The relevance of time to CPR and defibrillation to survival is well established. Furthermore the effectiveness of law enforcement agency (LEA) defibrillation strategies is well demonstrated. Despite this, few LEA have committed to the necessary policy change, training and purchase of equipment. This presentation will review LEA defibrillation best practices as well as results from a survey of LEA in Massachusetts. In reviewing this information the participants will gain insight into LEA attitudes towards resuscitation and aid in the advancement of efforts to utilize LEA in the delivery of lifesaving interventions.

2. 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.

4. 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

5. 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.

6. 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.

7. 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.

8. 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…

9. 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.

10. 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.

11. 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)

13. 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.

14. 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

15. Progress
• Evidence continues to
support LEA-D
concept
• More LEA-D programs
have been established
• Lives are being saved

16. Some Ongoing Issues
• What agencies should adopt?
• Integration
• Dispatch policies
• Medical oversight
• Training
• Liability
• Program/system coordination
• Quality monitoring

17. Newman et al. NCED POSITION STATEMENT: LAW ENFORCEMENT AGENCY DEFIBRILLATION
PREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3

18. Anecdotes
• Agency removes AEDs because they
did not work on dogs ABC’s are alive
and well?
• State efforts did not
include dispatch policies

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 9. An effective CQI program
that includes written
policies, data collection and
analysis
CQI processes are established to ensure
excellence
A data collection tracking process is
established to monitor response and outcome
information and survival trends
Newman et al. NCED POSITION STATEMENT: LAW ENFORCEMENT AGENCY DEFIBRILLATION
PREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3

28. 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

29. 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

31. 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

32. 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

33. OTHER CONSIDERATIONS?

34. Best Practice?
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

35. 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

36. 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

39. Your TRUSTED
Training Partner

40. OFFICERS
can train
OFFICERS

41. 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