4/14/2016. Ticino, a nice place where to live. Dispatcher Assisted CPR & Quality Improvement
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1 Dispatcher Assisted CPR & Quality Improvement MANAGEMENT OF OUT-OF-HOSPITAL CARDIAC ARREST LOCAL IMPLEMENTATION IN CANTON TICINO Christine Waegli Centrale cantonale d allarme e di coordinamento sanitario I have no beneficial interest by any material or financial gains that could be interpreted as a conflict of interest. Ticino, a nice place where to live 3 1
2 Area km 2 (1, 085 sq/mi) Population inhabitants Density 120/km 2 (320/sq mi) Demographic characteristics of population ( ) Ambulance ALS Units Paramedic Doctor car Emergency Physician Specialized Nurse (Anesthesia / ICU) HEMS Emergency Physician 24H/7 EMCC MPDS EMT / Paramedic 3 (2) dispatcher on shift T-CPR 2
3 Ambulance ALS Units Paramedic Doctor car Emergency Physician Specialized Nurse (Anesthesia / ICU) HEMS Emergency Physician 24H/7 EMCC MPDS EMT / Paramedic 3 (2) dispatcher on shift T-CPR EMCC - Ticino Soccorso 144 Emergency medicals calls for ambulance Emergency doctor/farmacy/psichiatry/dentist and other medical services (e.g. home nursing, ) Coordination of the field responder Mass event EMD (14 units) Paramedic/EMT/RN Languages (italian, german, french, english) IT Field experience IMPROVING THE MANAGEMENT OF OUT-OF-HOSPITAL CARDIAC ARREST the steps 3
4 EVERYONE, AS PART OF THE COMMUNITY, EVEN MORE IF INTEGRATED IN A SYSTEM, CANSAVE A LIFE! Our system against OHCA Come together Ceremony Community Training BLS-D OHCA Pathway Training School FR (BLS-D) Alert System PAD Program OHCA Rehab Survival CPC/OP C AED Rental program First Responder (FR) network T-CPR FR & bystander psychological support Rapid Responder (RR) network Rapid Dispatch RR (ALS) Alert System 4
5 Our system against OHCA Come together Ceremony Community Training BLS-D OHCA Pathway Training School FR (BLS-D) Alert System PAD Program OHCA Rehab Survival CPC/OP C AED Rental program First Responder (FR) network T-CPR FR & bystander psychological support Rapid Responder (RR) network Rapid Dispatch RR (ALS) Alert System Our system against OHCA Come together Ceremony Community Training BLS-D OHCA Pathway Training School FR (BLS-D) Alert System PAD Program OHCA Rehab Survival CPC/OP C AED Rental program First Responder (FR) network T-CPR AED Service FR & bystander psychological support Rapid Responder (RR) network Rapid Dispatch RR (ALS) Alert System Community Training BLS-D 10,000 TRAINING BLS-AED 8, ,000 7,670 6,000 5,476 5,217 4,000 2, ,000 3,067 3,166 2,308 2,058 Start sistematic BLSD 1,489 training to high school 1,053 students (mean age 14 years) people trained = 13.9% of the whole population 5
6 Our system against OHCA Come together Ceremony Community Training BLS-D OHCA Pathway Training School FR (BLS-D) Alert System PAD Program OHCA Rehab Survival CPC/OP C AED Rental program First Responder (FR) network T-CPR AED Service FR & bystander psychological support Rapid Responder (RR) network Rapid Dispatch RR (ALS) Alert System Strategic geographic coverage by PAEDs Ascona(2013) Strategic geographic coverage by PAEDs Ascona(2013) Ascona(2015) Analysis All PAEDs! 6
7 Strategic geographic coverage by PAEDs Ascona(2013) Ascona(2015) Analysis All PAEDs! Ascona(2015) Exploit the opportunities 7
8 Guarantee readiness Flood November 2014 Meeting places Flood November Sport places Flood November
9 Inform the public Because 67% OHCA occurs at home! Our system against OHCA Come together Ceremony Community Training BLS-D OHCA Pathway Training School FR (BLS-D) Alert System OHCA Rehab Survival CPC/OP C AED Rental program First Responder (FR) network T-CPR AED Service FR & bystander psychological support Rapid Responder (RR) network Rapid Dispatch RR (ALS) Alert System Our First Responders Emergency Services (Police, Fire brigade, Border Patrol, Military Police) Samaritans (Lay personnel trained in first aid, organized in groups) Health care (doctors, nurses, paramedics, EMTs, ) first responders Citizens (lay people trained in BLS-AED) Alert via broadcast system (smartphone application): Response based on voluntariness and randomness = spontaneous aid (they re never on call!) 9
10 AED equipment Emergency Services (on board) Samaritans (head office) Health care Citizens 350 AEDs PAEDs Our main goal: Assure defibrillation in 5 minutes after collapse Weakness: Only a few are equipped with an AED Goal: 1 PAED = 10 First Responder Efficency PAD: Information / public awarness Accessibility to BLSD courses First Responder (1:10) Our system against OHCA Community Training BLS-D OHCA Pathway Training School FR (BLS-D) Alert System OHCA Rehab Survival CPC/OP C AED Rental program First Responder (FR) network T-CPR AED Service FR & bystander psychological support Rapid Responder (RR) network RR (ALS) Alert System 10
11 Rapid Responders EMS Personnel (Physicians & Paramedics) Rapid Responders EMS Personnel (Physicians & Paramedics) Live far away (> 20 km) Rapid Responders EMS Personnel (Physicians & Paramedics) Live far away (> 20 km) First Hour Quintet Cardiac Arrest Acute Coronary Syndrom Stroke Acute respiratory failure Major Trauma 11
12 Rapid Responders EMS Personnel (Physicians & Paramedics) Live far away (> 20 km) First Hour Quintet ALS equipped Rapid Responders EMS Personnel (Physicians & Paramedics) Live far away (> 20 km) First Hour Quintet ALS equipped Goal: reduction therapeutic interval Our system against OHCA Come together Ceremony Community Training BLS-D OHCA Pathway Training School FR (BLS-D) Alert System OHCA Rehab Survival CPC/OP C AED Rental program First Responder (FR) network T-CPR AED Service FR & bystander psychological support Rapid Responder (RR) network Rapid Dispatch RR (ALS) Alert System 12
13 Timeline Alert System First Responder Development concept Start-up SMS Alert Development smartphone app ios, Android, Windows Phone Operational period + optimization Implementation SMS Alert Operational period + optimization Implementation app 2 version EFFECTUAL the right person atthe right place ECONOMIC tiny AppCPU vs SMS ECOLOGIC conceived to involve the closest person EQUAL free, easy, everyone can use it EFFICIENT no waste of time and resources EMS / HEMS Company s AED First Responder Network Dispatch Life Support (DLS) 13
14 Does it works? Response time (activation + roll time) Period ; N = Green: 5 minutes limit (43%) Goal TCF: Assure defibrillation in 5 minutes after collaps 14
15 Response time (activation + roll time) Yellow: 10 minutes limit (77%) Survival decrease 10% with every minutes whithout CPR Period ; N = FR on site: therapeutic interval Decreased therapeutic interval (FR on site before ambulance) ( , n = 1 311) 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% > 5 min 15.6% 5-3 min 16.4% 3-1 min 15.4% < 1 min 5.4% with EMS 27.4% After EMS 19.7% Before EMS 52.9% Response time (activation + roll time) Period ; N = Shift left to right: Faster ( more Emergency Services) Shorter distance (more lay FRs) 15
16 1200 Territorial distribution & uses of AEDs Number of AEDs Companies / Health facilities PAD Emergency Services 48 16
17 The big challange ACE was the further step (2015) but there s still a lot to do: How can we teach EMD s to recognize agonal/ ineffective breathing? How can we reduce the time «hands on chest»? Measure - understand the problems Which are the barriers? Human Technical Protocols Others 17
18 In conclusion Interaction and communication are essential to make the difference! Even the smallest problem needs to be faced in urgency there will be no time! To improve we must consider all the factors but especially we need to consider all (other) perspectives! Thank you for your attention! City of Lugano 18
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