With the advent of increased research regulations, the concept of the save pin had largely become forgotten as research agencies struggled to obtain patient outcomes for patients who sustained OHCA outside the context of an REB approved research project. Sunnybrook Base Hospital, as part of the Canadian Resuscitation Outcomes Consortium nationally and the Resuscitation Research Repository (R3) research group locally, is now able to provide to all services outcome data on an aggregate basis (Survival from OHCA in Peel Region is X %) but not able to provide outcomes on a patient level basis which is required to provide save pins as we had in the past. Paramedics have universally communicated their desire to me for a return of some form of a save pin program.
SURVIVAL TO HOSPITAL ADMISSION AS A MARKER FOR PREHOSPITAL OHCA CARE?
In the world of prehospital research, there is a growing body of evidence that suggests that from a paramedic point of view, the ultimate goal is obtaining a return of spontaneous circulation (ROSC) and maintaining that ROSC until emergency department arrival and admission to hospital. The logic is actually quite simple. Paramedics can only control the care they provide in the prehospital environment and factors such as provision of angiography and PCI or the provision of targeted temperature management, often times essential to patient survival, is beyond the control of the paramedic and as such survival to hospital discharge may not, in fact be the best marker of paramedic resuscitation. The outcome of survival to hospital admission is an outcome that can be provided to all services (and their paramedics) via CanROC and R3 databases.
THE NEW SAVE PIN PROGRAM FOR SURVIVAL TO HOSPITAL ADMISSION
Starting with data from the 2023 calendar year a new save pin program will be unveiled that will recognize the excellent work of paramedics who are able to obtain ROSC in the field and maintain ROSC to hospital arrival and admission. Given the fact that ROSC will be much more common than survival to hospital discharge there is the potential that some paramedics would receive a fairly large number of save pins which would be a slightly cumbersome process. As such, we are proposing a certificate to go along with the save pin. The certificate will document the number of “saves” the paramedic had over the calendar year.
CREATING THE SAVE PINS AND CERTIFICATES
We would as well like to hold a contest for paramedics to create both the save pin and the certificate. Please send all certificate and save pin designs to Courtney.Troung@unityhealth.to. Once we have received all the certificate and save pin designs, we will send them out to all paramedics to vote on their favourite design which will then be used for all certificates and pins for all our services. The deadline for designs of both the certificate and save pins will be July 15, 2024.
CONSENSUS AND DISTRIBUTION OF SAVE PINS
The revised save pin concept has been presented to all Sunnybrook Base Hospital Utilization Committees as well as at our Base Hospital Program Committee and has been enthusiastically endorsed. While the CanROC/R3 research group will provide the data to each service, it will be the services decision as to how to distribute the save pins to their respective paramedics.
In closing, the revised save pin program provides an exciting opportunity for services to recognize paramedics for their exceptional work in the care of patients sustaining OHCA. While it may not have quite the same appeal as save pins for survival to hospital discharge, it will more accurately reflect the care paramedics actually provide. It is my hope that paramedics embrace the concept moving forward.
Yours Truly,
(Original signed by)
Dr. Sheldon Cheskes, MD, CCFP (EM), FCFP DRCPSC
Medical Director, Sunnybrook Centre for Prehospital Medicine,
Regions of Halton and Peel
Professor, Department of Family and Community Medicine,
Division of Emergency Medicine, University of Toronto
Principal Investigator, Canadian Resuscitation Outcomes Consortium
Sodium bicarbonate will be available in pre-packaged kits to include: 
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