Intended for healthcare professionals

Rapid response to:

Letters Field of play resuscitation

Do not move player requiring resuscitation on field until return of spontaneous circulation

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e2448 (Published 02 April 2012) Cite this as: BMJ 2012;344:e2448

Rapid Response:

Re: Do not move player requiring resuscitation on field until return of spontaneous circulation

Whether or not a regional air ambulance service provides support to cardiac events depends on how rural that area is and the corresponding likelihood of delay in transferring a patient to a cardiac centre. As ambulance response times in London are consistently below 8 minutes (1) and specialist hospitals are readily accessible, London patients are only considered for aero-medical support if they have suffered from major trauma.

Jones and Moorehouse suggest HEMS as a potential solution to the dilemma of whether to continue to try and obtain a cardiac output “stay and play” or to transfer to a specialist center whilst continuing CPR “scoop and run”. Despite HEMS being undoubtedly useful in expertly intubating the footballer and expediting transfer to a specialist unit their capabilities would not greatly supersede those of the attending paramedics, as unlike in a trauma scenario rapid sequence induction of anaesthesia is not required, indeed paramedics are trained to intubate arrested patients as part of their core competencies.

Whereas the use of ALS in pre-hospital, non-traumatic, cardiac arrest is a contentious issue, with intubation shown not to increase survival (2), skilled personnel, advanced techniques and helicopter transfer are shown to significantly benefit the outcomes for trauma patients (3). Although a helicopter extraction from White Hart Lane may have benefited this extremely unusual case (and looked astounding on match of the day), the standard use of HEMS in urban cardiac arrests would overwhelm the service and reduce the benefit to those that need it most – the severely injured.

References:

1 – The information centre for health and social sciences. Ambulance services England. 2011. http://www.ic.nhs.uk/webfiles/publications/Audits%20and%20Performance/Am...

2 – Stieg IG, Wells GA, Field B et al. Advanced cardiac life support in out-of-cardiac arrest. New England Journal of Medicine. 2004. 351: 647-56 http://www.nejm.org/doi/full/10.1056/NEJMoa040325

3 - Helicopters and the civilian trauma system: national utilization patterns demonstrate improved outcomes after traumatic injury. Brown JB, Stassen NA, Bankey PE, J Trauma. 2010 Nov;69(5):1030-4; discussion 1034-6.
http://www.ncbi.nlm.nih.gov/pubmed/21068607

Competing interests: No competing interests

09 April 2012
Nick Wilson
Research Fellow and Postgraduate Student (Trauma Sciences MSc)
Henry Nnajiuba (FY1 and Postgraduate Student)
Southend Hospital
and Barts and the London SMD