac arrest patients. Comply with AHA’s ECC current guidelines (2005) Lead the south Texas in advanced cardiac care Promote awareness of GCRAC, Hospitals and local EMS services

9. Sample Protocol

10. “ICE” Plan EMS support Hospital Support (with cardiac services) –DeTar Hospital and Citizen’s Medical Center are on both on board –Community Hospitals to follow EMS plan GCRAC support

11. GCRAC Request GCRAC to purchase cooling units for primary response ambulances in RAC. Develop RAC wide protocols for both EMS and hospitals. Provide oversight of program through the Acute Care Committee

12. Training of EMS PHI Air Medical has offered to provide the hypothermia training to all EMS agencies at no cost.

13. Costs Cooling units – GCRAC funding? Normal Saline – EMS units / Hospital Ice Packs – EMS Units / Hospital Training –Class is provided by PHI Air Medical –Staff payment during training – EMS agency / Hospital

14. Cooling Units Refrigerators –Cost effective –Very large – space limited –Hard to secure in ambulance Cooling Units – designed for EMS use –Chillcore case by Thomas EMS – Engle EMS Unit cooler by Engle USA

15. Engle EMS Unit Some what mobile Requires mounting hardware Requires thermometer Adjust temperature using dial like home fridge Lower cost $600

16. Chillcore Case Mobile Cools at constant temp –As low as 20 degrees C Battery pack 12V or 110V Cost $799

17. GCRAC Staffed EMS Units Victoria FD 4 Calhoun Co EMS3 Edna EMS 2 Ganado EMS / Jackson Co ESD ? Yoakum EMS 2 Lavaca Co. Rescue2 Cuero EMS2 Goliad EMS2 Yorktown EMS? (BLS service)? PHI Air Medical0 Total17-20 units

18. Costs Chillcore Unit 17-20 x $799 = $13583 - $15980 Engel EMS Unit 17-20 x $600 = $10200 - $12000

19. Thank you for your time! Find out more info at: JEMS online web casts MCHD EMS – hypothermia Wake Co. EMS