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Strengthening the Chain of Survival The Role of the Emergency Dispatcher

Strengthening the Chain of Survival The Role of the Emergency Dispatcher. December 2012 Tom Rea Harborview Medical Center King County EMS. Qualifying Comments. 1. I am a physician – not a dispatcher.

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Strengthening the Chain of Survival The Role of the Emergency Dispatcher

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  1. Strengthening the Chain of SurvivalThe Role of the Emergency Dispatcher December 2012 Tom Rea Harborview Medical Center King County EMS

  2. Qualifying Comments 1. I am a physician – not a dispatcher. 2. What I will discuss may be obvious, but I challenge you to reflect on your system’s approach. 3. I am an employee of the University of Washington and King County Public Health. 4. I do receive grant support from the Medtronic Foundation’s Heart Rescue Program. 5. Technology risk-taker www.nena.org/cardiac

  3. Overview: Emergency dispatchers can have a meaningful impact on survival following cardiac arrest. Strengthening the Chain of SurvivalThe Role of the Dispatcher Objectives – Understand: • What is cardiac arrest? • Dispatcher interface with the chain of survival • Challenges of identification • Challenges of rescuer engagement • Details of CPR instruction • Programmatic quality assurance www.nena.org/cardiac

  4. A Fundamental Philosophy You must understand local circumstances ……….in order to achieve success. www.nena.org/cardiac

  5. What is cardiac arrest? Sudden unexpected cardiovascular collapse

  6. Links in the Chain of Survival • Prompt activation of emergency care 9-1-1 • Early CPR • Early Defibrillation • Timely advanced care • Timely post-resuscitation care

  7. Key to Success – It takes a community • Prompt activation of emergency care 9-1-1 • Early CPR • Early Defibrillation • Timely advanced care • Timely post-arrest care

  8. Pyramid of Resuscitation Early Recognition Expert Post Resuscitation Care Expert ACLS Early Defibrillation Early CPR

  9. Pyramid of Resuscitation Early Recognition Expert Post Resuscitation Care Expert ACLS Early Defibrillation Early CPR

  10. Pyramid of Resuscitation Early Recognition Expert Post Resuscitation Care Expert ACLS Early Defibrillation Early CPR

  11. The Most Important First Responder

  12. A carefully reasoned explanation

  13. Early (Bystander) CPR…….? Resuscitation 101 • A. Improves blood flow to the brain • Improves blood flow to the heart • C. Improves the chance of survival

  14. Early (Bystander) CPR…….? A. Improves blood flow to the brain B. Improves blood flow to the left ventricle C. Improves the chance of survival

  15. The rate of bystander CPR in most communities is..? • 10% • 25% • 50% • 70%

  16. The rate of bystander in most communities is ...? • 10% • 25% • 50% • 70% An effective strategy to improve resuscitation …… implemented in only about a quarter of those in need.

  17. What are the roadblocks to bystander CPR? • Cardiac arrest is hard to recognize. • Rescuers do not have confidence to act. • Traditional CPR is technically too difficult.

  18. What are the roadblocks to bystander CPR? • Cardiac arrest is hard to recognize. • Rescuers do not have confidence to act. • CPR is technically too difficult. YES YES YES ………….What to do?

  19. Option 1: CPR Training Programs

  20. The rate of bystander in most communities is ...? • 10% • 25% • 50% • 70%

  21. Option 2: Dispatcher-Assisted CPR

  22. Option 2: Dispatcher-Directed CPR

  23. Yes……..but address the roadblocks Cardiac arrest is hard to recognize Laypersons may not have confidence CPR can be technically difficult

  24. Cardiac Arrest Recognition

  25. Cardiac Arrest Recognition A cardiac arrest patient is (True or False): 1. Not responsive (not awake/ not conscious) 2. Not breathing

  26. Cardiac Arrest Recognition True - Not responsive (not awake/not conscious) Sometimes - Not breathing

  27. Cardiac Arrest Recognition True - Not responsive (not awake/not conscious) True - Not breathing……normally Agonal Breaths “Gasping” “Snoring” “Snorting” “Sighing” “Gurgling” “Puffing” “Light” “Labored” “Shallow” Audio 1 www.nena.org/cardiac

  28. How often are agonal gasps apparent in cardiac arrest? • 10% • 20% • 33% Mask

  29. How often are agonal gasps apparent in cardiac arrest? • 10% • 20% • 33% Mask

  30. Cardiac Arrest Recognition Not responsive (not awake/not conscious) Not breathing normally Audio 2 www.nena.org/cardiac

  31. Are we casting the net too widely? Post-ictal Hypoglycemia Intoxication

  32. Let’s apply the 2 question approach: Not responsive (not awake/not conscious) Not breathing normally True Arrest No arrest

  33. For every 100 true cardiac arrests you identify with the 2 question approach, you will also identify ? not in arrest? • 5 • 25 • 50 • 100 • 500 True Arrest No arrest

  34. For every 100 true cardiac arrests you identify with the 2 question approach, you will also identify ? not in arrest? • 5 • 25 • 50 • 100 • 500 True Arrest No arrest

  35. Dispatcher Instructions: Who gets CPR? Not responsive (not awake/not conscious) Not breathing normally True Arrest No Arrest

  36. Dispatcher Instructions: Who gets CPR? Not responsive (not awake/not conscious) Not breathing normally Minimal risk of major injury 1 : 1000 True Arrest No Arrest

  37. Challenges of Early CPR Cardiac arrest is hard to recognize Laypersons may not have confidence CPR can be technically difficult

  38. Confidence Predicts Action

  39. How do we gain confidence? Education Practice Experience Encouragement

  40. How do we gain confidence? Education Practice Experience Encouragement

  41. Challenges of Early CPR Cardiac arrest is hard to recognize Laypersons may not have confidence CPR can be technically difficult

  42. The average time required to open the airway and provide 2 breaths for bystanders during the first cycle is…..? • 10 seconds • 20 seconds • 30 seconds • 60 seconds Initial airway management

  43. The average time required to open the airway and provide 2 breaths for bystanders during the first cycle is…..? • 10 seconds • 20 seconds • 30 seconds • 60 seconds Initial airway management

  44. During subsequent cycles of CPR by the bystander, ventilations interrupt chest compressions …..? • 5 seconds • 10 seconds • 15 seconds • 20 seconds Subsequent CPR cycles

  45. During subsequent cycles of CPR by the bystander, ventilations interrupt chest compressions …..? • 5 seconds • 10 seconds • 15 seconds • 20 seconds Subsequent CPR cycles

  46. Solution? Eliminate ventilations Focus on chest compressions

  47. Eliminate ventilations Focus on chest compressions Survival 15% 10% Hands Only Rescue Breathing + Chest Compressions

  48. Details

  49. Dispatcher CPR Instructions All caller questions – Conscious / Breathing Normally Medical help is getting there as fast as they can. We need to help (them) right now. I will tell you what to do. Get them flat on their back on the floor. Kneel by their side. Put your hand on the center of their chest, right between the nipples, and put your other hand on top of that hand. With straight arms push down as hard as you can, just like you’re pumping the chest. Let’s start.  Push and count out loud 1, 2, 3, 1, 2, 3… Audio 3 www.nena.org/cardiac

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