Your SlideShare is downloading. ×
  • Like
Law Enforcement Role in Response to Sudden Cardiac Arrest
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Now you can save presentations on your phone or tablet

Available for both IPhone and Android

Text the download link to your phone

Standard text messaging rates apply

Law Enforcement Role in Response to Sudden Cardiac Arrest

  • 3,304 views
Published

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 …

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.

Published in Health & Medicine , Business
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
No Downloads

Views

Total Views
3,304
On SlideShare
0
From Embeds
0
Number of Embeds
1

Actions

Shares
Downloads
50
Comments
2
Likes
3

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. 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.
  • 2. Guidelines 2005“CPR and AED use by public safety first responders(traditional and nontraditional) are recommended toincrease survival rates for SCA (Class I)! DOI: 10.1161/CIRCULATIONAHA.105.166554
  • 3. 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 personnelWhite RD. Patient outcomes following defibrillation with a low energy biphasic truncated exponentialwaveform in out-of-hospital cardiac arrest. Resuscitation. 2001;49:9-14.
  • 4. Why LEA-D? • 81% of police departments respond to medical emergencies • 50%provide some level of patient care* • Defibrillation capability can greatly enhance care renderedCobb LA, Fahrenbruch CE, Walsh TR, et al. Influence of cardiopulmonary resuscitation prior to defibrillationin patients with out-of-hospital ventricular fibrillation. JAMA. 1999;281:1182-8.
  • 5. Why LEA-D? • Technology has made it possible for atypical responders to effectively use AEDs • LEA personnel trained in CPR-AEDs demonstrate comparable skill competencyWhite RD. Technological advances and program initiatives in public access defibrillation using automatedexternal defibrillators. Curr Opin Crit Care. 2001;7:145-51.Davis EA, Mosesso VN. Performance of police first responders in utilizing automated external defibrillationon 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.
  • 6. High Discharge Survival Rate After Out-of-Hospital VentricularFibrillation With Rapid Defibrillation by Police and ParamedicsAnnals of Emergency Medicine , Volume 28 , Issue 5 , Pages 480 - 485R . 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 andparamedics in an emergency medical services system .Resuscitation , Volume 39 , Issue 3 , Pages 145 - 151R . 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…
  • 7. Law Enforcement Agencies and Out-of-Hospital Emergency Care .Annals of Emergency Medicine , Volume 29 , Issue 4 , Pages 497 - 503H . Alonso-Serra , T . Delbridge , T . Auble , V . Mosesso , E . Davis Conclusion: Many law enforcement agencies are involved to some extent inproviding out-of-hospital emergency medical care, and most of the agencieswe surveyed would support additional medical training and new or expandedroles for themselves in EMS systems.Providing automated external defibrillators to urban police officers inaddition to a fire department rapid defibrillation program is not effectiveResuscitation , Volume 66 , Issue 2 , Pages 189 - 196M . 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.
  • 8. Attitudes of Law Enforcement Officers Regarding Automated ExternalDefibrillatorsAcademic Emergency Medicine, Volume 9 Issue 7 Page 751-753, July 2002William J. Groh MD, Miriam R. Lowe MS, Amanda D. Overgaard BS,Jeanie M. Neal MS, W. Craig Fishburn BS, Douglas P. Zipes MDConclusion: Limited knowledge and negative attitudes of lawenforcement officers regarding their involvement in treating OHCA andusing AEDs are commonly present. These factors could result inbarriers that negatively impact law enforcement AED programs.
  • 9. 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)
  • 10. LAW ENFORCEMENT AGENCYDEFIBRILLATION (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.
  • 11. LAW ENFORCEMENT AGENCYDEFIBRILLATION (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
  • 12. Progress • Evidence continues to support LEA-D concept • More LEA-D programs have been established • Lives are being saved
  • 13. Some Ongoing Issues• What agencies should adopt? • Integration • Dispatch policies • Medical oversight • Training • Liability• Program/system coordination • Quality monitoring
  • 14. Newman et al. NCED POSITION STATEMENT: LAW ENFORCEMENT AGENCY DEFIBRILLATIONPREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3
  • 15. Anecdotes• Agency removes AEDs because they did not work on dogs ABC’s are alive and well?• State efforts did not include dispatch policies
  • 16. 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 DEFIBRILLATIONPREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3
  • 17. 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 DEFIBRILLATIONPREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3
  • 18. 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 DEFIBRILLATIONPREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3
  • 19. 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 DEFIBRILLATIONPREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3
  • 20. 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 DEFIBRILLATIONPREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3
  • 21. 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 casesNewman et al. NCED POSITION STATEMENT: LAW ENFORCEMENT AGENCY DEFIBRILLATIONPREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3
  • 22. 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 effectivenessNewman et al. NCED POSITION STATEMENT: LAW ENFORCEMENT AGENCY DEFIBRILLATIONPREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3
  • 23. 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 competencyNewman et al. NCED POSITION STATEMENT: LAW ENFORCEMENT AGENCY DEFIBRILLATIONPREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3
  • 24. 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 trendsNewman et al. NCED POSITION STATEMENT: LAW ENFORCEMENT AGENCY DEFIBRILLATIONPREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3
  • 25. 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
  • 26. Why do you want to have AEDcapabilities 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
  • 27. What barriers are impeding youragency getting AED capability? • Training Costs • Need for policy changes • High equipment cost • Union / Collective bargaining issues Source: Massachusetts LEA Survey 2006
  • 28. 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 • TBDSource: Massachusetts LEA Survey 2006
  • 29. OTHER CONSIDERATIONS?
  • 30. 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 cardiaccare is for police officers who are already mobile and deployed throughout ourcommunity to be trained and to respond immediately with AEDs and otherlifesaving skills and equipment. To enhance that the department is working withthe AHA to enhance public and professional education, expand our public accessAED program and assure the highest quality pre-arrival instructions given by our9-1-1 dispatchers prior to the arrival of our police officer first responders".- Chief Michael Spera
  • 31. The Old Saybrook Department of Police Services providesall first responder services in the town of Old Saybrook.Recently, the department’s police officers / firstresponders have all completed 90 hours of training andhave upgraded their credentials from Emergency MedicalResponder to Emergency Medical Technician. Some of theunintended consequences include improved lines ofcommunication between the first responders andparamedics. Additionally, there has been appreciableimprovement in feedback about cases and an iterativeprocess where the first responders are learning to betterwork with the paramedics and improve quality andtimeliness of care."Our patrol division members were so passionate about upgrading their trainingthat they voluntarily gave up their overtime and rearranged their vacationschedules to take the required 90 hours of training to earn their EMTcertifications 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
  • 32. 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 toimproving recognition, response, care and outcomes in Old Saybrook. Icommend Chief Spera, EMS Director Coco, and all the integrated agencies andsupporters of this effort. This community can serve as an excellent role modelfor others”.– David Hiltz, NREMT-P, American Heart Association
  • 33. Your TRUSTEDTraining Partner
  • 34. OFFICERScan trainOFFICERS
  • 35. Summary We need to influence more agencies and individual officers not only toadopt but to establish the system in amanner that brings about the greatestdegree of efficiency and effectiveness