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WWW.JEMS.COM DECEMBER 2017 | JEMS 25
their level of functioning. For instance, it’s
estimated that the chance of surviving an
out-of-hospital cardiac arrest is reduced by
10% per each minute the use of a defibrillator is delayed. 3
The latest results show that Norway’s
EMS response in urban areas is 17 minutes—
still five minutes away from the 12-min-
ute goal. In rural areas of the country, EMS
response time is 32 minutes, which is 7 minutes later than the 25-minute target.
Making these results public has resulted in
increased focus on EMS as well as increased
discussion and debate in both the Norwegian
health service organizations and the media.
Though EMS hasn’t yet met their goals,
the trend is promising, with response times
decreasing for high-acuity calls in both urban
and rural areas.
We’ve developed quality indicators that
are telling us more about the quality of care
and outcome for patients treated by EMS.
These quality indicators highlight just one
BYSTANDER CPR & ROSC
part of a complex course of patient treatment,
In order to have more data available to
measure and evaluate quality indicators, we’re
working on establishing quality medical reg-
istries of prehospital services and implement-
ing national electronic healthcare patient
records for our ambulance services. Fortu-
nately, the Norwegian Cardiac Arrest Regis-
try is already a data provider to the national
quality indicators for this patient group.
There are two quality indicators for cardiac
arrest: bystander CPR and return of spontaneous circulation (ROSC) to hospital.
The first indicator measures the number
of sudden and unexpected out-of-hospital
cardiac arrests where a bystander has started
CPR before EMS arrives on scene.
In Norway, as well as in the rest of the
world, the public plays an important role
in the chain of survival. Minutes count
when cardiac arrest occurs and bystanders
must recognize the situation and call the
emergency number for CPR guidance. The
immediate start of CPR by bystanders has
therefore been made a top priority in Nor-
way and all the Nordic countries.
In Norway, eight out of 10 patients with
cardiac arrest (82.6%) now receive bystander
CPR before EMS arrival.
The second indicator for cardiac arrest
is ROSC to hospital, which measures how
many patients with sudden unexpected cardiac arrest regain a heart rhythm before arriving at a hospital or have regained a heart
rhythm for at least 20 minutes. Results for
this indicator are dependent on the efforts,
interaction and cooperation between the
public and all the actors in the emergency
In Norway, 30% of cardiac arrest patients
are currently resuscitated successfully.
The Nordic collaboration on benchmarking
EMS began in 2014, with a goal to develop