BMJ Emergency Medicine Team of The Year Finalist - Resuscitation Rapid Response Unit

BMJ Awards 2014

We are proud to announce that The Resuscitation Rapid Response Unit have been shortlisted as a finalist in the BMJ Awards 2014 as Emergency Medicine Team of The Year.
Read on to find out more about the 3RU team.
The BMJ Awards 2014 will take place on the 8th May 2014 at the Park Plaza Hotel, Westminster. We wish our team the best of luck on the night.


The Resuscitation Rapid Response Unit (3RU), Edinburgh

Over 3,500 out-of-hospital cardiac arrests (OHCA) occur in Scotland every year. OHCA is the commonest immediately life-threatening medical emergency that can affect anyone, of any age, at any time. Cardiac arrest leads to a large number of patient deaths, with typically around 5% of patients surviving to hospital discharge. Of those who do survive, some are left with permanent neurological disability. Survival from OHCA depends on the ‘Chain of Survival’ – rapid recognition of cardiac arrest, early bystander CPR, early defibrillation, effective prehospital resuscitation and advanced post-resuscitation care.

In 2007, the Resuscitation Research Group, part of the Emergency Medicine Research Group in Edinburgh, identified the need to improve the chain-of-survival for OHCA patients in south-east Scotland, where the local survival to discharge rate at the time was less than 1%. The national Heartstart Scotland database showed an urgent need to improve outcome from OHCA. The group identified the requirement to improve all elements of the local chain of survival in order to save lives.  Following on from the initial TOPCAT study on OHCA, the team identified a unique opportunity to dramatically improve the quality of prehospital resuscitation practice, through defibrillator downloads, resuscitation feedback, simulation training and through the creation of the unique Resuscitation Rapid Response Unit (3RU).

The 3RU team led by Dr Gareth Clegg, Resuscitation Research Group lead,  consists of two doctors, 13 paramedics, a resuscitation officer, a research nurse and several medical students. The team volunteers to meet on a bi-weekly basis in their own time to maintain a high level of enthusiasm.

The team regularly visits the regional ambulance control centre, to ensure awareness of cardiac arrest is high. The team is collaborating with Psychologists from Edinburgh University, analysing original 999 calls in order to improve the uptake of telephone-assisted CPR.

The team was the first in the UK to pioneer a unique system of defibrillator data download and resuscitation feedback. Following every cardiac arrest, detailed resuscitation quality data is captured. The data is analysed and individually fed back to the attending ambulance crew so performance can be continually improved.

The team meets in the clinical simulation centre to undertake advanced resuscitation skills training, which is open to any paramedic. This not only includes technical skill practice but all non-technical skills such as resuscitation team leadership, communication and decision-making. Video analysis is used to ensure the highest quality standards are met.

The 3RU team is now using a mechanical CPR device and prehospital video recording in order to provide the highest possible care and inform future development needs. The overall aim is to improve outcome from OHCA, directly saving lives.

The Resuscitation Research Group has made a direct impact on the number of patients now surviving out-of-hospital cardiac arrest in Edinburgh. In 2007, the survival rate from OHCA in south-east Scotland was 0.7% and is now consistently over 17%. In 2013, 24% of all OHCA in Edinburgh were discharged neurologically intact from hospital. This extraordinary improvement in survival rate translates into hundreds of patients who would otherwise have died, returning home to their families. Many of the survivors have visited the 3RU team and maintain close relations with the paramedics who saved them. Not only have hundreds of lives been saved but the burden of neurological disability has been substantially reduced.

The Scottish Ambulance Service is now exploring mean of rolling out the 3RU programme across the country and if the success can be replicated, over 300 additional lives per year will be saved.

The Edinburgh 3RU team are now gaining both national and international recognition for their contribution to resuscitation science. The team’s practical approach to local ‘Chain of survival’ improvement, coupled with the dramatic improvement in survival has gained the attention of emergency medical services across the UK and further afield.

The team has published extensively in the medical literature on resuscitation physiology, therapeutic hypothermia, dispatch and bystander CPR. They are always keen to share their protocols and have reported on the creation of the 3RU project in the hope of inspiring others. They have published their important clinical finding that defibrillator download, analysis and feedback can substantially improve quality of resuscitation.

The most recent addition to the team’s portfolio of innovation is the ‘Pavement-to-PCI’ pathway. For patients who suffer refractory out-of-hospital cardiac arrest as a result of acute coronary artery occlusion, their only hope of survival is through emergency angiography, or percutaneous coronary intervention (PCI). The Pavement-to-PCI pathway is a truly novel concept used by the 3RU team to rapidly transport patients in refractory cardiac arrest using mechanical CPR.

Survival from OHCA in Edinburgh and is now consistently the highest in the country and amongst the highest in the UK.

The 3RU team is always keen to share their passion for saving lives. Ambulance services from Wales, East Midlands, the North East and the South East coast have all visited Edinburgh, with many now poised to adopt their own resuscitation improvement programs based on the Edinburgh-model. The group has attracted attention internationally, winning the leading research prize at the European Resuscitation Council meeting in Vienna and have recently been approached by ambulance services in North America who are keen to replicate the Edinburgh success. 

The team is truly multi-disciplinary with doctors, dispatchers, medical students, nurses, paramedics and resuscitation officers all having input and each individual has designated responsibilities within the team. Hospital clinicians now work in the prehospital environment and vice-versa as a fully integrated team.

The team work in close collaboration with the Emergency Department at Edinburgh Royal Infirmary, Scottish Ambulance Service, as well as the Critical Care and Cardiology Units. The team always warmly welcome visitors to their team meetings to improve collaborative working and share their passion for saving lives. The team also work closely with local charities such as Chest, Heart and Stroke Scotland, never hesitating to use their success stories in presentations, newsletters and press releases to promote awareness of cardiac arrest and support charity work and fundraising. The team also work closely with industry partners aiming to improve resuscitation technology.