strengthening the chain of survival the role of the emergency dispatcher november, 2011 tom rea...
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Strengthening the Chain of SurvivalThe Role of the Emergency Dispatcher
November, 2011 Tom Rea
Harborview Medical CenterKing County EMS
Strengthening the Chain of SurvivalThe 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 CopassMickey 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 9-1-1
• 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 roadblocksto 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
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 Arrest No arrest
Let’s 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 Arrest No arrest
A. 5B. 25C. 50D. 100E. 500
For every 100 true cardiac arrests you identify with the 2 question approach, you will also identify ? not in arrest?
True Arrest No arrest
A. 5B. 25C. 50
D. 100E. 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 Only Rescue Breathing
Survival
+ Chest Compressions
Seattle - King County experience (1978 - 1984)
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 (1985 - 2007)
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
PassiveTransfer informationAllocate Resources
ActiveInterpret informationEngage 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.