law enforcement role in response to sudden cardiac arrest

In the next hour, we will:

Learn about the evidence supporting LEA

defibrillation strategies and LEA

defibrillation best practices including

examples of effective implementation.

…..

Discuss advancement of LEA defibrillation

strategies and help save lives.

Guidelines 2005

“CPR and AED use by public safety first responders

(traditional and nontraditional) are recommended to

increase survival rates for SCA (Class I)!

DOI: 10.1161/CIRCULATIONAHA.105.166554

Why LEA-D?

• Often more LEA personnel than EMS

personnel in a given community

• Patrol units poised to respond rapidly

to emergencies.

• EMS often station-based, fewer in

number

• LEA personnel often arrive at the

scene before EMS personnel

White RD. Patient outcomes following defibrillation with a low energy biphasic truncated exponential

waveform in out-of-hospital cardiac arrest. Resuscitation. 2001;49:9-14.

Why LEA-D?

• 81% of police departments respond to

medical emergencies

• 50%provide some level of patient care*

• Defibrillation capability can greatly

enhance care rendered

Cobb LA, Fahrenbruch CE, Walsh TR, et al. Influence of cardiopulmonary resuscitation prior to defibrillation

in patients with out-of-hospital ventricular fibrillation. JAMA. 1999;281:1182-8.

Why LEA-D?

• Technology has made it possible for

atypical responders to effectively use

AEDs

• LEA personnel trained in CPR-AEDs

demonstrate comparable skill

competency

White RD. Technological advances and program initiatives in public access defibrillation using automated

external defibrillators. Curr Opin Crit Care. 2001;7:145-51.

Davis EA, Mosesso VN. Performance of police first responders in utilizing automated external defibrillation

on victims of sudden cardiac arrest. Prehosp Emerg Care. 1998;2:101-7.

Riegel B. Training nontraditional responders to use automated external defibrillators. Am J Crit Care.

1998;7:402-10.

High Discharge Survival Rate After Out-of-Hospital Ventricular

Fibrillation With Rapid Defibrillation by Police and Paramedics

Annals of Emergency Medicine , Volume 28 , Issue 5 , Pages 480 - 485

R . White , B . Asplin , T . Bugliosi , D . Hankins

Conclusion: A high discharge-to-home survival rate was obtained with early

defibrillation by both police and paramedics. When shocks resulted in ROSC,

the overwhelming majority of patients survived (96%). Even brief time

decreases (e.g., 1 minute) in call-to-shock time increase the likelihood of

ROSC from shocks only, with a consequent decrease in the need for ALS

intervention. Short call-to-shock time and ROSC response to shocks only are

major determinants of a high rate of survival after VF.

Seven years' experience with early defibrillation by police and

paramedics in an emergency medical services system .

Resuscitation , Volume 39 , Issue 3 , Pages 145 - 151

R . White

Conclusion: Both restoration of a functional circulation, without need for

advanced life support interventions, and discharge survival without neurologic

disability are very dependent upon the rapidity with which defibrillation is

accomplished…

Law Enforcement Agencies and Out-of-Hospital Emergency Care .

Annals of Emergency Medicine , Volume 29 , Issue 4 , Pages 497 - 503

H . Alonso-Serra , T . Delbridge , T . Auble , V . Mosesso , E . Davis

Conclusion: Many law enforcement agencies are involved to some extent in

providing out-of-hospital emergency medical care, and most of the agencies

we surveyed would support additional medical training and new or expanded

roles for themselves in EMS systems.

Providing automated external defibrillators to urban police officers in

addition to a fire department rapid defibrillation program is not effective

Resuscitation , Volume 66 , Issue 2 , Pages 189 - 196

M . Sayre , J . Evans , L . White , T . Brennan Conclusion: Equipping police cars with AEDs in an urban area where the fire

department-based first response system also carries defibrillators did not

improve the hospital discharge survival rate for victims of OOH-CA.

Attitudes of Law Enforcement Officers Regarding Automated External

Defibrillators

Academic Emergency Medicine, Volume 9 Issue 7 Page 751-753, July 2002

William J. Groh MD, Miriam R. Lowe MS, Amanda D. Overgaard BS,

Jeanie M. Neal MS, W. Craig Fishburn BS, Douglas P. Zipes MD

Conclusion: Limited knowledge and negative attitudes of law

enforcement officers regarding their involvement in treating OHCA and

using AEDs are commonly present. These factors could result in

barriers that negatively impact law enforcement AED programs.

LEA-D concept is endorsed in a joint

position statement by the International

Association of Chiefs of Police (IACP)

and the International Association of Fire

Chiefs (IAFC)

LAW ENFORCEMENT AGENCY

DEFIBRILLATION (LEA-D)

A review of the published LEA-D studies (Rochester,

Pittsburgh, and Indiana) indicates that significant

improvements in survival were achieved in study

communities with higher population density per

square mile.

LAW ENFORCEMENT AGENCY

DEFIBRILLATION (LEA-D)

Police AED Issues Forum panelists agreed that

Successful LEA-D programs possess certain

attributes, which are elucidated in the NCED LEA-D

Best Practices Checklist

Progress

• Evidence continues to

support LEA-D

concept

• More LEA-D programs

have been established

• Lives are being saved

Some Ongoing Issues

• What agencies should adopt?

• Integration

• Dispatch policies

• Medical oversight

• Training

• Liability

• Program/system coordination

• Quality monitoring

Newman et al. NCED POSITION STATEMENT: LAW ENFORCEMENT AGENCY DEFIBRILLATION

PREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3

Anecdotes

• Agency removes AEDs because they

did not work on dogs

• State efforts did not

include dispatch policies

ABC’s are alive

and well?

1. The ability to respond quickly

and reliably to medical

emergencies

The mean LEA response interval (time from

9-1-1 call receipt to arrival at the scene) is

less than 8 minutes.

The LEA unit arrives at least 2 minutes before other designated emergency response units that provide defibrillation.

The LEA agency continuously strives to minimize response intervals.

Newman et al. NCED POSITION STATEMENT: LAW ENFORCEMENT AGENCY DEFIBRILLATION

PREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3

2. A supportive medical

response culture within the

law enforcement agency LEA and local government leaders

support the LEA-D concept and endorse it in writing.

Police officers and their advocates (e.g., unions) support the concept.

Methods for addressing psychological issues (e.g., critical incident stress debriefing) are established.

Success is celebrated (e.g., through recognition, awards).

Newman et al. NCED POSITION STATEMENT: LAW ENFORCEMENT AGENCY DEFIBRILLATION

PREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3

3. Strong champions who serve

as program advocates

Strong champions, such as police officers,

community leaders, and survivors, actively

promote the program.

Newman et al. NCED POSITION STATEMENT: LAW ENFORCEMENT AGENCY DEFIBRILLATION

PREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3

4. Integration with the

emergency medical services

(EMS) system

Local EMS leaders support the program and

endorse it in writing.

Local EMS collaborates on program

development and training.

LEA-D protocols are integrated with EMS

protocols to ensure a seamless transfer of

care.

Newman et al. NCED POSITION STATEMENT: LAW ENFORCEMENT AGENCY DEFIBRILLATION

PREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3

5. An effective, coordinated

dispatch system

All 9-1-1 call-takers undergo emergency medical dispatch (EMD) training

Dispatch protocols emphasize the priority of cardiac arrest calls

Complaints that trigger designation as a probable cardiac emergency are carefully

evaluated to avoid under- or overtriage

The closest LEA and EMS units are dispatched simultaneously to cardiac arrest calls

Call processing time is minimized (9-1-1 call receipt to dispatch interval <60 seconds)

Newman et al. NCED POSITION STATEMENT: LAW ENFORCEMENT AGENCY DEFIBRILLATION

PREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3

6. A proactive, hands-on

medical director

The medical director is actively involved in

program and protocol development, including oversight of training

The medical director oversees continuous quality improvement (CQI) processes and reviews all responses to cardiac arrest and all automated external defibrillator (AED)uses

The medical director communicates frequently with program personnel, including officers and dispatchers, and provides feedback on specific cases

Newman et al. NCED POSITION STATEMENT: LAW ENFORCEMENT AGENCY DEFIBRILLATION

PREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3

7. A designated program

coordinator

A specific individual, the program coordinator,

is responsible for day-to-day operations and

program management

The program coordinator is authorized to act to

ensure program effectiveness

Newman et al. NCED POSITION STATEMENT: LAW ENFORCEMENT AGENCY DEFIBRILLATION

PREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3

8. Effective, competency-based

initial and refresher training

Training is accomplished through use of a nationally recognized, competency-based, device-specific training program that emphasizes cardiopulmonary resuscitation (CPR) and AED skills acquisition and retention

Refresher training is conducted regularly to ensure continued competency

Newman et al. NCED POSITION STATEMENT: LAW ENFORCEMENT AGENCY DEFIBRILLATION

PREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3

CQI processes are established to ensure

excellence

A data collection tracking process is

established to monitor response and outcome

information and survival trends

9. An effective CQI program

that includes written

policies, data collection and

analysis

Newman et al. NCED POSITION STATEMENT: LAW ENFORCEMENT AGENCY DEFIBRILLATION

PREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3

Have officers used their AED?

AEDs Used # %

Yes 86 75.439

No 23 20.175

Unknown 5 4.386

(Total n=114)

Source: Massachusetts LEA Survey 2006

Why do you want to have AED

capabilities to your department?

• Their proven value

• To better serve the residents

• To save lives

• To save lives, including our own

Source: Massachusetts LEA Survey 2006

What barriers are impeding your

agency getting AED capability?

• Training Costs

• Need for policy changes

• High equipment cost

• Union / Collective

bargaining issues

Source: Massachusetts LEA Survey 2006

What solutions have you found

to overcome these barriers?

• Training compensated

by contract

• Training is done as part

of in-service training at

the police academy

• TBD

Source: Massachusetts LEA Survey 2006

OTHER CONSIDERATIONS?

Recently, the Old Saybrook Department of Police Services, in cooperation with the Old Saybrook Ambulance Association and Middlesex Hospital has decided to move forward with several strategies to improve response, care and outcomes and are addressing community education, responder education, emergency system access and dispatch and research/quality improvement.

"We thoroughly understand that the fastest way to provide emergency cardiac care is for police officers who are already mobile and deployed throughout our community to be trained and to respond immediately with AEDs and other lifesaving skills and equipment. To enhance that the department is working with the AHA to enhance public and professional education, expand our public access AED program and assure the highest quality pre-arrival instructions given by our 9-1-1 dispatchers prior to the arrival of our police officer first responders". - Chief Michael Spera

Best Practice?

The Old Saybrook Department of Police Services provides all first responder services in the town of Old Saybrook. Recently, the department’s police officers / first responders have all completed 90 hours of training and have upgraded their credentials from Emergency Medical Responder to Emergency Medical Technician. Some of the unintended consequences include improved lines of communication between the first responders and paramedics. Additionally, there has been appreciable improvement in feedback about cases and an iterative process where the first responders are learning to better work with the paramedics and improve quality and timeliness of care.

"Our patrol division members were so passionate about upgrading their training that they voluntarily gave up their overtime and rearranged their vacation schedules to take the required 90 hours of training to earn their EMT certifications in order to provide a higher level of medical care to their patients. This has already resulted in improved cardiac care”. - Phil Coco, EMS Director/Instructor

Arresting V-Fib with Early Defibrillation

All police cruisers are equipped with AEDs and rapid dispatch is supported by departmental policies and procedures. Additionally, there are 19 publically accessible AEDs in the community. Information regarding the type and location of these devices is integrated into the computer assisted dispatch system in Old Saybrook, and the readiness of the devices is monitored by the Department of Police Services.

“I have been so very impressed with the attention and commitment to improving recognition, response, care and outcomes in Old Saybrook. I commend Chief Spera, EMS Director Coco, and all the integrated agencies and supporters of this effort. This community can serve as an excellent role model for others”. – David Hiltz, NREMT-P, American Heart Association

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Summary

We need to influence more agencies

and individual officers not only to

adopt but to establish the system in a

manner that brings about the greatest

degree of efficiency and effectiveness