TOPCAT2: an expert response to out-of-hospital cardiac arrest

Improved quality of pre-hospital resuscitation in out-of-hospital cardiac arrest (OHCA) in Edinburgh, Scotland has been accomplished, in part, through the introduction of resuscitation team leadership supported by a programme of audit, feedback and training for ambulance crews (Lyon et al, 2012).

Building on previous work, the TOPCAT2 study aimed to demonstrate the feasibility of establishing a second tier, expert paramedic response to support crews in managing OHCAs in Edinburgh.

Identified as a service improvement evaluation, TOPCAT2 provided an unspecified length of training for eight paramedics in both technical (cardiopulmonary resuscitation and defibrillation skills) and non-technical skills, including teamwork and communication. Training sessions incorporated refreshers in advanced life support skills, as well as seminar sessions combined with simulation and video recording to facilitate debriefing and subsequent development of non-technical skills.

The participating paramedics were selected based on their regular attendance at voluntary OHCA education sessions and performance during simulated OHCA, but there is no reference in this paper to their length of service, training or experience. The paramedics worked on Rapid Response Units, one for each shift during the three month pilot, and were preferentially tasked to suspected OHCA calls.