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Sentinel
 
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Author(s): Webber And Doyle

Author(s): Webber And Doyle

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    Sentinel Sentinel Presentation Transcript

    • SENTINEL A systematic approach to the early recognition of drowning. The right response, to the right victim, at the right time Billy Doyle EMT-P BHSc MS PGDipHSc Jonathon Webber RN BHSc DipMgt CertAmb Consultant Lifeguards | AquaSafe New Zealand
      • Background to Sentinel
      • The Sentinel System
      • The Science of Sentinel
      • Applying the Model
      • Summary
      Presentation Overview
    • Background to Sentinel
      • Not all behaviour displayed in the surf environment is indicative of drowning
      • Our research has identified some lifeguards fail to recognise the seriousness of the behaviour they observe
    •  
      • How do we decide which of these victims have an imminent threat to life and which do not?
      • Is there a way of classifying drowning behaviour as it relates to ‘threat to life’?
      Problem Statement
    • SENTINEL SYSTEM FOR DROWNING RISK STRATIFICATION Detection Process of Drowning At Risk of Drowning STATUS ONE TWO THREE FOUR FIVE Threat to Life IMMEDIATE IMMINENT SERIOUS LOW NIL Stage of Drowning Terminal Crisis Distress High Risk* Low Risk* Behaviour Displayed
      • Involuntary submersion
      • Floating “face down”
      • Unconscious
      • Cardiac or respiratory arrest
      • Witnessed seizure in water
      • Instinctive drowning response (as described by Frank Pia)
      • Unable to signal or call for help
      • Signs of distress
      • Loss of flotation
      • May not be able to signal or call for help
      • Not coping with hazards
      • Prolonged period at status 4
      • No signs of distress
      • Afloat; makes poor progress
      • May have flotation device
      • May call or signal for help
      • Coping with hazards
      • No signs of distress
      • Able to support self by standing on ground
      • Effective swimming
      • Can call or signal for help
      • Minimum or no hazards present
    • SENTINEL SYSTEM FOR DROWNING RISK STRATIFICATION Response Process of Drowning At Risk of Drowning STATUS ONE TWO THREE FOUR FIVE Threat to Life IMMEDIATE IMMINENT SERIOUS LOW NIL Stage of Drowning Terminal Crisis Distress High Risk* Low Risk* Response Required
      • Multiple rescue assets deployed
      • Immediate rescue +/- in water BLS
      • Immediate activation of EMS
      • Post rescue care
      • Data collection
      • Urgent rescue
      • Immediate in water support (especially airway)
      • Post rescue care
      • Data collection
      • Expedient rescue
      • Post rescue care
      • Data collection
      • Continued surveillance
      • Possible extraction from hazard or education
      • Post rescue care
      • Data collection
      • Surveillance
      • Primary drowning prevention (education)
    • 1 Adapted from: Szpilman, D. Circulation 2000;102: I 233-36 2 Based on: Australasian College for Emergency Medicine. Policy on the Australasian Triage Scale (Reviewed) 2006; P06 SENTINEL SYSTEM FOR DROWNING RISK STRATIFICATION Patient Assessment & Care REASSESS    STATUS ONE STATUS TWO STATUS THREE STATUS FOUR STATUS FIVE Threat to Life IMMEDIATE IMMINENT SERIOUS LOW NIL Drowning Classification and Treatment ¹ Respiratory or Cardiac Arrest Large amount of foam in mouth or nose; no radial pulse,  LOC Large amount of foam in mouth or nose; radial pulse present Small amount of foam in mouth or nose Cough, without foam in mouth or nose Suction CPR with high-flow oxygen & bag/mask Suction High-flow oxygen Monitor breathing Recovery position Suction High-flow oxygen Recovery position Oxygen Warm and calm the victim Warm and calm the victim Oxygen not normally required EMS Response Priority 1 Dispatch Priority 1 Dispatch Priority 1 Dispatch Priority 2 Dispatch Priority 3 Dispatch (or N/A) Hospital Response ² Trauma call; seen immediately Trauma call; seen within 10 mins Triage: seen within 30 mins Triage; seen within 60 mins Triage: seen within 120 mins Mortality ¹ 44 – 93% 19.4% 5.2% 0.6% 0%
    • © 2007 AquaSafe New Zealand Limited SENTINEL SYSTEM FOR DROWNING RISK STRATIFICATION Lifesaving Skills Required STATUS ONE TWO THREE FOUR FIVE Threat to Life IMMEDIATE IMMINENT SERIOUS LOW NIL Lifesaving Education
      • In-water resuscitation
      • CPR
      • Oxygen, bag/mask, oral airways, suction , AED
      • Multi-agency response training
      • Drowning classification and treatment
      • In-water resuscitation
      • CPR
      • Oxygen, bag/mask, oral airways, suction , AED
      • Drowning classification and treatment
      • Oxygen therapy, suction
      • Drowning classification and treatment
      • Oxygen therapy
      • Drowning classification and treatment
      • Preventive lifeguarding
      • Drowning classification and treatment
      • Proceedings of the World Congress on Drowning, 2002
      Is there a Missing Link?
      • Multi-centre research is needed to further validate the model
      • The results of an early pilot study look promising
      • Sentinel provides an easy to use, standardised system to report severity of drowning
      • This is especially important when we consider no uniform method exists to measure the number of non-fatal drownings
      Where to from here?
      • 2007 DROWNING
      • STATISTICS
      • _______________________________________________
      • Drownings 77
      • Rescues 1,866
        • Ambulance to hospital 19
        • Assisted from beach 54
        • Treated and released 38
        • Walked off 1,755
      • 2008 DROWNING
      • STATISTICS
      • _______________________________________________
      • Drownings 65
      • Non-fatal Drownings 568
        • Status 1 7
        • Status 2 21
        • Status 3 540
        • At risk of Drowning: 100,791
        • Status 4 (Rescues) 623
        • Status 5 (Prev. Actions) 100,168
      • 25 volunteer lifeguards invited to participate in pilot study
      • All received training on how to use system
      • Primary outcome; time taken (secs) to detect drowning behaviour
      Sentinel Pilot Study
      • Five 4 minute video clips (1 clip per Sentinel status code) of a patrolled ocean surf beach shown to each participant
      • Every 30 seconds a simulated patient ( ∑ 8 ) would begin to display the behaviour described on the Sentinel model
      Data Collection
    •  
    •  
    •  
    •  
      • Probability of detecting status one behaviour in this study using Sentinel criteria is:
      • 0.75
      • (0.25 false positive)
      Results and Discussion
      • You will be shown a series of 5 open-water “drownings”
      • For each clip assign a Sentinel status code to the one person who you consider has the greatest threat to life
      • At the conclusion of the exercise we will discuss the results
      Practical Exercise
    • SENTINEL SYSTEM FOR DROWNING RISK STRATIFICATION Detection Process of Drowning At Risk of Drowning STATUS ONE TWO THREE FOUR FIVE Threat to Life IMMEDIATE IMMINENT SERIOUS LOW NIL Stage of Drowning Terminal Crisis Distress High Risk* Low Risk* Behaviour Displayed
      • Involuntary submersion
      • Floating “face down”
      • Unconscious
      • Cardiac or respiratory arrest
      • Witnessed seizure in water
      • Instinctive drowning response (as described by Frank Pia)
      • Unable to signal or call for help
      • Signs of distress
      • Loss of flotation
      • May not be able to signal or call for help
      • Not coping with hazards
      • Prolonged period at status 4
      • No signs of distress
      • Afloat; makes poor progress
      • May have flotation device
      • May call or signal for help
      • Coping with hazards
      • No signs of distress
      • Able to support self by standing on ground
      • Effective swimming
      • Can call or signal for help
      • Minimum or no hazards present
    •  
    • STATUS 1
    • STATUS 2
    • STATUS 3
    • STATUS 4
    • STATUS 4
      • Sentinel is a drowning risk stratification system that spans from identification in the water through to admission in the hospital emergency department
      • The primary goal of Sentinel is to reduce time to detection of drowning victims and ensure an appropriate response
      • It is hoped that Sentinel will go some way to strengthening the wet “chain of survival” and increase the knowledge surrounding non-fatal drowning by quantifying these outcomes
      • Further multi-centre research is needed to fully validate the model
      Summary
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