TUESDAY, FEBRUARY 19, 2008
Where Not to Have a Heart Attack
My friend Tom Merriman, a nationally-honored investigative reporter at WJW-TV in Cleveland, wanted to know if his city lives up to its reputation as the heart capital of the world. It is, after all, home to the famous Cleveland Clinic.
What he found is that if you have a heart attack, it may take far too long for help to reach you and deliver a lifesaving shock.
Take a look at Tom's project. Then read this interview I did with him on how he did the project and how you can adapt it.
Tompkins: What did you learn in this investigation?
Merriman: I used to joke that despite its many problems, Cleveland is a great place to have a heart attack. Actually, I was dead wrong.
While patients from around the globe come here to receive cutting-edge cardiac care at the Cleveland Clinic, the presence of a world-class heart hospital does not translate into increased survivability on the streets of Cleveland. In fact, our record of saving people who go into cardiac arrest is pretty awful.
I also learned that for every minute that passes without a heartbeat, your chance of survival declines by 10 percent. If it takes first responders 6 minutes to reach your house and another minute to hook you up, analyze your heart and deliver a shock, your likelihood of survival is already down to 30 percent. That's best-case scenario.
More realistically, there is some period of delay from the time an individual goes into cardiac arrest and the time a witness dials 911. On top of that, many EMS systems are incapable of consistently reaching victims in under 6 minutes. So when you add all of these factors together, it's reasonable to believe that a typical person experiencing cardiac arrest in their home or on the street has somewhere between a zero and 20 percent chance of survival.
Tompkins: Why were there such differences in survival rates?
Merriman: The cardiologists we interviewed said "time to electricity" is the one factor that matters most. The communities with the highest resuscitation rates had median response times under 4 minutes and 30 seconds. Response time appears to be a function of geography, staffing and squad positioning.
We found it to be very difficult to pinpoint one factor that separated one department from another. The age of the population, likelihood of bystander CPR, availability of public AEDs (automated external
defibrillators) and firefighter training also certainly impact resuscitation rates.
Most departments had no idea whether they were relatively effective in saving cardiac-arrested patients. Those with high resuscitation rates had a difficult time explaining their success. Many seemed to just accept death as a likely outcome. The American Heart Association is pushing cities to start gathering data that would enable fire departments to identify where the "chain of survival" breaks down.
Tompkins: Where did the data come from?
Merriman: Ohio law requires each fire and EMS department to submit quarterly data (including cardiac resuscitation data) to the Ohio Department of Public Safety. Back in the 1970s when the reporting law was passed, municipalities successfully lobbied to keep individual departments' data a secret. We could ask the state for data related to a grouping of five or more cities, but state officials are forbidden by law to release information about a specific department. Apparently, our local mayors may have envisioned a news story like the one that we finally aired three decades later!
Since we couldn't get the data from the state, we obtained an e-mail list of each fire chief in Cuyahoga County and sent a single request to all of the chiefs simultaneously. We asked for number of cardiac arrests, number of cases where CPR was attempted, number of cases where AED was attempted, number of spontaneous circulations achieved, and number of deaths for a three-year period.
We used the CPR number to eliminate patients who were obviously dead on arrival. We wanted to focus on cases where paramedics attempted to save someone in cardiac arrest. The spontaneous circulation number indicates how many times first responders were able to restore a pulse to a patient. We divided the spontaneous circulation number by the CPR number to reach our rate of resuscitation.
Tompkins: How important was your Internet version of this story?
Merriman: The primary thrust of the broadcast story was to drive viewers to the Web site to look up their community's resuscitation rate and tap into a link that would enable them to order a CPR training kit for their family.
The grim reality is that in most cities if you sit around and wait for first responders to arrive, your loved one is going to die. The only way to buy a patient time is to perform CPR. In our live tag to this story, we pushed people to our Web site where we had a link to the American Heart Association. Their training kit enables you to learn CPR in 20 minutes.
Conveying this story through a dual medium (TV and Web) also relieved the pressure of trying to communicate every suburb's numbers in the broadcast report. It empowered us to engage in better broadcast storytelling.
Tompkins: What advice do you have for other reporters who want to take this project on?
Merriman: Starting with a fire chief e-mail list is critical. Managing the inflow of data and following up on the unresponsive is a lot easier if you are using e-mail as the primary means of communication. Faxing requests to over 30 departments and trying to keep track of the responses by phone would have been a nightmare.
On a final note, I don't think this is exactly the greatest investigation in the history of broadcast journalism. Nevertheless, it proved to be an issue of great interest to our viewers. As our baby boomers grow older, people have considerable anxiety about what might happen if they had a heart attack. We were able to offer some useful information they cared about. This story could be easily replicated in most markets in the country.
Posted at 1:46:14 AM
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