Where you live Shouldn t Determine If You live: EMS Strategies for Cardiac Arrest Survival

Transcription

1 Where you live Shouldn t Determine If You live: EMS Strategies for Cardiac Arrest Survival 1 1

2 Rod Kimble EMT-P Sr. Account Manager CPR & ECC Programs 23 yrsin Fire Service and EMS Flight Paramedic with HealthNet Aeromedical Services, Morgantown, WV Passion lies within curriculum development and systems of care improvement. 2

3 David Hiltz, NREMT-P 14 years as Account Manager for CPR & ECC Programs Special interest in emergency medicine and resuscitation Implementation of numerous AHA initiatives such as Operation Heartbeat and Operation Stroke. 3

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5 Webcast Objectives Evidence based strategies for improving survival from out of hospital cardiac arrest AHA programs and products for use by the Emergency Medical Services community How to develop a localized action plan to improve outcomes 5

6 Despite Decades of Effort Survival Not Optimized 6

7 Poll Question Is the EMS Community best suited for ownership oflocalized efforts to improve the system of care and outcomes for OOH SCA? 7

8 Approach to Improving Outcomes Many Systems No Data No Plan Ideal System Data Collected QualityImprovement Plan Fragmented Efforts Partially Implemented Guidelines Holistic Approach Fully Implemented Guidelines 8

9 A Systems Approach 9 9

10 Issues: CPR Component Challenges to Improving Quality Recognition Initiation of CPR Compression Rate Failure to recognize gasping as sign, unreliable Pulse Detection LowBystander CPR response Rate, Incorrect Dispatch instructions Slow compression Rate Compression Depth Shallow compression Depth Chest Wall Recoil Rescuer Leaning on Chest 10 10

11 CPR Component CompressionInterruptions Issues: cont d Challenges to Improving Quality Excessive interruptionsfor pulse check, Ventilations, defibrillation, intubation, IV access, other Ventilations Defibrillation Team Performance Ineffectiveventilations, prolonged interruptions in compressions, excessive ventilations (esp with airway) Prolonged time to defibrillate avail, prolonged interruptionsin chest compressions pre-and post shocks Delayedrotation, leading to rescuer fatigue and decay in compression quality, poor communication among rescuers leading to unnecessary interruptions in compressions 11 11

12 Guideline Implementation 12

13 Guideline Implementation IMPROVED SURVIVAL 13

14 Tale of Two Communities 14 14

15 Tools and Resources 15

16 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. 16

17 Link 1: Immediate Recognition and Activation Failure to recognize gasping as sign Unreliable pulse detection Failure to recognize early warning signs of ACS Delayed activation 17

18 Tools and Resources >>insert banner from ceannouncements/public-service- Announcements_UCM_312002_SubHomePage.jsp# << 18

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20 Call to Action EMS agencies can access existing print, radio, and video Public Service Announcements to use in their own communities and increase awareness, response and Activation. 20

21 Link 2: Early CPR Low bystander CPR response rates Incorrect dispatch instructions 21

22 >>Play audio file<< 22

23 Tools and Resources 23 23

24 Call to Action EMS providers and agencies should use tools such as Hands-Only CPR, self instructional and certification programs designed to support community education. 24

25 Link 3: Rapid Defibrillation Delayed time to defibrillator use Delayed interruptions in chest compressions pre- and post-shocks 25

26 Tools and Resources 26

27 Call to Action EMS providers and agencies should use tools such as the AED Implementation Guide and Scientific Statements designed to support rapid defibrillation. 27

28 Link 4: Effective ACLS Compression rate Slow compression rate Compression depth Shallow compression depth Chest wall recoil Rescuer leaning on the chest 28

29 Link 4: Effective ACLS Compression interruptions Excessive interruptions for: Rhythm/pulse checks-ventilations-defibrillation Intubation-Intravenous Access 29

30 Effective ACLS Appropriate education Simulation and increased frequency of training. MOC discussion G2010 evidence, elearning Structured and Supported Debriefing 30

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32 Feedback and Debriefing Provider focused Assist in improving performance Improved adherence to guidelines Higher rate of ROSC 32 32

33 Maintenance of Competency 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 33 33

34 Maintenance of Competency 34 34

35 CPR Fractions 35 35

36 Call to Action EMS providers and agencies should practice resuscitation skills and team performance, incorporating strategies such as measuring of CPR fractions and debriefing as methods for improving quality and outcomes. 36

37 Link 5: Post-Cardiac Arrest Care Therapeutic Hyperthermia Post ROSC 12-lead ECG Transport to Cardiac Arrest Center 37

38 Tools and Resources 38

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40 Call to Action EMS providers and agencies are integral to the advancement post resuscitation care and evolving systems of care. The importance of your role at all levels of design and implementation is innumerable. 40

41 Summary 41 41

42 Questions and Answers 42

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