A/Prof Marcus Ong Consultant, Senior Medical Scientist & Director of Research Department of Emergency Medicine Singapore General Hospital

1. National Strategy for Improving Outcomes for Sudden Cardiac Arrest in Singapore A/Prof Marcus Ong Consultant, Senior Medical Scientist & Director of Research Department of Emergency Medicine Singapore General Hospital Adjunct Associate Professor Duke-NUS Graduate Medical School Office of Research Prepared for the Advisory Committee on National Coronary Heart Disease Strategy.

4. Characteristics of Cardiac Arrest Patients Data from the Cardiac Arrest and Resuscitation Epidemiology in Singapore, 2001-2002

8. The Take Heart Approach

9. Treatment Impact on Outcomes 5 – 10% Rapid cooling, coronary vessel clearing and implanted defibrillators in the hospital 4 – 6% Circulation enhancement by EMS and hospital personnel 4 – 6% Improved quality CPR by EMS 4 – 6% Rapid AED use 2 – 5% Bystander CPR Expected Survival Improvement Intervention Resuscitation Strategies and Their Impacts

10. Chain of Survival Courtesy of Life Support Training Centre, Singapore General Hospital

12. Early Access CARE Study: EMS Response Time Time (Mins) Patient collapsed Ambulance called 10.6 Ambulance dispatched 0.7 Ambulance arrived at location 9.5 Ambulance arrived at patient’s side 2.4 CPR Started 1.8 1st shock given 2.3 ROSC 15.6 Arrival at ED 3.2 46.1

16. DISCUSSION Number of Ambulances/population

21. PADS I Study

22. PADS I Study Number of cardiac arrest cases by hour

25. IMPROVED RESPONSE TIMES WITH MOTORCYCLE BASED FAST RESPONSE PARAMEDICS IN AN URBAN SETTINGS Ong Marcus, MBBS, FRCS Ed (A&E) Registrar, Department of Emergency Medicine, Singapore General Hospital Chan YH, Phd Head Biostatistics, Clinical Trials and Epidemiology Research Unit, Ministry of Health A/P V Anatharaman, MBBS, MRCP, FRCS Ed (A&E), FAMS Senior Consultant and Head, Department of Emergency Medicine, SGH Clinical Associate Professor, Faculty of Medicine, NUS introduction aims/objectives methods results conclusions Pre-hospital response intervals are known to be an important factor in the level of care provided by any Emergency Medical System. In big cities, response intervals are known to be long due to traffic and accessibility problems. To see if response intervals can be improved with motorcycle based Fast Response Paramedics (FRP) compared with standard ambulances in an urban setting. A prospective, observational study. Simultaneous dispatch of motorcycles based FRP’s equipped with Automated External Defibrillators and standard ambulances for cardiac arrest, cardiac, respiratory conditions and road traffic accidents. 48 consecutive ambulance runs were recorded. Locations involved: home (41.7%), work (29.2%), road accident (20.8%) and others (8.3%) Ambulances took on average 4.96 minutes longer than motorcycles to respond (p<0.001, 95% CI 2.61 to 7.31). Adjusting (via multiple regression) for the day of the week, location, station, traffic and case, ambulances took on the average 4.71 (p<0.001, 95% CI 2.45 to 6.98) minutes longer to respond. Improvements in response times were greater when overall response times were longer (weekdays, residential/office location, moderate or heavy traffic). Use of motorcycle based paramedics allow for faster response intervals and earlier interventions, especially early defibrillation in cardiac arrest. Larger follow-up studies are planned to assess the impact of implementation of more FRP’s on mortality and morbidity.

26. Early Cardio-Pulmonary Resuscitation (CPR) CARE Study: Bystander CPR

27. Early CPR Lateef et al 2001 SGH ASM

28. Quality of CPR: Pocket QCPR feedback device for use with manual CPR (CPREZY)

29. Defibrillator pads incorporating an accelerometer for QCPR feedback (Zoll E series defibrillation pads)

30. Defibrillator screen display incorporating QCPR feedback indicators (Zoll E series)

33. Public Access Defibrillation in Singapore: What is the Geographic-Time Distribution of Cardiac Arrests in Singapore? (PADS I Study) PADS I Study Early Defibrillation

34. PADS I Study

35. 85.77 12,436 70.35 (19.41) 32 27 Ghim Moh 30.82 90,864 64.52 (18.57) 84 12 Clementi 32.31 60,870 57.15 (20.11) 59 54 Sengkang 31.77 31,481 62.88 (21.88) 30 32 Towner 63.34 19,999 52.71 (24.31) 38 47 Bedok (Bedok Reservoir) 81.47 11,047 63.32 (14.55) 27 05 South Bridge Road / Kreta Ayer 108.10 8,017 61.37 (16.72) 26 21 Jalan Besar 163.24 11,639 64.43 (22.41) 57 15 Alexandra (Bukit Merah/Redhill) Arrest Rate per year over 3 years (per 100,000 population) Esitmated Population base (2000 census) Mean Age of arrests(SD) N Postal code Area

36. Early Defibrillation Breakdown of Location of Cardiac Arrest Cases

37. Defibrillation by Health Care Providers Breakdown of Location of Cardiac Arrest Cases : Many are within reach of a GP/Clinic (CARE Study Phase I & II - 1 Oct 2001 to 14 Oct 2004)

38. 1995: First Five Years of Pre-Hospital Automatic Defibrillation Project in Singapore

44. Dr Marcus Ong MBBS (Singapore), FRCS Ed (A&E), MPH, FAMS Consultant, Director of Research and Senior Medical Scientist Department of Emergency Medicine Singapore General Hospital

47. “ “ A Prospective Clinical Study Comparing Controlled Therapeutic Hypothermia Post-Cardiac Arrest Using External and Internal Cooling to Standard Intensive Care Unit Therapy” 

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