Medical Emergency Response Planning Schools

Response to Cardiac Arrest and Selected Life-Threatening Medical Emergencies Presented by The New England Community Strategies Council

American Heart Association Training
Programs Are Discussed In This
Presentation.
Disclosures

ECC Mission
Build healthier lives, free of cardiovascular diseases and
stroke by improving the Chain of Survival in every
community.
This is accomplished by improving the quality of
resuscitation provided by all rescuers and increasing the
probability that collapsed victims will receive prompt CPR.
CPR Facts and Statistics Adobe PDF, File Size 76.0 KB

Preventing Unnecessary Death from SCA
Bystander CPR rates are less than 30%
Many deaths from SCA can be prevented
Survival rates after
cardiac arrest almost
double when CPR is
initiated and access to
a defibrillator is provided

Educational Objectives
Review and understand the related evidence based guidelines and recommendations
Learn about innovative strategies for the delivery of CPR education
Use these guidelines and recommendations in establishing response plans in schools

Life-threatening emergencies can happen in any school at any time as a result of preexisting health problems, violence, unintentional injuries, natural disasters, and toxins. In recent years, stories in the press have documented tragic premature deaths in schools from SCA, blunt trauma to the chest, firearm injuries, asthma, head injuries, drug overdose, allergic reactions, and heatstroke.

Life-threatening
emergencies in
schools are uncommon.
When they do occur,
they require a planned,
practiced, and efficient
response.

Case for Support
School nurses, athletic
trainers, and
teachers are often
required to provide
emergency care.
Gagliardi M, Neighbors M, Spears C, et al. Emergencies in the school setting: are public school teachers adequately trained to respond? Prehosp Disaster Med . 1994;9:222–225. Sapien RE, Allen A. Emergency preparation in schools: a snapshot of a rural state. Pediatr Emerg Care . 2001;17:329–333.

Children and Adults
School medical emergencies can involve students or adults.
All schools have adult faculty and staff, and most schools host large numbers of adults during extracurricular activities.

Injury vs. Illness Causes
1. Prevention of injury and other causes of cardiac arrest
2. Early CPR
3. Early activation of the EMS system
4. Early advanced care
The American Heart Association in collaboration with the International Liaison Committee on Resuscitation. Part 9: pediatric basic life support. In: Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care . Circulation. 2000;102(suppl 8):I-253–I-290.

SCA in the Young
A reality…

Ventricular Fibrillation
Liberthson RR. Sudden death from cardiac causes in children and young adults. N Engl J Med . 1996;334:1039–1044.
Maron BJ, Thompson PD, Puffer JC, et al. Cardiovascular preparticipation screening of competitive athletes: addendum. An addendum to a
statement for health professionals from the Sudden Death Committee (Council on Clinical Cardiology) and the Congenital Cardiac Defects
Committee (Council on Cardiovascular Disease in the Young), AmericanHeart Association. Circulation . 1998;97:2294.
Maron BJ. Sudden death in young athletes. N Engl J Med . 2003;349:1064–1075.

SCA in Adults
SCA is a leading cause of death for adults 35 to 40 years of age and is the most common cause of death for those 45 years of age
The risk of SCA in adults is100 to 200 times the estimated risk in children and adolescents and those under 35
The American Heart Association in collaboration with the International Liaison Committee on Resuscitation. Part 4: the automated external defibrillator: key link in the chain of survival. In: Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care . Circulation. 2000;102(suppl 8):I-60–I-76. Kannel WB, Wilson PW, D’Agostino RB, et al. Sudden coronary death in women. Am Heart J . 1998;136:205–212. de Vreede-Swagemakers JJ, Gorgels AP, Dubois-Arbouw WI, et al. Out-of-hospital cardiac arrest in the 1990’s: a population-based study in the Maastricht area on incidence, characteristics and survival. J Am Coll Cardiol . 1997;30:1500–1505. Kuisma M, Maatta T. Out-of-hospital cardiac arrests in Helsinki: Utstein style reporting. Heart . 1996;76:18–23.

Survival

Nurse? Not Always!

MERPS Elements
1. Effective and efficient communication
throughout the school campus
2. Coordinated and practiced response plan
3. Risk reduction
4. Training and equipment for first aid and
CPR
5. Implementation of a lay rescuer AED
program

Effective Communications
Establish a rapid communication
System linking all parts of the
school campus, including
outdoor facilities and practice
fields, to the EMS system
Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers .

Coordinated Response Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers .

Risk Reduction
Prevent injuries
Identify those at risk
Training and equipment

Training and Equipment Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers .

Sample First Aid Kit

AED Program
Medical/healthcare provider oversight
Training and use of the AED
Coordination with the EMS
Device maintenance
Ongoing quality improvement

CPR Training

Accessibility Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers .

AED?
“ EMS call–to-shock interval of 5 minutes
cannot be reliably achieved with
conventional EMS services…”

Calculating Risk

When funds are limited, but there is a desire to establish some AED school programs, priority should be given to establishing programs in large schools, schools used for community gatherings, schools at the greatest distance from EMS response, and schools attended by the largest number of adolescents and adults (eg, high schools and trade schools).

Location of AED Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers .

Estimation of Costs

Legislative Mandates Unfunded legislative mandates, particularly those that address the purchase of equipment rather than programs of planned response, will limit effectiveness and place a substantial burden on school budgets

MERPS Conclusions
The medical emergency response plan
includes:
1. Communication system
2. Coordination
3. Risk reduction
4. Training in and equipment
5. AED program when need identified

Staying Alive!

Teaching Students CPR
To increase bystander CPR and accelerate CPR education, creative new approaches exist to reach a larger public audience
The development and validation of a 22-minute self-instructional CPR course has provided a tool for educating large numbers of school-aged children
This presentation will also provide an overview of schools that have implemented training for their student bodies and how this may impact survival from SCA

Reducing Barriers is Key
Bystander CPR can substantially improve rates of survival from SCA
CPR is a highly accessible therapy that requires little medical training and no equipment when provided in its most basic form
Potential rescuers from school age to the elderly can learn CPR skills
Survival rates from witnessed SCA associated with ventricular fibrillation have been reported to be as high as 49% to 74%
Equipping the public with the skills to perform the first 3 links in the AHA chain of survival can make a dramatic difference in survival from SCA
http:// www.americanheart.org/presenter.jhtml?identifier =3054555

Why Train the Public?
Once called, EMS systems in the
U.S. have an average response
time of about 4 to 7 minutes;
for some it is over 10 minutes
80% of all out-of-hospital
cardiac arrests occur in
the home
Relatives are frequent
witnesses to cardiac arrests

Students and CPR

CPR Anytime
A personal, inflatable CPR manikin, “Mini Anne”
An American Heart Association Family & Friends ™ CPR booklet
CPR Skills Practice DVD
Accessories for the program

School Successes in Other Countries
Funded by an insurance company foundation
50% of schools
2.5 multiplier
120,000 citizens* trained in under 6 weeks
* 2.2% of the total population
Denmark schools program

School Successes in Other Countries
Funded by donations through the Norwegian Air Ambulance
98% of schools
2.5 multiplier
200,000 citizens* trained in under 6 weeks!
* 4.3% of the total population
Norway schools program

Schools in New England
Boston, MA
Funded by the Boston Public Health Council and donations
>3,000 trained
2.5 multiplier
7,500 citizens* trained!

Providence, RI
Funded by donations through Heart Safe Foundation
>2,000 trained
2.5 multiplier
5,000 citizens* trained!

Westborough, MA
Funded by the Metro West Community Healthcare Foundation
300 students in a day
2.5 multiplier
750 citizens* trained!

Teaching Students CPR Conclusion
To increase bystander CPR and accelerate CPR education, creative new approaches exist to reach a larger public audience
The development and validation of a 22-minute self-instructional CPR course has provided a tool for educating large numbers of school-aged children

When IT Happens… Which Story Will be YOURS ?

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Medical Emergency Response Planning Schools

by David Hiltz

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