An Opportunity for aLaw EnforcementAgency toSave LivesWritten by David Hiltz, American Heart Associationand Phil Coco, Old...
Old Saybrook Police: Leading Efforts to Improve Emergency Care                                    Recently, the Old Saybro...
Optimizing 9-1-1                                     The Old Saybrook Department of Police Services                       ...
Integration with EMSOfficers from the Old Saybrook Department of PoliceServices enjoy an excellent relationship with the O...
Arresting V-Fib with Early Defibrillation                               All police cruisers are equipped with AEDs and rap...
HEARTSafeAppropriately, Old Saybrook has submitted an application to be designated by theConnecticut Department of Public ...
Other Remarks                             A lead agency for improving outcomes, EMD, efforts to                           ...
About the Old Saybrook Department of Police Serviceshttp://www.oldsaybrookct.org/pages/oldsaybrookct_police/indexAbout the...
RelatedAmerican Heart Association (November 28, 2005). 2005 American Heart Associationguidelines for cardiopulmonary resus...
Newman, M.M., Mosesso, V.N. Jr., Ornato, J.P., Paris, P.M., Andersen, L., Brinsfield, K.,Dunnavant, G.R., Frederick, J., G...
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Opportunity for law enforcement agencies to save lives

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Old Saybrook Police: Leading Efforts to Improve Emergency Care.

Half of men and women in western society with serious coronary artery disease experience their first signs of the disease in a dramatic way—sudden cardiac arrest.

Whether a victim lives or dies at this point depends on whether the collapse is witnessed, if the people who are there are trained and willing to perform CPR, and whether the arrest has occurred in a system that can bring about early arrival of needed resources and timely execution of evidence based interventions.

Many have recognized the need to improve community systems of emergency cardiovascular care to optimize patient survival. The "Chain of Survival" represents the current approach to improving recognition, response, care and outcomes.

The American Heart Association estimates that if communities could achieve a 20% survival rate, an estimated 50,000 lives could be saved each year. One potential strategy for delivering early CPR and rapid defibrillation in the out of hospital setting includes the utilization of law enforcement agency (LEA) personnel.

Indeed, in many communities, LEA units are frequently on patrol and can respond immediately to emergencies. With this in mind, LEA can often arrive on scene before EMS units and begin time sensitive treatments. Furthermore LEA has an established role as “guardians of public safety”.

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.

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Opportunity for law enforcement agencies to save lives

  1. 1. An Opportunity for aLaw EnforcementAgency toSave LivesWritten by David Hiltz, American Heart Associationand Phil Coco, Old Saybrook Department of Police ServicesHalf of men and women in western society with serious coronary artery diseaseexperience their first signs of the disease in a dramatic way—sudden cardiac arrest.Whether a victim lives or dies at this point depends on whether the collapse iswitnessed, if the people who are there are trained and willing to perform CPR, andwhether the arrest has occurred in a system that can bring about early arrival ofneeded resources and timely execution of evidence based interventions.Many have recognized the need to improve community systems of emergencycardiovascular care to optimize patient survival. The "Chain of Survival" represents thecurrent approach to improving recognition, response, care and outcomes.The American Heart Association estimates that if communities could achieve a 20%survival rate, an estimated 50,000 lives could be saved each year. One potentialstrategy for delivering early CPR and rapid defibrillation in the out of hospital settingincludes the utilization of law enforcement agency (LEA) personnel.Indeed, in many communities, LEA units are frequently on patrol and can respondimmediately to emergencies. With this in mind, LEA can often arrive on scene beforeEMS units and begin time sensitive treatments. Furthermore LEA has an established roleas ―guardians of public safety‖.
  2. 2. Old Saybrook Police: Leading Efforts to Improve Emergency Care 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 toTransforming Police Emergency Medical Responders into and be trained and to respond immediately with AEDs and other lifesaving skills equipment. To enhance that the department is working with the AHA to enhance publicEmergency Medical Technicians in Old Saybrook 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 SperaThe Old Saybrook Department of Police Services provides allfirst responder services in the town of Old Saybrook. Recently,the department’s police officers / first responders have allcompleted 90 hours of training and have upgraded theircredentials from Emergency Medical Responder to EmergencyMedical Technician. As part of this program, each member hasdone a 10 hour ride-along with a Middlesex Hospital paramedic.This ride-along program has been very beneficial. Some of theunintended consequences include improved lines ofcommunication between the first responders and paramedics.Additionally, there has been appreciable improvement infeedback about cases and an iterative process where the firstresponders are learning to better work with the paramedicsand improve quality and timeliness of care."Our patrol division members were so passionate about upgrading their training thatthey voluntarily gave up their overtime and rearranged their vacation schedules to takethe required 90 hours of training to earn their EMT certifications in order to provide ahigher level of medical care to their patients. This has already resulted in improvedcardiac care‖. - Phil Coco, EMS Director/Instructor
  3. 3. Optimizing 9-1-1 The Old Saybrook Department of Police Services is also acutely aware of the need for an effective 9-1-1 system and serves the public safety answering point for all 9-1-1 calls that are initiated in the town. Each emergency dispatcher is trained and certified as an Emergency Medical Dispatcher (EMD) by the National Academy of Emergency Dispatch. On May 1st the department launched a new initiative to earn the National Academy of Emergency Dispatch Accredited Center of Excellence status. To achieve this, a department must meet or exceed twenty standards that ensure that the community is receiving the best possible services from the dispatch center in terms compliance to strict protocols including their ability to properly identify patients in need of CPR and to provide instructions to insure proper CPR begins even before the professional first responders arrive.To support this effort, the department has begunusing a computerized version of the AdvancedMedical Priority Dispatch System – known as ProQA.The department’s EMS director is a nationallycertified EMD instructor and quality assurancereviewer. Beginning on June 1, 2011, thedepartment will begin a process of reviewing 100%of all requests for emergency medical servicehandled by OSPD ECC EMDs. Their compliance toprotocol will be measured using the establishedscoring standards as published by the NationalAcademy of Emergency Dispatch with feedbackprovided to each EMD. Their goal is to reachaccreditation level compliance to protocol and meetor exceed all twenty standards.
  4. 4. Integration with EMSOfficers from the Old Saybrook Department of PoliceServices enjoy an excellent relationship with the OldSaybrook Ambulance Association, who providesemergency service and transportation to area hospitals.The Old Saybrook Ambulance Association is a volunteer,non-profit organization that is on call 24 hours each day.The Police Department, Ambulance Associationand Middlesex Hospital EMS collaborate to thefullest extent to enhance multi-agencyresponse, coordination of care and outcomes.Citizen CPR Immediate bystander recognition of cardiac arrest and 9-1-1 activation are critical. In many communities, these actions may be significantly delayed. Initial care in the first critical minutes after SCA, including performance of CPR and potential use of an automated external defibrillator (AED) depends on the actions of people near the victim.Knowing that CPR is a highly accessible therapy that requires little medical training andno equipment when provided in its most basic form, the Old Saybrook Department ofPolice Services is committed to developing and initiating a Hands-Only Citizen CPRcampaign, and improve bystander CPR rates in the community. The Old SaybrookDepartment of Police Services also provides resuscitation education to those who seek itas an Authorized Provider of American Heart Association ECC Programs.
  5. 5. 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.Playing a Role in STEMIThere is improved feedback about cases and the firstresponders have been trained to help the paramedicsprepare patients for paramedic assessment includingbeing sure that all patients presenting with coronarysymptoms have had their shirts removed prior toparamedic arrival to facilitate faster 12-lead EKG. The firstresponders have also been trained to set up the 12-leadEKG for the paramedic, to apply the cardiac monitor andset-up IV equipment while the paramedic performs othertasks as our system is a single paramedic system. This isall designed to expedite care and facilitate faster transferto a PCI center when appropriate.Measuring and ImprovingIn another cooperative effort with the local ambulance service, Middlesex Hospital andthe American Heart Association, the police department EMS division is working toestablish standards to determine the town’s cardiac arrest save rate. Using a three yearretrospective study of cases along with an ongoing study of prospective cases we willestablish the rate, control chart changes made within the EMD and EMS programs andtry to identify positive trends. This will allow the group to measure the impact of futureprograms and enable modifications and the sharing of results as appropriate. ―Middlesex Hospital EMS has been proudly supporting the efforts of the Old Saybrook Department of Police Services to improve cardiac arrest outcomes. By assisting with data collection and deploying quality improvement resources, we are confident all the tools necessary are available to achieve this great goal.‖ - Jim Santacroce, Middlesex Hospital EMS Manager
  6. 6. HEARTSafeAppropriately, Old Saybrook has submitted an application to be designated by theConnecticut Department of Public health as a HEARTSafe Community and is hopefulthat they will be approved. We know that the signs will bring pride and ongoinginspiration to this community.CT HEARTSafe Criteria1. Conduct community CPR and/or CPR/AEDtraining sessions. The number of heartbeatsearned and required depends on communitypopulation.2. Placement of a permanent AED with AED-trained personnel in public or private areaswhere many people are likely to congregateor be at higher risk for cardiac arrest.3. Community has a designated First Responder.4. All EMS first response-designated vehicleshave been equipped with AEDs and staffedwith currently certified CPR/AED personnel.5. Advanced Life Support personnel will bedispatched to all ALS medical emergencies.*Optional - Not Required: EMS response with12-lead ECG capability to calls for chest painof suspected ischemic origin.6. An ongoing process to evaluate and improvethe ―Chain of Survival‖ in the community.
  7. 7. Other Remarks A lead agency for improving outcomes, EMD, efforts to improve citizen CPR, support and monitoring of publically placed defibrillators, rapid response by trained and equipped officers, integrated care with EMS, an evolving STEMI system of care, data collection and quality improvement…what a great combination.―I have been so very impressed with the attention and commitment to improvingrecognition, response, care and outcomes in Old Saybrook. I commend Chief Spera,EMS Director Coco, and all the integrated agencies and supporters of this effort. Thiscommunity can serve as an excellent role model for others‖.– David Hiltz, NREMT-P, American Heart AssociationDavid Hiltz is with the American Heart Association’s Emergency Cardiovascular CarePrograms and has a special interest in systems of care and resuscitation. David hascontributed to the development of numerous AHA initiatives and is active on task forcesrelated to EMS and resuscitation.Phil Coco is the Director of Emergency Medical Services for the Old Saybrook PoliceDepartment and Paramedic for Middlesex Hospital where he has served for 24 years.Phil is an Emergency Medical Services Instructor, Fellow and Instructor with theNational Academy of Emergency Dispatch, Deputy Fire Marshal, Fire Officer andInstructor and an American Heart Association Instructor for BLS, ACLS and PALS and amember of the FEMA EMS national incident management leadership team.Michael Spera is the Chief of Police and Emergency Management Director in OldSaybrook. Chief Spera is the President of the Connecticut Emergency ManagementAssociation, a Firefighter/Paramedic and Emergency Medical Services Instructor for theState of Connecticut. Additionally, Chief Spera is a Homeland Security CoordinatingCouncil Member, Chairman for the Municipal Safety Committee and a graduate of theFBI National Academy with a Bachelor of Science in Public Safety Administration.
  8. 8. About the Old Saybrook Department of Police Serviceshttp://www.oldsaybrookct.org/pages/oldsaybrookct_police/indexAbout the American Heart Associationhttp://www.heart.org/HEARTORG/Old Saybrook cops taking EMT classes en masse (video)http://www.nhregister.com/articles/2011/02/21/news/shoreline/bb1_mon_ospoliceemts_art022011.txtPolice Toolkit from the Resuscitation Academyhttp://www.resuscitationacademy.org/downloads/PoliceDefibrillationToolkit_1010.pdfThe Shocking Truth about Cops and Defibrillationhttp://www.slideshare.net/Hiltz/the-shocking-truth-about-cops-and-defibrillationVideoshttp://www.npssinc.org/html/aed_awareness.html
  9. 9. RelatedAmerican Heart Association (November 28, 2005). 2005 American Heart Associationguidelines for cardiopulmonary resuscitation and emergency cardiovascular care:Part 5: electrical therapies: automated external defibrillators, defibrillation,cardioversion, and pacing. Circulation: Journal of the American Heart Association.(p. 35-46).Brillhart, A.M., Rea, T.D., Becker, L., Eisenberg, M.S. & Murray, J.A.(October/December 2002). Time to first shock by emergency medical technicians withautomated external defibrillators, Prehospital Emergency Care. Vol. 6, No. 4, (p.373-377).CPR facts and statistics as viewed on the American Heart Association website:http://www.americanheart.org/print_presenter.jhtml?identifier=3034352Department of Emergency Medicine, Medical College of Virginia, VirginiaCommonwealth University Health Center (2003). The public access defibrillation (PAD)trial study design and rationale. Resuscitation. 56, (p.135-147).Joglar, J.A. & Page, R.L. (August 27, 2002). Automatic external defibrillator use bypolice responders: where do we go from here? Circulation: Journal of the AmericanHeart Association. (p. 1030-1033).Lerner, E.B., Billittier, A.J., Newman, M.M., & Groh, W.J. (October / December 2002).Automatic external defibrillator (AED) utilization rates and reasons fire and police firstresponders did not apply AEDs. Prehospital Emergency Care. Vol. 6, No.4., (p.378-382).Martinez-Rubio, A. & Baron-Esquivias, G. (2004). The automatic external cardioverterdefibrillator. Indian Pacing and Electrophysiology Journal. Vol. 4, No.3, (p. 114-121).Mosesso, V.N. Jr., Newman, M.M., Ornato, J.P., Paris, P.M., Anderson, L., Brinsfield,K., Dunnavant, G.R., Frederick, J. Groh, W.J. Johnston, S., Lerner, E.B., Murphy, P.G>,Myerburg, R.J., Rosnberg, D.G., Saviano, M., Sayre, M.R., Sciammarella, J., Schoen, V.Vargo, P., van Alem, A., & White, R.D. (July/September 1997). Law enforcementagency defibrillation (LEA-D): proceedings of the National Center for EarlyDefibrillation Police AED Issues Forum. Prehospital Emergency Care. Vol. 6, No. 3.Myerburg, R.J., Fenster, J., Velez, M., Rosenberg, D., Lai, S., Kurlansky, P., Newton,S.,Knox, M. & Castellanos, A. (Aug 27, 2002). Impact of community-wide police cardeployment of automated external defibrillators on survival from out-of-hospital cardiacarrest. Circulation: Journal of the American Heart Association. (p. 1058-1064).
  10. 10. Newman, M.M., Mosesso, V.N. Jr., Ornato, J.P., Paris, P.M., Andersen, L., Brinsfield, K.,Dunnavant, G.R., Frederick, J., Groh, W.J., Johnston, S., Lerner, E.B., Murphy, G.,Myerburg, R.J., Rosenberg, D.G., Savino, M., Sayre, M.R., Sciammarella, J., Schoen, V.,Wargo, P., van Alem, A. & White, R.D. (1991). Law enforcement agency defibrillation(LEA-D): position statement and best practices recommendations from the NationalCenter for Early Defibrillation, National Center for Early Defibrillation, (p.346-347).Nichol,, G., Hallstrom, A.P., Ornato, J.P., Riegel, B., Stiell, I.G., Valenzuela, T., Wells,G.A., White, R.D. & Weisfeldt, M.L. (April 7, 1998). Potential cost-effectiveness ofpublic access defibrillation in the United States. Circulation: Journal of the AmericanHeart Association. (p. 1315-1320).Nolan, R.P., Wilson, E., Shuster, M., Rowe, H., Stewart, D. & Zambon, S. (1999).Readiness to perform cardiopulmonary resuscitation: an emerging strategy.Psychosomatic Medicine, 61, 546-551.Pepe, P.E. & Mosesso, V.N.. (January/March 2000) All-advanced life support vs. tieredresponse ambulance systems. Prehospital Emergency Care. Vol. 4, No. 1, (p. 1-6).Van Alem, A.P., Vrenken, R.H., de Vos, R., Tijssen, J.G.P. & Koster, R.W. (December6, 2003). Use of automated external defibrillator by first responders in out of hospitalcardiac arrest: prospective control trial. British Medical Journal. Vol. 327, p.1-5.

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