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43 Global resuscitation alliance utstein recommendations for developing emergency medical services systems to improve cardiac arrest survival
  1. N Gayathri1,
  2. L Tiah2,
  3. AFW Ho3,
  4. A Ajaz4,
  5. HM Ohn5,
  6. KD Wong6,
  7. LA Wallis7,
  8. BS Leong8,
  9. F Lippert9,
  10. M Castren10,
  11. MHM Ma11,
  12. MJ El Sayed12,
  13. PP Pek1,
  14. J Overton13,
  15. S Perret14,
  16. T Hara15,
  17. YY Ng16,
  18. MEH Ong17
  1. 1Singapore General Hospital, Department of Emergency Medicine, Singapore
  2. 2Changi General Hospital, Accident and Emergency Department, Singapore
  3. 3Singhealth Emergency Medicine Residency, Singapore
  4. 4Addis Ababa University School of Medicine, Department of Emergency Medicine, Ethiopia
  5. 5Parami General Hospital, Emergency Department, Yangon, Myanmar
  6. 6Hospital Pulau Pinang, Emergency and Trauma Department, George Town, Penang, Malaysia
  7. 7University of Cape Town, Division of Emergency Medicine, CapeTown, South Africa
  8. 8National University Hospital, Emergency Medicine Department, Singapore
  9. 9University of Copenhagen, Emergency Medical Services Copenhagen, Copenhagen, Denmark
  10. 10Karolinska Institutet, Department of Clinical Science and Education, Stockholm, Sweden; University of Helsinki and Helsinki University Hospital, Department of Emergency Medicine and Services, Helsinki, Finland
  11. 11College of Medicine, National Taiwan University, Department of Emergency Medicine, Taipei, Taiwan
  12. 12American University of Beirut Medical Centre, Department of Emergency Medicine, Beirut, Lebanon
  13. 13International Academies of Emergency Dispatch, Salt Lake City, Utah, USA
  14. 14Vientiane Rescue, Vientiane, Laos
  15. 15Graduate School, Kokushikan University, Department of EMS System, Tokyo, Japan
  16. 16Singapore Civil Defence Force, Singapore
  17. 17Singapore General Hospital, Department of Emergency Medicine, Singapore; Duke-NUS Medical School, Health Services and Systems Research, Duke-NUS Medical School, Singapore


Aim The Global Resuscitation Alliance (GRA) 10 steps were established in 2015 to improve survival for Out-of-Hospital Cardiac Arrest (OHCA). However, these 10 steps were recommended mainly for developed Emergency Medical Services (EMS) systems and implementing these steps can be challenging for developing EMS systems. We aimed to explore barriers faced by developing EMS systems and to establish pre-requisites needed to improve survival. We also developed a framework for developing EMS systems to build their emergency response capability.

Method A consensus meeting was called in Singapore on 1 st and 2nd August 2017. There were 74 participants who were key stakeholders from 26 countries including EMS directors, physicians and academics. The group was subdivided into 4 groups to represent the chain of survival- community, dispatch, ambulance and hospital, with a separate group on perinatal resuscitation. Pertinent questions were given to the group for discussion, following which their answers were presented and voted upon to reach a consensus.

Results Each group’s discussion points were used to construct the modified survival framework and create 11 key statements to describe the pre-requisites for achieving the GRA 10 steps. The participants then voted on the importance and feasibility of these 11 statements as well as the GRA 10 steps.

Conclusion In this paper, we propose a modified framework of survival for developing EMS systems. There are barriers for developing EMS systems to improve OHCA survival rates. These barriers may be overcome by systematic prioritisation and cost effective innovative solutions.

Conflict of interest None

Funding The consensus meeting was support by the Laerdal Foundation grant, grant no: 50 005

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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