Reprint from USA TodayAugust 24, 2007
September 24, 2007

Four years ago, in a special report headlined “Six minutes to live or die http://www.usatoday.com/news/nation/ems-day1-cover.htm,” USA TODAY reporter Robert Davis documented how emergency medical services in most of the nation’s 50 largest cities were fragmented, inconsistent and slow.

He described case after case in which heart attack victims who might have been saved in one city died or suffered brain damage in another, simply because CPR wasn’t delivered within that critical six minutes.

Davis discovered a critical difference between successful cities, most notably Seattle, which had a remarkable “save” rate of 45% in the year studied (2001), and those like Atlanta, which had no idea how poorly it was doing and only later discovered that it saved an abysmal 3%. Most important, Davis found that the top performers had systems that any city could replicate. In failing cities, meanwhile, emergency services were chaotically managed with little accountability.

Though good journalism can point the way toward saving lives, change requires official action and commitment. In a follow-up story this week, Davis reported how Atlanta Mayor Shirley Franklin responded. The city’s performance has improved fivefold since 2005. Franklin’s actions should be a template for lagging cities such as Washington, New York, Nashville, Los Angeles and Chicago.

The two key ingredients:

• Accountability. A system that works overcomes the all-too typical problem illustrated by the case of baggage handler Andrew Redyk, 64, who died at Los Angeles International Airport after he had a heart attack in 2001. Emergency crews took almost half an hour to reach him, but officials couldn’t know that from their data. It listed the response time as six minutes http://www.usatoday.com/news/nation/ems-day2-cover.htm .

  Atlanta is now one of a handful of cities participating in the Cardiac Arrest Registry to Enhance Survival (CARES), launched three years ago by Emory University and the Centers for Disease Control and Prevention.

  CARES is a central database that collates information from 911 centers, paramedic run reports and hospital discharge records. The database provides the kind of tracking that can help leaders see problems. CARES designates officials to be responsible for entering the data and pushes them to complete it. City officials can track how their emergency services are doing and compare them with other cities that have signed up.

  In Chicago, Philadelphia, El Paso and San Diego, by contrast, medical directors report problems getting hospitals to share information on survival rates.

• Leadership. Franklin is aggressively pushing solutions when weaknesses are identified. One example borrowed from Seattle: training more ordinary citizens in CPR, boosting the chances that bystanders can help before medical teams arrive. Last year, Franklin ordered all 8,000 city employees, including herself, to be trained in CPR. She has more than doubled the rate at which bystanders give help, from 7% to 17% http://www.usatoday.com/news/health/2007-08-20-ems-atlanta_N.htm?csp=34.

  Cities like Seattle or Houston, with the highest “save” rates, go even further, finding creative ways to ingrain CPR training in people’s lives. These include CPR training in schools, making CPR mandatory for some professions and streamlining training. Their bystander CPR rates exceed 40%.

  And, of course, successful cities force coordination, ending turf fights like those that commonly exist between emergency services and fire departments.

The bottom line is that if other cities follow Atlanta’s template, improvements are guaranteed. Lives can be saved — more than 1,000 each year in the nation’s biggest cities. As Franklin noted, “All you need to do is save one life, and it’s worth it. It’s miraculous.”

Posted at 12:21 AM/ET, August 24, 2007 in Health care/Insurance - Editorial http://blogs.usatoday.com/oped/health_careinsurance_editorial/index.html.