Out of Hospital Arrest: How are We Doing in Lane County? By: Joshua Moore, FireFighter EMT-P Eugene Springfield Fire Department

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1 Out of Hospital Arrest: How are We Doing in Lane County? By: Joshua Moore, FireFighter EMT-P Eugene Springfield Fire Department

2 Objectives: 1. State the 5 links in the AHA Chain of Survival. 2. How has ACT:C3 improved our local chain? 3. How do you play a role in that chain? 4. What improvements can you develop within your scope of practice?

Components of ACT:C3 Community Awareness and CPR training Chest Compressions Oriented Dispatch

3 2 Chain of Survival: 5 Links. Early Access Early CPR Early Defibrillation Advanced Life Support Post- Cardiac Arrest Care Components of ACT:C3 Community Awareness and CPR training Chest Compressions Oriented Dispatch Instructions CardioCerebral Resuscitation Protocols for EMS Responders Hospital(s) Registry Participation & Data Analysis AED Site Process, Database & SmartPhone App

recognize cardiac arrest, perform CPR, and call 911 then our survival of

4 Radio, TV, Print PSA. Public Training Public Awareness & Training "If we can get people to recognize cardiac arrest, perform CPR, and call 911 then our survival of sudden cardiac arrest will improve." Craig Aman, Lieutenant Seattle Fire and Medic One, during cardiocerebral resuscitation lecture Aug 1st, 2012.

5 Chest Compression Oriented Dispatch Instructions. Old model took 4-6 min before compressions. New model less than 2 min. Easier for dispatch to explain and public to respond studies have proven that arrest victims receiving bystander CPR are 4.5 times more likely to survive. 2. The leading reasons given for not doing CPR: a. Afraid of doing CPR wrong. b. Exposure to body fluids. DART Study Circulation. 2010;121: patients, 18% not in arrest with public compressions. 2% FX, no visceral organ damage. Benefits outweigh risks.

6 CardioCerebral Resuscitation (CCR) 1.) 200 preshock chest compressions. 2.) 200 uninterrupted postshock chest compressions before pulse or rhythm checks. 3.) Delayed advanced airways for 3 cycles of 200 compressions and rhythm analysis. 4.) Attempted Intravenous or intraosseous epinephrine before or during 2nd cycle of compressions. 5.) Excessive interruptions of chest compressions are lethal. 6.) Pulse checks should be done towards the end of 200 compressions and through rhythm analysis. Feeling compression pulse helps determine ROSC presence after compressions stop. 7.) Forced ventilations are mandatory after 15 minutes of chest compressions. However, they must be performed at a controlled TV and rate (Medic One (King County, WA provides ½ BVM TV at 6 vents/min). Studies show 6-10 optimal. However, in observation trials Paramedics and ER docs average 37 ventilations/minute. 8.) ETC02 monitors cell metabolism. Dead if less than 10mmHg after 20 min resuscitation. Hypothermia induced in field. Pit Crew Approach 1. Prioritize cerebral perfusion and continuous chest compressions. 2. Increase response to arrest calls; 9 personnel from Each responder has specific tasks to perform based on apparatus assignment. 4. Assigned Code Commander Role and Time Keeper/Scribe Role. 5. Work until ROSC or Dead in field.

7 Data Analysis and Arrest Registry 1. Two Rural Counties in WI were the first to prove results of CCR. They more than tripled survival rates without brain injuries. They maintained those survival rates for the 3 years of the study and 3 years follow-up period. 2. King County & Medic One has averaged 46% save rates over the last 6 years and hit 50% save rate in Tucson AZ and 25 other Arizona EMS agencies have adopted compression CPR for citizens and CCR for EMS crews and have experienced a 3:1 save rate over CPR and mouth to mouth models. They averaged 37-48% save rates over the last few years. 4. Kansas City, MO switched to compression CPR for lay persons and CCR for EMS crews and also raised save rates without hypoxic brain injuries by 350%. Multiple registries are available nationally.

8 AED Component. Coming soon 1. Site Process Streamlined. 2. Site database production. 3. Smartphone Applications.

9 "Resuscitation implies a commitment on the side of life. To devote one's energies to the restoration of lives cut short before fulfillment is to declare that life is intrinsically valuable, that it is worth living." - Peter Safar 1. What is priority of your codes? 2. Can roles can be predetermined like a pit crew? 3. What vitals are you using for determination to cease efforts? 4. Do your friends and family know compression CPR? 5. How can you encourage sharing data among providers?

10 In Memory of Ray Garza

High-Functioning EMS CPR Teams. Sally A Taylor - Paramedic Atlantic Partners EMS

High-Functioning EMS CPR Teams Cardiac Arrest Management Sally A Taylor - Paramedic Atlantic Partners EMS Insanity: Doing the same thing over and over and expecting a different result. John Dryden The