The Cardiac Arrest Support Tier: a service evaluation

AIM: This service evaluation seeks to determine whether the pre-hospital Cardiac Arrest Support Tier (CAST), implemented by a Hazardous Area Response Team (HART), was clinically effective, feasible and acceptable during its pilot year. METHODS: Chest compression feedback, provision of Return of Spontaneous Circulation (ROSC) care and CAST paramedic exposure to Out-of-Hospital Cardiac Arrest (OHCA) were audited. The number of incidents that CAST responded to and the number of staff it committed were also assessed. An online questionnaire was used to gauge acceptability of the project among frontline Ambulance Service Trust staff. RESULTS: CAST attended 178 OHCAs and committed a median of three (IQR 2–3) paramedics to each incident. In comparison to data from both South Western Ambulance Service Foundation Trust (SWASFT) and the National Ambulance Service in England, CAST delivered the full complement of post-ROSC care more frequently during the same period (CAST = 80% vs SWASFT = 68.5% vs England = 77.46%). CAST paramedics had a median exposure to 15.5 (IQR 12–19) OHCAs during the pilot year. Unfortunately, chest compression feedback was unavailable due to ongoing equipment inaccuracies and failure. Additionally 64.6% (n = 42/65) of SWASFT respondents believed CAST to be beneficial to resuscitation attempts, 63.1% (n = 41/65) would like CAST to continue to support resuscitation attempts in the future and 55.6% (n = 35/63) felt supported by CAST staff on scene. CONCLUSION: CAST is logistically feasible, is acceptable to the majority of SWASFT staff and demonstrated the successful delivery of evidence-based practice (EBP) to OHCA incidents.