Can college campuses act as springboards for the advancement of chain of survival priorities?
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Transcript of Can college campuses act as springboards for the advancement of chain of survival priorities?
Can college campuses act as springboards for the
advancement of chain of survival priorities?
15th Annual National Collegiate EMS Foundation Conference
Philadelphia, PAMarch 2, 2008
Objectives Review current evidence based guidelines and recommendations.
Describe how a population and criteria based incentive program has been used to advance chain of survival priorities on college campuses.
Discuss the role of college based EMS agencies in advancing lifesaving priorities.
Explore the possibilities of widespread CPR education on college campuses using CPR Anytime.
Provide an opportunity for additional dialog and collaboration between the AHA, NCEMSF, and other stakeholders.
Guidelines 2005 International Consensus on Cardiopulmonary Resuscitation
(CPR) and Emergency Cardiovascular Care (ECC) Science with Treatment Recommendations (CoSTR)
Scientific consensus of experts from a variety of countries, cultures and disciplines.
Recognized experts were brought together by the International Liaison Committee on Resuscitation (ILCOR) to evaluate and form an expert consensus on all peer reviewed scientific studies related to CPR and ECC.
1974
1980
1986
1992
2000
2005
What’s New and Why
These changes are presented because they have the potential to impact specific actions taken byyou on scene or the protocols for treatmentand operations that are used in your particularEMS system.
Basic Focal Points
The 2005 Guidelines place great emphasis on Improving the quality
of CPR delivered by all providers
Increasing the chance that a cardiac arrest victim will receive bystander CPR
BLS Changes
Providing high-quality CPR with special attention to chest compression depth and rate, permitting complete chest wall recoil and minimal interruptions to compressions.
All rescuers acting alone should use a 30:2 ratio of
compressions-toventilations for all victims
except newborns.
BLS Changes
Avoid over-ventilation: too many breathsper minute or breaths that are too largeor too forceful.
Avoid death through hyperventilation!
BLS Changes
When two or more health-care providersare present during CPR, rescuers shouldrotate the compressor role every twominutes.
Rescuers fatigue before they tire. Switch often.
BLS Changes
Ventricular fibrillation (VF) cardiac arrest, use a single shock, followed by immediate CPR for two minutes, starting with compressions first.
Use a single shock.
Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.
BLS Changes
For adult out-of-hospital cardiac arrest that is not witnessed by the EMS provider, rescuers may give a period of CPR (about two minutes) before checking the rhythm and attempting defibrillation. This requires protocol
development.
Early Defibrillation Strategies
Campus Police
ACLS Changes
Do QUALITY CPR!
ACLS Changes Recommended use of endotracheal (ET)
intubation is limited to providers withadequate training and opportunities topractice or perform intubations.
Confirmation of ET tube placementrequires both clinical assessment anduse of a device.
ACLS Changes
Organize care to minimize interruptionsin chest compressions for rhythm check, shock delivery, advanced airway insertion orvascular access.
Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.
ACLS Changes
Pictures and images are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.
Gadgets
Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.
To Cool is to be Cool
Unconscious adult patients with spontaneous circulation after out-of-hospital cardiac arrest
should be cooled to 32°C to 34°C for 12 to 24 hours when the initial rhythm was ventricular fibrillation
(VF).
Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.
No Ventilation CPR?
NO Guideline change at this time!
So Far We Know… Do quality BLS! Do not over-ventilate! Switch compressors! Single shock Organize care Value of 12 lead Technology Cooling beneficial
Increasing the Chances that a Cardiac Arrest Victim Will Receive Bystander CPR
70-80% SCA in and around home Less than 1/3 get CPR before EMS Fewer still get quality CPR Time to intervention and survival relationship
is well established
Sudden Cardiac Arrest by Location
0%
10%
20%
30%
40%
50%
60%
70%
80%
1
Patient Residence
Public Place
Health Care Facility
Business/Industry
Other Residence
Other
Traffic <55mph
Traffic 55+mph
EducationResidence is most common
location!
Can’t Get There in Time
OPALS Studies and OPALS Cardiac Arrest Database [OCAD]
Phase I demonstrated the importance of bystander CPR in patient survival in 4,690 patients.
Phase II demonstrated, in an additional 1,641 patients, that the inexpensive optimization of an existing defibrillation program could lead to significant improvements in survival.
Phase III, 36 months with a full ALS paramedic program, enrolled an additional 4,247 patients and showed no incremental benefit in survival from ALS but was the first study to quantify the importance of the links in the cardiac arrest chain of survival.
So Now What?
Recommendations “Community Coronary Care Units” Organized response to emergencies EMD Citizen CPR Early defibrillation Effective BLS and ACLS Early detection of ACS Early definitive intervention
HEARTSafe Community
A population and criteria based incentive program designed to advance systems change and chain of survival priorities.
HEARTSafe
MIT"It is the story of how the vision of a hard-working engineering student, then alum, ignited fellow students, alumni, faculty and staff around the goal of ready access to life-saving care on campus"
HEARTSafe Community
Lobby to become a HEARTSafe Campus in FL, MA, NH, CT, and ME.
Explore possibilities of creating a similar program?
And Now We Also Know…
How a population and criteria based incentive program has been used to advance chain of survival priorities on college campuses.
Can College Based EMS Agencies Advance Lifesaving Priorities?
Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.
Why?
How? Quality Training Quality Care Development of Good Habits, Early Future Leaders INFLUENCE CAMPUS
and COMMUNITY MENTALITY and BEHAVIOR
CPR and Behavioral Change Commercial marketing expensive and often
ineffective Social marketing experience is good Incentive change methods offer a less
expensive option
CPR Issues Multiple barriers Time limitations Costs Manpower Engagement Relevance
Best ROI
The BIG Questions How can we get large numbers of people to
learn CPR? How can we encourage
people to be willing to perform CPR?
Traditional CPR 2-hour course
3 (+/-) students/manikin
6 (+/-) students/instructor
Students get minimal skills practice
Can be logistically difficult for students and instructor
Reasons to Create a More User Friendly Method
Reduce course time to increase participation
Reduce reliance on an instructor to increase training availability and efficiency (facilitators do not need to be certified instructors)
Use a video self-instructional format to make home use possible
A simpler and friendlier presentation to increase trainee self-confidence
Family & Friends CPR Anytime: Self-directed Training
for the Community A personal, inflatable CPR
manikin, “Mini Anne”
An American Heart Association Family & Friends™ CPR booklet
CPR Skills Practice DVD
Accessories for the program
The Multiplier Effect
Even when individuals use the CPR Anytime products in a group setting, they are given their kit to share with others at home
Some programs have reported an average of more than 3 additional users per kit!
Efficacy of CPR Anytime
CPR Anytime trainees “tended to have better overall performance” than did those who were traditionally trained
in a two-hour CPR courseResuscitation 67 (2005) 31–43
Retention of CPR Skills using CPR Anytime
Retention of basic skills is as high for this shortened program as it is for traditional training courses
Since the people are able to keep the training kit, they can conveniently refresh their skills at will
Doing it BIG
Passion…
Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.
Wrap Improving the quality of CPR delivered
by all providers Increasing the chance that a cardiac
arrest victim will receive bystander CPR
Questions Are you “connected” with the AHA? Is there room for expanding your agencies
“footprint” on campus? Does widespread CPR “fit” with performance
improvement, recruiting, and other efforts? Are you satisfied with “status quo”?
Parting Message
Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers.