Strengthening the Chain of Survival The Role of the Emergency Dispatcher

1. Strengthening the Chain of SurvivalThe Role of the Emergency Dispatcher November, 2011 Tom Rea Harborview Medical Center King County EMS

2. Overview: Emergency dispatchers can have a meaningful impact on survival following cardiac arrest. Strengthening the Chain of SurvivalThe Role of the Dispatcher Objectives – Understand: • Public health perspective of cardiac arrest • Dispatcher interface with the chain of survival • Challenges of identification • Challenges of rescuer engagement • Details of CPR instruction • Summary

3. A Fundamental Principle You must understand local circumstances ……….in order to achieve success. Mickey Eisenberg Michael Copass Leonard Cobb

4. Is there an opportunity for your community?

5. The Public Health Toll of Cardiac Arrest

6. The leading cause of death in the US is: ____ HIV ____ Stroke ____ Colon Cancer ____ Cardiac Arrest ____ Tuberculosis

7. The leading cause of death in the US is: _1_ Cardiac Arrest _2_ Stroke _3_ Colon Cancer _4_ HIV _5_ Tuberculosis

8. How do we reduce death from cardiac arrest?

9. 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

10. Early (Bystander) CPR…….? A. Improves blood flow to the brain B. Improves blood flow to the left ventricle C. Helps prevent deterioration of VF to asystole D. Improves the chance of survival

11. Early (Bystander) CPR…….? A. Improves blood flow to the brain B. Improves blood flow to the left ventricle C. Helps prevent deterioration of VF to asystole D. Improves the chance of survival

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

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

14. The rate of bystander in most communities is ...? • 10% • 25% • 50% • 70% An effective therapy that is only partly implemented.

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

16. What are the roadblocksto bystander CPR? • Cardiac arrest is hard to recognize • Rescuers do not have confidence - fearful • CPR is technically too difficult ………….What to do?

17. Option 1: CPR Training Programs

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

19. Option 2: Dispatcher-Assisted CPR

20. Yes……..but answer the question Cardiac arrest is hard to recognize Laypersons may not have confidence CPR can be technically difficult

21. Cardiac Arrest Recognition

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

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

24. Cardiac Arrest Recognition True - Not responsive (not awake/not conscious) True - Not breathing……normally Agonal gasps

25. Cardiac Arrest Recognition Not responsive (not awake/not conscious) Not breathing normally

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

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

28. 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

29. 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

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

31. 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

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

33. Confidence predicts action

34. How do we gain confidence? Education Practice Experience

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

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

37. 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

38. 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

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

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

41. Eliminate ventilations Focus on chest compressions Mechanisms

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

43. The Story of Dispatcher Assisted CPR Seattle - King County experience (1978 - 1984) 50% 25% Bystander-initiated (no dispatch assist)

44. The Story of Dispatcher Assisted CPR Dispatcher program increased the rates of bystander CPR by……?A. 5%B. 10%C. 15%D. 20% 25% Bystander-initiated (no dispatch assist)

45. The Story of Dispatcher Assisted CPR Bystander CPR since initiation of dispatcher assistance (1985 - 2007) 50% Dispatcher-assisted 20% 25% Bystander-initiated (no dispatch assist) 30% Potential to nearly double proportion who receive CPR

46. Conceptual Role of the Dispatcher Passive Transfer information Allocate Resources Active Interpret information Engage Resources Deliver Training

47. Summary Dispatchers have a critical role in early activation and early CPR. Dispatchers must: - interpret information (recognize the arrest) - engage the callers (instill confidence) - provide training (deliver CPR instructions) Dispatchers can save lives.