Post on 07-May-2015
description
Where You Live Shouldn’t Determine If You Live:
EMS Strategies for Cardiac Arrest Survival
Monday May 21st 1 pm EDT
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Rod Kimble EMT-P• Sr. Account Manager CPR & ECC
Programs
• 23 yrs in Fire Service and EMS
• Flight Paramedic - HealthNet Aeromedical Services, Morgantown, WV
• Passion in curriculum development and systems of care improvement.
David Hiltz, NREMT-P
• 14 years as Account Manager for CPR & ECC Programs
• Special interest in emergency medicine and resuscitation
• Implementation of AHA initiatives such as Operation Heartbeat and Operation Stroke.
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You Will Learn
• Strategies for increasing survival rates for out-of-hospital cardiac arrest
• AHA programs and products for use by the Emergency Medical Services community
• Development of localized action plan to improve outcomes
Survival Not Optimized
Poll Question
Is the EMS Community best suited for ownershipof localized efforts to improve the system of care and outcomes for Out-of-Hospital CardiacArrest?
Approach to Improving OutcomesMany Systems Ideal System
No Data Data Collected
No Plan Quality Improvement Plan
Fragmented Efforts Holistic Approach
Partially Implemented Guidelines
Fully Implemented Guidelines
A Systems Approach
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IssuesCPR Component Challenges to Improving Quality
Recognition Failure to recognize gasping as sign, unreliable Pulse Detection
Initiation of CPR Low Bystander CPR response Rate, Incorrect Dispatch instructions
Compression Rate Slow compression Rate
Compression Depth Shallow compression Depth
Chest Wall Recoil Rescuer Leaning on Chest
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Issues (cont’d)CPR Component Challenges to Improving Quality
Compression Interruptions Excessive interruptions for pulse check, Ventilations, defibrillation, intubation, IV access, other
Ventilations Ineffective ventilations, prolonged interruptions in compressions , excessive ventilations (especially with airway)
Defibrillation Prolonged time to defibrillator avail, prolonged interruptions in chest compressions pre- and post shocks
Team Performance Delayed rotation, leading to rescuer fatigue and decay in compression quality, poor communication among rescuers leading to unnecessary interruptions in compressions
Guideline Implementation
Guideline Implementation
IMPROVED SURVIVAL
Tale of Two Communities
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Tools and Resources
Heart.org/cprguidelines
Call to Action
Emergency Medical Services should develop localized plans to optimize survival. These plans
will be based on data and address individual links in the chain of survival, as well as all the
links together.
Link 1: Immediate Recognition and Activation
• Failure to recognize gasping • Unreliable pulse detection• Delayed 9-1-1 activation
Tools and Resources
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Call to Action
EMS agencies can access existing print, radio, and video Public Service Announcements to use
in their communities to increase awareness, response and 9-1-1 activation.
Link 2: Early CPR
• Low bystander CPR response rates• Incorrect dispatch instructions
Actual Dispatcher Call
http://www.heart.org/idc/groups/heart-public/@wcm/@ecc/documents/downloadable/ucm_323609.mp3
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Tools and Resources
Call to Action
EMS providers and agencies should use tools such as Hands-Only™ CPR; self-instructional and
certification programs to support community education.
Link 3: Rapid Defibrillation
• Delayed time to defibrillator use• Interruptions in chest compressions pre- and
post-shocks
Tools and Resources
Call to Action
EMS providers and agencies should use tools such as the AED Implementation Guide and
Scientific Statements to support rapid defibrillation
Link 4: Effective ACLS
• Slow compression rate• Shallow compression depth• Rescuer leaning on the chest
Link 4: Effective ACLS
• Compression interruptions• Excessive interruptions for:
Rhythm/Pulse Checks, Ventilations, Defibrillation,Intubation, and Intravenous Access
Iterative Process
Appropriate education
G2010 Evidence, eLearning
Simulation & frequency of
training
Structured & Supported Debriefing
Competency
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Feedback and Debriefing
• Provider focused• Assist in improving
performance• Improved adherence
to Guidelines• Higher rate of ROSC
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Tools and Resources
Maintenance of Competency
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• Emerging trends supporting continuous maintenance of competence • Evidence that basic and advanced life support skills decay rapidly
• Optimal mechanism for maintenance of competence is not known
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CPR Fractions
Call to Action
EMS providers and agencies should practice resuscitation skills and team performance,
incorporating the measuring of CPR fractions and debriefing as methods for
improving quality and outcomes.
Link 5: Post-Cardiac Arrest Care
• Therapeutic Hypothermia• Post ROSC 12-lead ECG• Transport to Cardiac Arrest Center
Tools and ResourcesPart 9: Post Cardiac Arrest Care: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
Regional Systems of Care for Out-of-Hospital Cardiac Arrest: A Policy Statement From the American Heart Association.
Call to Action
EMS providers and agencies are integral to the advancement of post resuscitation care and
evolving systems of care. The importance of your role at all levels of
implementation is immeasurable.
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The Next best thing to preventing Sudden Cardiac Arrest: PREPARING FOR IT!
Mission: Lifeline and Cardiac Arrest Systems of Care
www.heart.org/missionlifeline
Summary
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Questions and Answers
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THANK YOU!
AppendixYou’re the CureYou don't have to be a lobbyist to call on lawmakers - just an advocate passionate about heart and stroke issues. In just a few moments, you can make a huge difference. We'll make it easy for you to email, phone or even visit your legislators. And we'll keep you informed on the progress you're making as one of the very important voices for the cure. http://www.heart.org/HEARTORG/Advocate/ActionCenter/Action-Center_UCM_001134_SubHomePage.jsp
http://www.resuscitationacademy.com/index.php/resources/registry/
Importance and Implementation of Training in Cardiopulmonary Resuscitation and Automated External Defibrillation in SchoolsA Science Advisory From the American Heart Associationhttp://circ.ahajournals.org/content/123/6/691.full.pdf
Response to Cardiac Arrest and Selected Life-Threatening Medical EmergenciesThe Medical Emergency Response Plan for SchoolsA Statement for Healthcare Providers, Policymakers, School Administrators, and Community Leaders http://www.heart.org/idc/groups/heartpublic/@wcm/@ecc/documents/downloadable/ucm_425826.pdf
Debriefing and Cardiac Arrest Quality Improvement — Document http://www.slideshare.net/Hiltz/debriefing-and-cardiac-arrest-quality-improvement-8692570
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CPR and ECC ScienceRead more about 2010 AHA Guidelines and Statements. http://www.heart.org/HEARTORG/CPRAndECC/Science/Science_UCM_001125_SubHomePage.jsp
Emergency Medical Service Dispatch Cardiopulmonary Resuscitation Prearrival Instructions to Improve Survival From Out-of-Hospital Cardiac Arrest A Scientific Statement From the American Heart Associationhttp://circ.ahajournals.org/content/early/2012/01/09/CIR.0b013e31823ee5fc
How EMS Systems are Changing for the better http://www.ems1.com/cardiac-care/articles/1210274-How-EMS-systems-are-changing-for-the-better/
Law Enforcement Role in Response to Sudden Cardiac Arrest — Presentationhttp://www.slideshare.net/Hiltz/law-enforcement-role-in-response-to-sudden-cardiac-arrest
Opportunity for law enforcement agencies to save lives — Document Transcript http://www.slideshare.net/Hiltz/opportunity-for-law-enforcement-agencies-to-save-lives
Reducing Barriers for Implementation of Bystander-Initiated Cardiopulmonary ResuscitationA Scientific Statement From the American Heart Association for Healthcare Providers, Policymakers, and Community Leaders Regarding the Effectiveness of Cardiopulmonary Resuscitationhttp://circ.ahajournals.org/cgi/content/extract/117/5/704
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LAW ENFORCEMENT AGENCY DEFIBRILLATION (LEA-D):POSITION STATEMENT AND BEST PRACTICES RECOMMENDATIONS FROM THE NATIONAL CENTER FOR EARLY DEFIBRILLATION http://www.naemsp.org/pdf/lead.pdf Medical Emergency Response Planning Schools — Presentation http://www.slideshare.net/Hiltz/medical-emergency-response-planning-schools Medical Emergency Response Planning Schools — Podcast http://ems12lead.com/2011/10/aeds-and-emergency-response-plans-in-schools-syncope-and-sudden-death-in-student-athletes-part-3-ems-12-lead-podcast-episode-3-monica-kleinman-m-d/
Regional Systems of Care for Out-of-Hospital Cardiac ArrestA Policy Statement From the American Heart Associationhttp://circ.ahajournals.org/cgi/content/abstract/121/5/709
Q & A Medical Emergency Response Plan for Schools (MERPS)
Medical Emergency Response Plan for Schools (MERPS) Sample Plan One
Medical Emergency Response Plan for Schools (MERPS) Sample Plan Two
CPR Statistics - CPR & Sudden Cardiac Arrest (SCA)
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