Strengthening the Chain of Survival The Role of the Emergency Dispatcher November, 2011 Tom Rea Harborview Medical Center King County EMS

Strengthening the Chain of Survival The Role of the Dispatcher Overview: Emergency dispatchers can have a meaningful impact on survival following cardiac arrest. 1. Public health perspective of cardiac arrest 2. Dispatcher interface with the chain of survival 3. Challenges of identification 4. Challenges of rescuer engagement 5. Details of CPR instruction 6. Summary Objectives – Understand:

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

Is there an opportunity for your community?

The Public Health Toll of Cardiac Arrest

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

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

How do we reduce death from cardiac arrest?

Links in the Chain of Survival Prompt activation of emergency care Early CPR Early Defibrillation Timely advanced care Timely post-resuscitation care

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

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

The rate of bystander CPR in most communities is..? A. 10% B. 25% C. 50% D. 70%

The rate of bystander in most communities is...? A. 10% B. 25% C. 50% D. 70%

The rate of bystander in most communities is...? A. 10% B. 25% C. 50% D. 70% An effective therapy that is only partly implemented.

What are the roadblocks to bystander CPR? A. Cardiac arrest is hard to recognize. B. Rescuers do not have confidence to act. C. CPR is technically too difficult.

A. Cardiac arrest is hard to recognize B. Rescuers do not have confidence - fearful C. CPR is technically too difficult ………….What to do? What are the roadblocks to bystander CPR?

Option 1: CPR Training Programs

The rate of bystander in most communities is...? A. 10% B. 25% C. 50% D. 70%

Option 2: Dispatcher-Assisted CPR

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

Cardiac Arrest Recognition

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

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

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

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

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

No………….so prove it True ArrestNo arrest Lets apply the 2 question approach: Not responsive (not awake/not conscious) Not breathing normally

For every 100 true cardiac arrests you identify with the 2 question approach, you will also identify ? not in arrest? True ArrestNo arrest A. 5 B. 25 C. 50 D. 100 E. 500

For every 100 true cardiac arrests you identify with the 2 question approach, you will also identify ? not in arrest? True ArrestNo arrest A. 5 B. 25 C. 50 D. 100 E. 500

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

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

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

Confidence predicts action

How do we gain confidence? Education Practice Experience

How do we gain confidence? Education Practice Experience Encouragement

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

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

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

A. 5 seconds B. 10 seconds C. 15 seconds D. 20 seconds During subsequent cycles of CPR by the bystander, ventilations interrupt chest compressions …..? Subsequent CPR cycles

A. 5 seconds B. 10 seconds C. 15 seconds D. 20 seconds During subsequent cycles of CPR by the bystander, ventilations interrupt chest compressions …..? Subsequent CPR cycles

Eliminate ventilations Focus on chest compressions Mechanisms

Eliminate ventilations Focus on chest compressions 15%10% Hands OnlyRescue Breathing Survival + Chest Compressions

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

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

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

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

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