The Shocking Truth About Cops And Defibrillation

The Shocking Truth About Cops and Defibrillation

Conflict of Interest

Hiltz No disclosures

Greenhalgh No disclosures

Objectives

Learn about the evidence supporting LEA defibrillation strategies and LEA defibrillation best practices including examples of effective implementation.

Review results of a survey of LEA in Massachusetts in order to better understand LEA attitudes towards resuscitation.

Discuss advancement of LEA defibrillation strategies and help save lives.

Guidelines 2005

“ CPR and AED use by public safety first responders

(traditional and nontraditional) are recommended to

increase survival rates for SCA (Class I)!

This is NOT a new recommendation DOI: 10.1161/CIRCULATIONAHA.105.166554

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.

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.

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.

Literature Review

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 (eg, 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.

Literature Review

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…

Literature Review

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.

Literature Review

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.

Literature Review

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.

IACP and IAFC

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)

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.

Great reference paper

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

NCED no longer intact but recommendations remain

Progress

Evidence continues to support LEA-D concept

More LEA-D programs have been established

Lives are being saved

Some Ongoing Issues

What agencies should adopt?

Integration

Dispatch policies

Medical oversight

Training

Liability

Program/system coordination

Quality monitoring

And add union resistance in some cases

Anecdotes

Agency removes AEDs because they did not work on dogs

State efforts did not

include dispatch policies

ABC’s are alive and well.

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

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).

3. Strong champions who serve as program advocates

Strong champions, such as police officers, community leaders, and survivors, actively promote the program.

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.

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)

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

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

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

CQI processes are established to ensure excellence

A data collection tracking process is established to monitor response and outcome information and survival trends

10. An effective CQI program that includes written policies, data collection and analysis Newman et al. NCED POSITION STATEMENT: LAW ENFORCEMENT AGENCY DEFIBRILLATION PREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3

Massachusetts LEA Survey

What do police agencies think?

Massachusetts LEA Survey

Survey Background

Target group: Massachusetts Municipal Law Enforcement

Survey conducted: Spring/Summer 2006

# of surveys distributed 351

# of surveys returned 124 (35.33%)

Of those returned

with AEDS : 114 (91.94%)

without AEDs: 1 10 (08.06%)

AED Units

684+ AEDs are placed in total within the departments that returned their surveys

Some departments gave vague responses as to actual number of units but stated that they had them – these departments were counted as having “1” Source: Massachusetts LEA Survey 2006

Types of AED Units Source: Massachusetts LEA Survey 2006 100.00 684 Total: 8.04 55 Unknown 0.15 1 Defib Tech 2.05 14 SurvivaLink 4.82 33 Laerdal 9.94 68 Cardiac Science 11.55 79 Philips 13.01 89 Zoll 50.44 345 Medtronic/Physio-Control % of Total # of Units Manufacturer

Factors in getting AED Units (Total n=114) Source: Massachusetts LEA Survey 2006 11 Requirement 7 Community influence / “Right thing to do” 3 FD influence 2 Union influence 18 Donations / Grants 1 Improved technology 1 Research 5 No answer 29 First on scene / other services delayed 37 Life saving potential / statistical data on saves # Factor

Towns with AEDs - Comments

Proven value of AED devices

Better serve residents and visitors of community successfully implemented AED program in neighboring town

The number of lives that can be saved by using AED's

Would like to bring AED to save lives

The need to service our community

The potential to save lives, including our staff

Source: Massachusetts LEA Survey 2006

Obstacles Encountered in Getting AEDs Source: Massachusetts LEA Survey 2006 2 Unknown 1 Maintenance Concerns 1 FD Compatibility 3 Attitude 10 Training Issues 20 Union / Collective Bargaining 46 None 46 Financial # Obstacle

How Were Obstacles Overcome? Source: Massachusetts LEA Survey 2006 7 Department funds 6 Department education 6 Contractual – Stipend 3 Contractual – Mandatory 9 Contractual – Union Bargaining 17 N/A 2 EMS 2 Public education 2 Time/patience 35 No response 1 Unknown 16 Donations 19 Grants # Obstacles overcome by:

Do officers receive compensation for being trained? Source: Massachusetts LEA Survey 2006 4 58 52 # 3.51 N/A 50.8 No 45.6 Yes % Compensated?

Type of compensation received (Total n=52) Source: Massachusetts LEA Survey 2006 1.923 1 $300 1 1 3 1 3 2 1 1 2 # 1.923 $475 1.923 $750 1.923 $725 5.769 $500 5.769 $400 3.846 $250 1.923 $200 1.923 $150 3.846 $100 % Type 1.923 1 $325 (x1) 5.769 3 Unknown % 4 18 1 1 1 6 1 # 34.615 Unknown $ 7.692 Unknown 1.923 None 1.923 1% (x1) 1.923 2.5% 11.538 1.0% 1.923 0.5% % Type

Have officers used their AED? (Total n=114) Source: Massachusetts LEA Survey 2006 5 23 86 # 4.386 Unknown 20.175 No 75.439 Yes % AEDs Used

Have officers had any “saves” using their AED? (Total n=86) Respondent self-reported “saves” Some departments claimed multiple saves but did not give a number – only credited with “1” save for this report Source: Massachusetts LEA Survey 2006 16 18 52 # 18.605 Unknown 20.930 No 60.465 Yes % Patient Saves

Has your agency had any training issues? (Total n=114) Source: Massachusetts LEA Survey 2006 32 71 11 # 28.070 Unknown 62.281 No 9.649 Yes % Any Issues?

What were the training issues? (Total n=11) Source: Massachusetts LEA Survey 2006 09.090 1 Using obsolete equipment 09.090 1 Learning new protocols 1 2 6 # 09.090 Unknown / Unspecified 18.182 Financial 54.545 Yearly in-service training % Issue

Is you community “ HEART Safe”? (Total n=114) Source: Massachusetts LEA Survey 2006 06.140 7 In-Process 29.825 34 Unknown 27 46 # 23.684 No 40.351 Yes % HEART Safe ?

Can the AHA help? (Total n=126) Source: Massachusetts LEA Survey 2006 41 67 18 # 32.539 No response 53.175 No 14.286 Yes % Help?

Summary of help sought from the AHA

Advocate the government to provide AEDs

Donate equipment and/or money

Guidelines on unit maintenance

Work to get the unit cost decreased

Provide information on funding and grant opportunities/sources

Would you recommend getting AEDs to another Chief LEO? (Total n=114) Source: Massachusetts LEA Survey 2006 1.754 2 N/A 10.526 12 Unknown 3 97 # 2.632 No 85.088 Yes % Recommend?

Does your department want to have AED capabilities? (Total n=10) Source: Massachusetts LEA Survey 2006 3 7 # 30.000 No Response 70.000 Yes % Want AEDs?

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 staff

Source: Massachusetts LEA Survey 2006 VALUE

What barriers are impeding your agency getting AED capability?

Training Costs

Need for policy changes

High equipment cost

Union / Collective bargaining issues

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

Is there anything that the AHA could do to make it easier for you or to assist you in breaking down some of these barriers?

As Chief I would welcome a visit from the American Heart Association. However, it is the union who needs to be convinced

Potentially

Because of a budget crisis a visit would not influence the decision at this time

Not at this time

Limitations of this study

Study focused on agency perspectives vs. individual perspectives

Regional focus / attitudes

Influence of person completing survey

Interpretation of survey questions

Repeat the survey to see current activities, issues, and trends

Conduct the same survey in other geographical locations

Conduct a survey with individual officers to get a personal perspective

Future study needs / Next steps

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

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