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The economic impact of out-of-hospital cardiac arrest care
By Keith Lurie, MD; Mike Levy, MD, FAEMS, FACEP; Robert Swor, DO, FACEP, FAEMS & Johanna Moore, MD, MS
It was just another busy morning for 26-year-old Bailey as she prepared break- fast for her five-month-old and five-year-old children in her rural Minnesota house.
Suddenly, she collapsed onto the kitchen floor.
Bailey’s boyfriend, who happened to be
home that morning, immediately called 9-1-1
and started CPR. Although he knew CPR
from a course he had taken at his construction job, the dispatcher on the phone guided
him through chest compression-only CPR.
He later reported that Bailey was gasping from
time to time—a favorable prognostic sign.
It took about 12 minutes for EMS to arrive.
Defibrillation didn’t initially convert the
young patient, so Bailey was treated with
automated CPR and an airway circulatory
enhancement adjunct. After 15 minutes with
those therapeutic measures, return of sponta-
neous circulation (ROSC) was achieved and
she was transferred to St. Cloud Hospital
for advanced care, which included therapeutic
hypothermia. Several days later, Bailey woke
up—in time to get home for Christmas with
Bailey received the Take Heart America
(THA) “Bundle of Care,” 1 and that saved
her life. (See Figure 1.) All the elements of
the THA Bundle of Care are recommended
by the American Heart Association (AHA)
and International Liaison Committee on
Resuscitation (ILCOR) when THA was first
described 12 years ago.
As clinicians and EMS providers, we treat
patients like Bailey on a daily basis. Unfortunately, the kind of care she received—the best
care—is often denied due to limited resources.
In fact, little is known about the real economic impact of out-of-hospital cardiac arrest
(OHCA) and true cost of optimal care.
In this article, we look at the economic
impact of OHCA in two terms: 1) cost to
society for lives lost; and 2) cost to society
to save more lives. We provide recommen-
dations for reducing the economic burden
and improving survival outcomes—all based
upon the experience of the THA Cardiac
We often use the cost associated with the
best care as an excuse not to provide care. The
cost to provide the best OHCA care is relatively low compared to the other ways we use
our public resources and health care dollars.
We hope you can use this analysis to obtain
the resources you need and to optimize care
for your patients.
To examine the costs of OHCA, we took a
similar approach to the way the U.S. Department of Transportation (DOT) examined
the economic burden associated with automobile deaths.
The DOT estimated the economic impact
of loss of life from each car accident based
on direct costs (e.g., EMS, medical care and
rehab) and indirect costs (e.g., lost wages, loss
of productivity, employer earnings and taxes).
In 2010, there were 32,000 motor vehicle
deaths in the U.S. The combined direct and
indirect economic burden from automobile
accidents is approximately $870 billion. 2
To calculate the economic impact of
the more than 300,000 OHCAs that
occur in the U.S. each year, we categorized
direct costs as expenses for EMS and in-hospital care. The indirect costs, following the
examples of motor vehicle deaths, included
lost income, employers’ losses, quality of life
and costs associated with a poorer quality
We used the costs associated with what’s
Figure 1: The Take Heart America Bundle of Care