INTERNATIONAL NURSING
RESCUE
ON
TWO WHEELS
Author: Marek Maslanka, MS, RN, Krakow, Poland Section Editors: Pat Clutter, MEd, RN, CEN, FAEN, and Nancy Mannion Bonalumi, MS, RN, CEN, FAEN
esearch shows that the most important factors determining survival of sudden cardiac arrest are initiation of cardiac resuscitation by witnesses to the event, early defibrillation, and transportation to a facility with the ability to treat the causes of cardiac arrest. 1 Despite the development of emergency medical services (EMS) and the growth and improvement in the quality and availability of medical procedures, including interventional cardiology, in most European countries, the percentage of people who survive sudden cardiac arrest has not considerably increased. 2 In Europe approximately 400,000 episodes of sudden cardiac arrest occur annually, with a survival rate of less than 10%. 2 The cause of this high mortality rate is most often attributed to the inability of an ambulance to arrive and implement advanced life support treatment in less than 3 minutes from the onset of the event. Social media and marketing campaigns supported by the European Parliament have aimed to raise public awareness and encourage initiation of first aid by witnesses of sudden cardiac arrest as a key link in the chain of survival. 2 Despite these efforts and the involvement of individuals and institutions, in most cases, people who experience sudden cardiac arrest will not receive aid from the general public. Compounding bystander inaction is the delay in arrival of rescue personnel by ambulance. Survivability can decline as the clock ticks away. According to the U.S. American Heart Association, “For every minute that passes between collapse and defibrillation, the chance of survival from a witnessed Ventricular Fibrillation sudden cardiac arrest declines by seven to ten percent per minute if no bystander CPR is provided.” 3
R
Two Wheels to the Rescue
The use of a motorcycle for emergency medical rescue is not a new concept. Motorcycles have been used for medical treatment and transport since the early 1900s and were prominently used in World War I. However, the concept Marek Maslanka is President, Polish Society of Emergency Nursing. For correspondence, write: Marek Maslanka MS, RN; E-mail: [email protected]. J Emerg Nurs 2014;40:276-8. 0099-1767/$36.00 Copyright © 2014 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jen.2014.02.008
276
JOURNAL OF EMERGENCY NURSING
did not catch on in public EMS systems until the early 1990s when large cities such as Hong Kong, London, and Singapore implemented them as emergency first responders. 3 These programs became instantly successful because of the ability of motorcycles to maneuver through heavy traffic and densely populated areas, which resulted in reduced response times and improved patient outcomes. Because of the success of these programs, other large cities have conducted analytical research to evaluate their effectiveness in their own EMS systems. 5 Krakow is the second largest city in Poland, with a population of 780,000 and a regional population of 8 million. Each year, more than 5 million tourists visit Krakow, primarily the historic central district that dates back to the 10th century. In addition, Krakow’s internationally renowned universities attract more than 100,000 students. Because of Krakow’s heavy traffic, narrow streets, and long ambulance response times, the use of motorcycles was determined to be an effective way to improve the outcomes of emergency events. Objectives and Tasks of the Unit
The aim is to reach people experiencing a medical emergency in Krakow’s central area within 4 minutes from the time the unit is notified. An emergency responder on a motorcycle is the best method of rapid response for events in the city’s public places. As shown by the experience of the Dutch and the Swedish, early arrival of a rescuer with a defibrillator can increase the survival rate of sudden cardiac arrest up to approximately 25%. 3 Poland’s Emergency Medical Rescue Act of 2006 specifies that an ambulance must reach the victim within 15 minutes in communities that have more than 10,000 inhabitants and within 20 minutes in all other areas. 4 The task of the rescuer on 2 wheels is to fill the gap between a sudden cardiac event and the arrival of the rescue ambulance. This task is accomplished by the motorcycle unit, which patrols key areas of the city during its hours of operation. The design and dimensions of a motorcycle enable it to move quickly in the crowded, narrow, medieval streets of Krakow. The motorcycle’s size and agility is also a benefit in other areas around Krakow where getting an ambulance to the site is difficult, such as train stations, forests, and parks. The motorcycle units function on 2 levels: basic and advanced. The basic motorcycle model is equivalent to an
VOLUME 40 • ISSUE 3
May 2014
Maslanka/INTERNATIONAL NURSING
FIGURE 1 The author making his rounds on a rescue motorcycle.
Emergency Medical Technician in the United States and is staffed and equipped in accordance with the requirements of the Emergency Medical Rescue Act. The basic responder scope of practice includes administering oxygen therapy, ventilating with bag/valve/mask, using an automated defibrillator, and applying dressings and splints. In the advanced motorcycle model, a paramedic, nurse, or physician may respond. The advanced motorcycle unit carries equipment for the management of a difficult airway, including endotracheal intubation and a ventilator, an electrocardiogram monitor/ defibrillator, pharmacotherapy, and intravenous fluids. All supplies are stored on the motorcycle. Side compartments are specially designed to carry a heart monitor/ defibrillator, medications, oxygen, airway kits, intravenous kits, and Basic Life Support supplies (Figure 1). Roles and Responsibility of a Motorcycle Rescuer
One question often asked of the motorcycle rescuer is, “How do you do this work by yourself?” To perform emergency procedures by oneself can be difficult. The responder must acknowledge that it may not be possible to execute all emergency procedures and focuses on those that are most important and effective. Because the environment in which the rescuer is providing care may have many restrictions, it is key that the rescuer be highly trained and use effective ergonomics to keep unnecessary movements to a minimum. Another solution is to seek assistance from bystanders in performing certain tasks, such as chest compressions. Help can be sought from fire, police, or medical personnel who have responded, as well as civilians. In case of a mass casualty event, a motorcycle rescuer serves
May 2014
VOLUME 40 • ISSUE 3
in a support role during a large-scale response by caring for persons who have minor injuries and by acting as a guide for the ambulance response in the city. Difficulty in identifying an adequate number of qualified motorcycle rescuers led to the implementation of a rescue group on bicycles as a 2-wheeled alternative; these rescuers operate in the historic center of Krakow and its recreational areas. The equipment carried on the bicycle is very similar to that carried on the motorcycle. Rescuers on bicycles are most often emergency medical students and representatives of various professions. Rescuers on motorcycles and bicycles work from May 1 to October 30, from Friday afternoon through Sunday evening. Rescuers receive notification of events from Krakow’s centralized emergency dispatch center. The rescuers’ knowledge of motorcycle safety standards and their clinical skills must be verified before they are allowed to operate on the street. 5 Staff must meet formal requirements, including emergency vehicle operations; they must successfully pass emergency care education modules and be competent in riding a motorcycle. The medical training includes lectures and practical exercises based on case studies. Each spring, all rescuers for these units must attend a mandatory refresher session on safely operating a motorcycle. Support and Oversight
The R2 Foundation is a nongovernmental nonprofit organization in Poland that gathers donations to support EMS with equipment and training. It worked closely with Krakow’s civic leadership and public safety agencies to develop the program guidelines and organize the specialized educational requirements. Motorcycles equipped with a defibrillator, other equipment, and specialized uniforms were obtained through R2 Foundation funding. The bicycles were donated by the city of Krakow. Program Outcomes
It has been an honor for me to contribute to the establishment of the R2 Foundation by acting as the Chair and leading the effort to introduce motorcycle units in Krakow. Developing a range of medical training, techniques, and emergency procedures that can be performed by one rescuer was a novel experience for emergency care providers in Krakow. Data from the first 2 years of operation demonstrate the effectiveness of the motorcycle rescue unit in bridging the gap in emergency care until arrival of an ambulance (Table 1). The time it takes for a 2-wheeled rescuer to reach patients in Krakow’s urban areas clearly
WWW.JENONLINE.ORG
277
INTERNATIONAL NURSING/Maslanka
TABLE 1
Key statistics Total interventions Source: “112” calls Source: Encountered on patrol No. of bicycle responses Response time: bicycle (min) No. of motorcycle responses Response time: motorcycle (min) Transfer to EMS Transfer to police Aid and release
2011
2012
274 251 26 99 3 175 4 185 32 57
203 177 26 89 4 114 4.5 97 17 53
EMS, emergency medical services.
supports the overall goal of Krakow’s EMS to deliver timely care. Concerns that the public would not support this program were not realized, as bystanders have willingly provided assistance to the rescuers. By rapidly responding to emergency calls, assessing the patient, and recommending the most appropriate level of ambulance response, the program also created a more efficient and effective emergency response system. The impetus for this program was to improve the outcome of sudden cardiac arrest. The units responded to 7 cardiac arrest events during the data collection period, but specific patient outcomes could not be obtained. The opportunity exists for improved communication between the rescue units, hospitals, and civic leadership to demonstrate the full value of the program. The Future of Rescuers on Two Wheels
The success of Krakow’s program can be replicated by other communities in Poland. The R2 Foundation outlines the steps for implementation. Prior to implementing such a program, an analysis of local conditions would be required, such as the number of residents and tourists, the degree of urbanization, the width of the streets, the availability of
278
JOURNAL OF EMERGENCY NURSING
hospital units, weather conditions, geographical location (eg, whether the area is mountainous and the location of rivers and lakes). In addition, support and promotion by other public safety and civic agencies would be necessary. The necessity of developing protocols and preparing the rescuers to function by themselves must be considered. For emergency responders in a variety of places in the world, a rescuer on 2 wheels may be the solution when every second counts. REFERENCES 1. Meaney PA, Bobrow BJ, Mancini ME. on behalf of the CPR Quality Summit Investigators, the American Heart Association Emergency Cardiovascular Care Committee, and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Cardiopulmonary resuscitation quality: improving cardiac resuscitation outcomes both inside and outside the hospital. Circulation. 2013;128:417-35. Available at: http://circ.ahajournals.org/lookup/doi/10.1161/CIR.0b013e31829d8654. Accessed March 3, 2014. 2. European Parliament. Declaration of the European Parliament of 14 June 2012 on establishing a European cardiac arrest awareness week. Available at: http://www.europarl.europa.eu/sides/getDoc.do?pubRef=-//EP//TEXT+TA +P7-TA-2012-0266+0+DOC+XML+V0//EN&language=EN. Updated September 18, 2013. Accessed March 3, 2014. 3. Morrison LJ, Shuster M, Otto CW. Part 8: Advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2010;122(16 suppl 2):S345-421. 4. The State Emergency Medical Services, Ministry of Health. Available at: http://www.mz.gov.pl/system-ochrony-zdrowia/panstwowe-ratonwnictwomedyczne. Accessed March 19, 2013. 5. Eddy S. Motorcycle medics to the rescue. Available at: http://ezinearticles. com/?Motorcycle-Medics-to-the-Rescue&id=2023591. Accessed March 3, 2014.
Submissions to this column are encouraged and may be sent to Pat Clutter, MEd, RN, CEN, FAEN [email protected] or Nancy Mannion Bonalumi, MS, RN, CEN, FAEN [email protected]
VOLUME 40 • ISSUE 3
May 2014
RESCUE
ON
TWO WHEELS
Author: Marek Maslanka, MS, RN, Krakow, Poland Section Editors: Pat Clutter, MEd, RN, CEN, FAEN, and Nancy Mannion Bonalumi, MS, RN, CEN, FAEN
esearch shows that the most important factors determining survival of sudden cardiac arrest are initiation of cardiac resuscitation by witnesses to the event, early defibrillation, and transportation to a facility with the ability to treat the causes of cardiac arrest. 1 Despite the development of emergency medical services (EMS) and the growth and improvement in the quality and availability of medical procedures, including interventional cardiology, in most European countries, the percentage of people who survive sudden cardiac arrest has not considerably increased. 2 In Europe approximately 400,000 episodes of sudden cardiac arrest occur annually, with a survival rate of less than 10%. 2 The cause of this high mortality rate is most often attributed to the inability of an ambulance to arrive and implement advanced life support treatment in less than 3 minutes from the onset of the event. Social media and marketing campaigns supported by the European Parliament have aimed to raise public awareness and encourage initiation of first aid by witnesses of sudden cardiac arrest as a key link in the chain of survival. 2 Despite these efforts and the involvement of individuals and institutions, in most cases, people who experience sudden cardiac arrest will not receive aid from the general public. Compounding bystander inaction is the delay in arrival of rescue personnel by ambulance. Survivability can decline as the clock ticks away. According to the U.S. American Heart Association, “For every minute that passes between collapse and defibrillation, the chance of survival from a witnessed Ventricular Fibrillation sudden cardiac arrest declines by seven to ten percent per minute if no bystander CPR is provided.” 3
R
Two Wheels to the Rescue
The use of a motorcycle for emergency medical rescue is not a new concept. Motorcycles have been used for medical treatment and transport since the early 1900s and were prominently used in World War I. However, the concept Marek Maslanka is President, Polish Society of Emergency Nursing. For correspondence, write: Marek Maslanka MS, RN; E-mail: [email protected]. J Emerg Nurs 2014;40:276-8. 0099-1767/$36.00 Copyright © 2014 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jen.2014.02.008
276
JOURNAL OF EMERGENCY NURSING
did not catch on in public EMS systems until the early 1990s when large cities such as Hong Kong, London, and Singapore implemented them as emergency first responders. 3 These programs became instantly successful because of the ability of motorcycles to maneuver through heavy traffic and densely populated areas, which resulted in reduced response times and improved patient outcomes. Because of the success of these programs, other large cities have conducted analytical research to evaluate their effectiveness in their own EMS systems. 5 Krakow is the second largest city in Poland, with a population of 780,000 and a regional population of 8 million. Each year, more than 5 million tourists visit Krakow, primarily the historic central district that dates back to the 10th century. In addition, Krakow’s internationally renowned universities attract more than 100,000 students. Because of Krakow’s heavy traffic, narrow streets, and long ambulance response times, the use of motorcycles was determined to be an effective way to improve the outcomes of emergency events. Objectives and Tasks of the Unit
The aim is to reach people experiencing a medical emergency in Krakow’s central area within 4 minutes from the time the unit is notified. An emergency responder on a motorcycle is the best method of rapid response for events in the city’s public places. As shown by the experience of the Dutch and the Swedish, early arrival of a rescuer with a defibrillator can increase the survival rate of sudden cardiac arrest up to approximately 25%. 3 Poland’s Emergency Medical Rescue Act of 2006 specifies that an ambulance must reach the victim within 15 minutes in communities that have more than 10,000 inhabitants and within 20 minutes in all other areas. 4 The task of the rescuer on 2 wheels is to fill the gap between a sudden cardiac event and the arrival of the rescue ambulance. This task is accomplished by the motorcycle unit, which patrols key areas of the city during its hours of operation. The design and dimensions of a motorcycle enable it to move quickly in the crowded, narrow, medieval streets of Krakow. The motorcycle’s size and agility is also a benefit in other areas around Krakow where getting an ambulance to the site is difficult, such as train stations, forests, and parks. The motorcycle units function on 2 levels: basic and advanced. The basic motorcycle model is equivalent to an
VOLUME 40 • ISSUE 3
May 2014
Maslanka/INTERNATIONAL NURSING
FIGURE 1 The author making his rounds on a rescue motorcycle.
Emergency Medical Technician in the United States and is staffed and equipped in accordance with the requirements of the Emergency Medical Rescue Act. The basic responder scope of practice includes administering oxygen therapy, ventilating with bag/valve/mask, using an automated defibrillator, and applying dressings and splints. In the advanced motorcycle model, a paramedic, nurse, or physician may respond. The advanced motorcycle unit carries equipment for the management of a difficult airway, including endotracheal intubation and a ventilator, an electrocardiogram monitor/ defibrillator, pharmacotherapy, and intravenous fluids. All supplies are stored on the motorcycle. Side compartments are specially designed to carry a heart monitor/ defibrillator, medications, oxygen, airway kits, intravenous kits, and Basic Life Support supplies (Figure 1). Roles and Responsibility of a Motorcycle Rescuer
One question often asked of the motorcycle rescuer is, “How do you do this work by yourself?” To perform emergency procedures by oneself can be difficult. The responder must acknowledge that it may not be possible to execute all emergency procedures and focuses on those that are most important and effective. Because the environment in which the rescuer is providing care may have many restrictions, it is key that the rescuer be highly trained and use effective ergonomics to keep unnecessary movements to a minimum. Another solution is to seek assistance from bystanders in performing certain tasks, such as chest compressions. Help can be sought from fire, police, or medical personnel who have responded, as well as civilians. In case of a mass casualty event, a motorcycle rescuer serves
May 2014
VOLUME 40 • ISSUE 3
in a support role during a large-scale response by caring for persons who have minor injuries and by acting as a guide for the ambulance response in the city. Difficulty in identifying an adequate number of qualified motorcycle rescuers led to the implementation of a rescue group on bicycles as a 2-wheeled alternative; these rescuers operate in the historic center of Krakow and its recreational areas. The equipment carried on the bicycle is very similar to that carried on the motorcycle. Rescuers on bicycles are most often emergency medical students and representatives of various professions. Rescuers on motorcycles and bicycles work from May 1 to October 30, from Friday afternoon through Sunday evening. Rescuers receive notification of events from Krakow’s centralized emergency dispatch center. The rescuers’ knowledge of motorcycle safety standards and their clinical skills must be verified before they are allowed to operate on the street. 5 Staff must meet formal requirements, including emergency vehicle operations; they must successfully pass emergency care education modules and be competent in riding a motorcycle. The medical training includes lectures and practical exercises based on case studies. Each spring, all rescuers for these units must attend a mandatory refresher session on safely operating a motorcycle. Support and Oversight
The R2 Foundation is a nongovernmental nonprofit organization in Poland that gathers donations to support EMS with equipment and training. It worked closely with Krakow’s civic leadership and public safety agencies to develop the program guidelines and organize the specialized educational requirements. Motorcycles equipped with a defibrillator, other equipment, and specialized uniforms were obtained through R2 Foundation funding. The bicycles were donated by the city of Krakow. Program Outcomes
It has been an honor for me to contribute to the establishment of the R2 Foundation by acting as the Chair and leading the effort to introduce motorcycle units in Krakow. Developing a range of medical training, techniques, and emergency procedures that can be performed by one rescuer was a novel experience for emergency care providers in Krakow. Data from the first 2 years of operation demonstrate the effectiveness of the motorcycle rescue unit in bridging the gap in emergency care until arrival of an ambulance (Table 1). The time it takes for a 2-wheeled rescuer to reach patients in Krakow’s urban areas clearly
WWW.JENONLINE.ORG
277
INTERNATIONAL NURSING/Maslanka
TABLE 1
Key statistics Total interventions Source: “112” calls Source: Encountered on patrol No. of bicycle responses Response time: bicycle (min) No. of motorcycle responses Response time: motorcycle (min) Transfer to EMS Transfer to police Aid and release
2011
2012
274 251 26 99 3 175 4 185 32 57
203 177 26 89 4 114 4.5 97 17 53
EMS, emergency medical services.
supports the overall goal of Krakow’s EMS to deliver timely care. Concerns that the public would not support this program were not realized, as bystanders have willingly provided assistance to the rescuers. By rapidly responding to emergency calls, assessing the patient, and recommending the most appropriate level of ambulance response, the program also created a more efficient and effective emergency response system. The impetus for this program was to improve the outcome of sudden cardiac arrest. The units responded to 7 cardiac arrest events during the data collection period, but specific patient outcomes could not be obtained. The opportunity exists for improved communication between the rescue units, hospitals, and civic leadership to demonstrate the full value of the program. The Future of Rescuers on Two Wheels
The success of Krakow’s program can be replicated by other communities in Poland. The R2 Foundation outlines the steps for implementation. Prior to implementing such a program, an analysis of local conditions would be required, such as the number of residents and tourists, the degree of urbanization, the width of the streets, the availability of
278
JOURNAL OF EMERGENCY NURSING
hospital units, weather conditions, geographical location (eg, whether the area is mountainous and the location of rivers and lakes). In addition, support and promotion by other public safety and civic agencies would be necessary. The necessity of developing protocols and preparing the rescuers to function by themselves must be considered. For emergency responders in a variety of places in the world, a rescuer on 2 wheels may be the solution when every second counts. REFERENCES 1. Meaney PA, Bobrow BJ, Mancini ME. on behalf of the CPR Quality Summit Investigators, the American Heart Association Emergency Cardiovascular Care Committee, and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Cardiopulmonary resuscitation quality: improving cardiac resuscitation outcomes both inside and outside the hospital. Circulation. 2013;128:417-35. Available at: http://circ.ahajournals.org/lookup/doi/10.1161/CIR.0b013e31829d8654. Accessed March 3, 2014. 2. European Parliament. Declaration of the European Parliament of 14 June 2012 on establishing a European cardiac arrest awareness week. Available at: http://www.europarl.europa.eu/sides/getDoc.do?pubRef=-//EP//TEXT+TA +P7-TA-2012-0266+0+DOC+XML+V0//EN&language=EN. Updated September 18, 2013. Accessed March 3, 2014. 3. Morrison LJ, Shuster M, Otto CW. Part 8: Advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2010;122(16 suppl 2):S345-421. 4. The State Emergency Medical Services, Ministry of Health. Available at: http://www.mz.gov.pl/system-ochrony-zdrowia/panstwowe-ratonwnictwomedyczne. Accessed March 19, 2013. 5. Eddy S. Motorcycle medics to the rescue. Available at: http://ezinearticles. com/?Motorcycle-Medics-to-the-Rescue&id=2023591. Accessed March 3, 2014.
Submissions to this column are encouraged and may be sent to Pat Clutter, MEd, RN, CEN, FAEN [email protected] or Nancy Mannion Bonalumi, MS, RN, CEN, FAEN [email protected]
VOLUME 40 • ISSUE 3
May 2014
