Orchestrating better outcomes for cardiac arrest emergencies

9/1/2022 1:44:00 PM | Tomorrow's Medicine

The article is contributed/written by

Two decades ago, a young doctor set his sights on making a difference in out-of-hospital cardiac arrest (OHCA) care and embarked on a journey to further develop Singapore’s pre-emergency care model.

The first ten minutes after a cardiac arrest are crucial to the outcomes for cardiac arrest patients, with survival rates dropping ten per cent every minute after a collapse. With up to 3,000 local cardiac arrest occurrences annually, the fatality count quickly adds up unless bystanders and those in the community have the willingness, knowledge and skills to perform life-saving care. This realisation struck Prof Marcus Ong when he was a young physician at the Singapore General Hospital’s (SGH) Department of Emergency Medicine.

Today, Prof Ong is a Senior Consultant, Clinician Scientist, and Director of Singapore’s first Pre-hospital and Emergency Research Centre (PERC), launched by the SingHealth Duke-NUS Academic Medical Centre (AMC) in 2020.

“I wanted to make a difference and help people by bridging care gaps, addressing issues with solutions and building something sustainable beyond my lifetime. It was also important to me to engage the community in forming solutions to support a healthier population,” shared Prof Ong on why he joined medicine.

His passionate search for answers armed him with clinical and research expertise in Pre-hospital Emergency Care (PEC), emergency medicine, and Health Services Research (HSR). He has also pioneered research in these areas over the last two decades, many of which have been implemented into policies, increasing the survival of OHCA patients from two percent to over 26 percent.

Playing our part

“Singapore is very good at educational literacy, and now is the time to enhance our community’s health literacy,” he shared.

To address this, Prof Ong and his colleagues spearheaded the conceptualisation and implementation of the MyResponder mobile application upon noticing the effectiveness of crowdsourcing applications like Waze, which offers real-time information on traffic conditions as reported by members of the public. Today, anyone with a mobile phone can download MyResponder and be a community first responder, increasing the possibility of positive outcomes for OHCA patients.

Another initiative Prof Ong’s team initiated is the Dispatcher-Assisted first Responder (DARE) programme, which complements MyResponder and equips members of the community with knowledge on how to work closely with emergency services on the phone to assist collapsed patients, locate the nearest automated external defibrillator (AED) and perform cardiopulmonary resuscitation (CPR) correctly.

The 45-minute DARE programme is now presented in primary and secondary schools during physical education lessons, and an educational book for preschool children has been published.

“We hope to train a new generation of students equipped with life-saving skills. With our ageing population, this is part of the greater goal to empower our community to play important roles in emergency care services for the future,” Prof Ong said.

Building an emergency care model for the future

The healthcare landscape in Singapore is ever-changing with evolving patterns of disease. To meet these changes, a new sustainable model of care beyond the traditional linear emergency care system – one that translates research into public health policies – is required.

“Our typical patient entering the emergency room today is 70 to 80 years old and with multiple health issues,” he said. “It will require the implementation of alternate care pathways to address choke points of the existing uni-directional care system, such as ambulance demand and patient bed numbers.”

“We may encounter patients with diabetes, high blood pressure, who are living alone or have issues with home care,” Prof Ong elaborated.

“There are no simple solutions and will require a team of health professionals such as general practitioners, community nurses, medical social workers, mental health nurses, psychologists or psychiatrists in the community to address care of our current population.”

“The demographics of our population have changed, and our care has to reflect that to address patient and system needs by moving towards home-based multidisciplinary care.”

The establishment of PERC was the culmination of Prof Ong’s search for formalised pre-hospital and emergency care research programmes under one roof, bridging research, policy-making and implementation into improved outcomes for our population.

“We are now building a group of people that are committed to the same vision in pre-hospital and emergency care, and investing in young researchers and doctors to sustain our direction for a healthier Singapore well into the future,” Prof Ong said.

“The final step is to successfully communicate this to our community at large, to encourage a culture and environment where we are prepared and confident in performing life-saving care whenever cardiac arrest or emergencies occur in a public space.”