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.