'Coolest car in London' saves lives
The "Cool Car" brings hospital expertise right to the scene of emergencies. Overall just 9% of cardiac arrest victims in the UK survive long enough to leave hospital. This new approach could dramatically boost that figure.
A navy blue Skoda with green and yellow stripes might not sound like the coolest car in the capital - but this one might save your life.
Run by London's Air Ambulance, it gets its name from the innovative system it carries to cool patients down, which may reduce brain damage after cardiac arrest.
A call comes over the radio from the ambulance control room and the Cool Car revs into action.
"We're going to a man who's collapsed," announces intensive care specialist Dr Marius Rehn.
Critical care paramedic and driver Bill Leaning sounds the siren and accelerates away.
The work is "extremely time critical", explains Dr Rehn. When the heart stops every second counts - just three minutes without bloodflow to the brain can cause permanent damage.
"It's this massive climax where you have all these split second decisions going on all the time… it's really difficult."
On arrival, the Cool Car team work with local paramedics to resuscitate the patient. From the car boot they unload advanced equipment including the cooling system.
Cooling the body to 32C-36C (below the "normal" 37C) is known as therapeutic hypothermia and has been shown to reduce brain damage following cardiac arrest.
This may be partly because a colder brain has a slower metabolism, meaning it needs less oxygen to survive.
It is practised in hospital intensive care units, but by taking the innovative technique directly to the scene, the Cool Car team save vital minutes and seconds.
The team use external cooling packs placed on the armpits and groin, and up to two litres of 4C saline fluid delivered direct into the veins.
Figures show a selected group of patients treated by the Cool Car and taken directly to a specialist heart hospital had up to 48% survival of cardiac arrest.
Overall just 9% of the 60,000 cardiac arrests attended each year by ambulance services lead to survival and subsequent discharge from hospital.
The cooling technique is not the only trick up the team's sleeve, though.
They also carry an automated chest compression device, which measures chest size and resistance, to deliver optimum cardiopulmonary resuscitation (CPR) without interruptions.
And the expertise of the team means they can offer supportive care to help with pain and breathing, and specialist treatments like clot-busting drugs, all at the scene of the emergency.
So is the Cool Car the future of emergency medicine, or are other factors just as important?
With survival so poor, and events in the first minutes and hours so critical, experts have started to question what more can be done for cardiac arrest patients before getting to hospital.
Jonathan Benger is professor of emergency care at the University of the West of England, and believes a new approach is needed.
"To some extent we've kind of done the same thing for a long time," explained Prof Benger.
"It's not just about transport to hospital, it's about excellent treatment at the scene and other options. What we need to do is empower paramedics to make good decisions and not get too bound up with the traditional idea that the hospital is the answer."
But excellent treatment at the scene begins even before the experts arrive - with the public.
Paramedics aim to get to cardiac arrest calls within eight minutes, but as emergency medicine consultant Dr Gareth Grier explains: "If someone's in cardiac arrest you haven't got eight minutes - you've got three minutes before their brain dies."
It is therefore vital that bystanders start CPR before the ambulance arrives.
Other hi-tech ideas that are being brought out of hospitals and on to the streets include the VA-ECMO (ventricular assist extracorporeal membrane oxygenation), in which oxygen is added to the blood outside the body - effectively a heart-lung bypass machine.
Evidence shows it can save lives in those cases of cardiac arrest that do not respond to CPR, and it is being trialled by the Paris ambulance service.
Another innovation, aimed at the public, is the GoodSAM smartphone app, which locates nearby defibrillators and alerts passing first aiders to medical emergencies.
But it is not just the new "sexy" techniques that will make the difference, says Dr Grier.
It is also about "doing what we do already, but doing it better".
Prof Benger agrees.
"The challenge is to deliver the very, very best care that we can, consistently, and challenge the received dogma which can sometimes slow us down."