TRANSLATING SCIENCE INTO ACTIONS:IMPROVING CARDIAC ARRESTOUTCOMES IN NEW ZEALAND               HEARTSafe Forum For Change ...
3
A NECESSARY COMBINATION!
REGRETABLY…  WE HAVE SOME THINGS IN COMMON
THE MENACE OFSUDDEN CARDIAC ARREST
LOOKING AND SOUNDING      FAMILIAR?
ISSUES SUMMARY 1                 LOOK LIKE THIS?CPR Component       Challenges to Improving QualityRecognition         Fai...
ISSUES SUMMARY 2                   LOOK LIKE THIS?CPR Component               Challenges to Improving QualityCompression I...
THE PEOPLE AREN’T THE PROBLEM!
SYSTEM ISSUES       LOOK LIKE THIS?Many Systems         Ideal SystemNo Data              Data CollectedNo Plan            ...
IMPLEMENTATION??  LOOK LIKE THIS?      IMPROVED      SURVIVAL
WE NEED A HOLISTIC ANDINTERGRATED APPROACH
RAPID DEFIB   QCPR              CITIZEN CPR                                                 POST ROSCRECOGNITION
BRAGGINGRIGHTS!
NEARLY 9 MILLION PEOPLELIVING AND WORKING IN HEARTSafe          COMMUNITIES    NO FORMAL STRUCTURE    NO BOARD OF DIRECTOR...
HAVING CHAMPIONS   IS ESSENTIAL IN DEALING WITH ANTI-CHAMPIONS!
LOCALIZATIONFOR NEW ZEALAND?
A FEW STEPS(AND A FEW ISSUES)         IN ENDING  “SURVIVAL ENVY”
RECOGNITION AND RESPONSE TO EARLY WARNING SIGNS?
http://www.youtube.com/watch?v=xZdq-bZ0cV8
TELEPHONE CPR
CITZEN CPR?
LAW ENFORCEMENT
DID YOUR LAST CARDIAC ARREST       LOOK LIKE THIS?
PRACTICE LIKE YOU PLAY?
12 LEADS FOR ACS/POST ROSC?
THERAPEUTICHYPOTHERMIA?
A CULTURE OF QUALITY?   LOOK LIKE THIS?AN ITERATIVE PROCESS
40
HOW ARE HOSPITALSDOING ON THEIR END?
“Quality CPR is a means to improve survival fromcardiac arrest. Scientific studies demonstratewhen CPR is performed accord...
DRUGS WITH A PROVEN BENEFITIN RESUSCITATION      THE MENACE OF  SUDDEN CARDIAC ARREST
123456
CAN’T WE SOLVE OURPROBLEMS WITH TECHNOLOGY?
TRANSITION:Structured and Supported Debriefing       Our Definition!     A provider‐centric process     designed to standa...
Structured and Supported DebriefingStructured elements include three specific debriefing     phases with related goals, ac...
Thoughtful discussion after an attempted resuscitation is important to facilitate the  sorting out of events as well as ga...
IMPLEMENTATION    •Have long term view   •Patients and patience•INSTANT GRATIFICATION!
BOY, I AM    REALLY   LOOKING FORWARD TO     THEDEBRIEFING ON  THIS CASE!
PROVIDERS NEED TO     EXPRESS THEMSELVES AND THEIR FEELINGS…AND THIS IS A GREAT FORUM FOR THAT!
Team leader trained in Structured    and SupportedDebriefings
SCONE DIPLOMACY!
NOT PUNATIVE!
ROLE OF FACILITATOR•PROVIDE SAFE ENVIRONMENT FOR     SHARING EXPERIENCES •DRAW OUT INFORMATION AND        EXPERIENCES•CONT...
INSTRUMENTEDMANIKINS
PAVE THE ROAD TOIMPROVED SURVIVAL!
HEARTSafe MORRINSVILLE?
Improving Community Based Response to Cardiac Arrest - New Zealand
Improving Community Based Response to Cardiac Arrest - New Zealand
Improving Community Based Response to Cardiac Arrest - New Zealand
Improving Community Based Response to Cardiac Arrest - New Zealand
Improving Community Based Response to Cardiac Arrest - New Zealand
Improving Community Based Response to Cardiac Arrest - New Zealand
Improving Community Based Response to Cardiac Arrest - New Zealand
Improving Community Based Response to Cardiac Arrest - New Zealand
Improving Community Based Response to Cardiac Arrest - New Zealand
Improving Community Based Response to Cardiac Arrest - New Zealand
Improving Community Based Response to Cardiac Arrest - New Zealand
Improving Community Based Response to Cardiac Arrest - New Zealand
Improving Community Based Response to Cardiac Arrest - New Zealand
Improving Community Based Response to Cardiac Arrest - New Zealand
Improving Community Based Response to Cardiac Arrest - New Zealand
Improving Community Based Response to Cardiac Arrest - New Zealand
Improving Community Based Response to Cardiac Arrest - New Zealand
Improving Community Based Response to Cardiac Arrest - New Zealand
Improving Community Based Response to Cardiac Arrest - New Zealand
Improving Community Based Response to Cardiac Arrest - New Zealand
Improving Community Based Response to Cardiac Arrest - New Zealand
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Improving Community Based Response to Cardiac Arrest - New Zealand

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As part of the lead up to World Heart Day, the forum aims to address challenges and identify ways organisations and networks can reach best in class rates for survival throughout New Zealand.
Guest speakers, David Hiltz and Professor Ian Jacobs are key opinion leaders from international best in class survival communities. We are also delighted to bring you Sir Richard Hadlee, himself a cardiac arrest survivor, as the dinner speaker.
The forum will bring these and many other thought leaders together to engage in networking and directed discussion on ways to improve the chain of survival.

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  • There is clearly more to our jobs than lesson maps, toolkits, textbooks and DVDs. We need to feel inspired and translate Guidelines into actionable strategies…ultimately we hope that our actions will result in something remarkable…snatching a life back from death itself!
  • Welcoming remarks and review of objectivesUpon the conclusion of this discussion, you should be able To explain evidence based strategies for improving survival from both in and out of hospital cardiac arrestTo identifyAHA programs and products for use by various groupsTo develop a localized action plan to improve outcomes We hope to provide you all with pragmatic strategies that can be used to improve survival as well as provide access to AHA science, products and programs that are specifically designed to help increase the probability of prompt bystander initiated CPR, and improve the quality of resuscitation provided by all rescuers.Returning a patients prior quality of life and functional state of health is the ultimate goal of a resuscitation system of care.
  • Thisexcellent summary table which continues on the following slide, outlines the key challenges to improve CPR quality and improve survival. As you can see, the challenges span recognition, initiation of CPR, compression rate and depth, incomplete recoil, ADVANCE SLIDEventilation, defibrillation and team performance. Each issue is significant, and if not addressed entirely, prevents optimized survival.The Guidelines for CPR and ECC are designed to address each of these challenges, and help improve outcomes.
  • …ventilation, defibrillation and team performance. Each issue is significant, and if not addressed entirely, prevents optimized survival.The Guidelines for CPR and ECC are designed to address each of these challenges, and help improve outcomes.
  • In this chart, we contrast between a majority of systems with that of an ideal, or more optimized resuscitation system. Regretfully, many systems do not collect meaningful data relating to cardiac arrest, employ fragmented efforts to improve survival, and often lack substantive plans.The American Heart Association would like to help. Full implementation of Guidelines, with data collection, planning and implementation of a broad based strategy is the best recommendation for improving survival from sudden cardiac arrest, acute coronary syndromes such as ST-elevation MI, and acute stroke.
  • Efforts to improve independent links in the chain of survival should not be dismissed, however, perhaps it is important to also understand that the potential benefit in survival is limited when we only work on some of the links, unless we can also invoke equal improvements in those remaining links.
  • There is wide community and hospital variability in cardiac arrest survival. High-performing systems haveused this continuous quality improvement approach with great success, as have systems that have more recentlyadopted this strategy. These successes have occurred in a variety of systems, suggesting that all communities andhospitals can substantially improve care and outcomes.Since each system has different characteristics and challenges, there is no single prescriptive strategy for improvement.However, each system has an obligation to address the fundamental principles of quality improvement: measurement,benchmarking, and feedback and change.A conceptual appreciation of this system and its working components is illustrated here. Improving care requires assessment of performance. Only when performance is evaluated can participants in a system effectively intervene to improve care. This process of quality improvement consists of an iterative and continuous cycle of(1) systematic evaluation of resuscitation care and outcome,(2) benchmarking with stakeholder feedback, and(3) strategic efforts to address identified deficiencies.The process of simply measuring and benchmarking care can positively influence outcome. However, ongoing review and interpretation are necessary to identify areas for improvement. Local data may suggest the need to increase bystander CPR response rates, improve CPRperformance, or shorten the time to defibrillation. Useful strategies might include programs targeting citizen awareness, education and training for citizens and professionals, and various technologic solutions. These programs need to be continually re-evaluated to ensure that potential areasfor improvement are fully addressed.Although future discoveries will offer opportunities to improve survival, we currently possess the knowledge and tools—represented by the Chain of Survival—to address many of these care gaps.
  • Instructors, like you and those in your Training Centers and Sites must be prepared to lead in thedevelopment and implementation of localized plans to optimize survival. These plans should be based on data, the Guidelines themselves and address each and every individual link in the chain of survival, as well as all the interactions of all the links combined.Knowledge by itself is just that, knowledge. We need to combine knowledge with action, and the best way to accomplish this is to have a plan.Where there is no plan or vision, the people are sure to perish.
  • THANK YOU.
  • The 2010 AHA Guidelines for CPR and ECC once againemphasize the need for high-quality CPR, including• A compression rate of at least 100/min (a change from“approximately” 100/min)• A compression depth of at least 2 inches (5 cm) in adults• Allowing for complete chest recoil after each compression• Minimizing interruptions in chest compressions• Avoiding excessive ventilation
  • Address minutes
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  • Improving Community Based Response to Cardiac Arrest - New Zealand

    1. 1. TRANSLATING SCIENCE INTO ACTIONS:IMPROVING CARDIAC ARRESTOUTCOMES IN NEW ZEALAND HEARTSafe Forum For Change Auckland, NZ David B. Hiltz, NREMT-P
    2. 2. 3
    3. 3. A NECESSARY COMBINATION!
    4. 4. REGRETABLY… WE HAVE SOME THINGS IN COMMON
    5. 5. THE MENACE OFSUDDEN CARDIAC ARREST
    6. 6. LOOKING AND SOUNDING FAMILIAR?
    7. 7. ISSUES SUMMARY 1 LOOK LIKE THIS?CPR Component Challenges to Improving QualityRecognition Failure to recognize gasping as sign, unreliable Pulse DetectionInitiation of CPR Low Bystander CPR response Rate, Incorrect Dispatch instructionsCompression Rate Slow compression RateCompression Depth Shallow compression DepthChest Wall Recoil Rescuer Leaning on Chest 10
    8. 8. ISSUES SUMMARY 2 LOOK LIKE THIS?CPR Component Challenges to Improving QualityCompression Interruptions Excessive interruptions for pulse check, Ventilations, defibrillation, intubation, IV access, otherVentilations Ineffective ventilations, prolonged interruptions in compressions , excessive ventilations (esp with airway)Defibrillation Prolonged time to defibrillate avail, prolonged interruptions in chest compressions pre- and post shocksTeam Performance Delayed rotation, leading to rescuer fatigue and decay in compression quality, poor communication among rescuers leading to unnecessary interruptions in compressions 11
    9. 9. THE PEOPLE AREN’T THE PROBLEM!
    10. 10. SYSTEM ISSUES LOOK LIKE THIS?Many Systems Ideal SystemNo Data Data CollectedNo Plan Quality Improvement PlanFragmented Efforts Holistic ApproachPartially Fully ImplementedImplemented GuidelinesGuidelines
    11. 11. IMPLEMENTATION?? LOOK LIKE THIS? IMPROVED SURVIVAL
    12. 12. WE NEED A HOLISTIC ANDINTERGRATED APPROACH
    13. 13. RAPID DEFIB QCPR CITIZEN CPR POST ROSCRECOGNITION
    14. 14. BRAGGINGRIGHTS!
    15. 15. NEARLY 9 MILLION PEOPLELIVING AND WORKING IN HEARTSafe COMMUNITIES NO FORMAL STRUCTURE NO BOARD OF DIRECTORS NO STAFF
    16. 16. HAVING CHAMPIONS IS ESSENTIAL IN DEALING WITH ANTI-CHAMPIONS!
    17. 17. LOCALIZATIONFOR NEW ZEALAND?
    18. 18. A FEW STEPS(AND A FEW ISSUES) IN ENDING “SURVIVAL ENVY”
    19. 19. RECOGNITION AND RESPONSE TO EARLY WARNING SIGNS?
    20. 20. http://www.youtube.com/watch?v=xZdq-bZ0cV8
    21. 21. TELEPHONE CPR
    22. 22. CITZEN CPR?
    23. 23. LAW ENFORCEMENT
    24. 24. DID YOUR LAST CARDIAC ARREST LOOK LIKE THIS?
    25. 25. PRACTICE LIKE YOU PLAY?
    26. 26. 12 LEADS FOR ACS/POST ROSC?
    27. 27. THERAPEUTICHYPOTHERMIA?
    28. 28. A CULTURE OF QUALITY? LOOK LIKE THIS?AN ITERATIVE PROCESS
    29. 29. 40
    30. 30. HOW ARE HOSPITALSDOING ON THEIR END?
    31. 31. “Quality CPR is a means to improve survival fromcardiac arrest. Scientific studies demonstratewhen CPR is performed according to guidelines,the chances of successful resuscitation increasesubstantially. Minimal breaks in compressions, fullchest recoil, adequate compression depth, andadequate compression rate are all components ofCPR that can increase survival from cardiac arrest.Together, these components combine to createhigh performance CPR (HP CPR)”
    32. 32. DRUGS WITH A PROVEN BENEFITIN RESUSCITATION THE MENACE OF SUDDEN CARDIAC ARREST
    33. 33. 123456
    34. 34. CAN’T WE SOLVE OURPROBLEMS WITH TECHNOLOGY?
    35. 35. TRANSITION:Structured and Supported Debriefing Our Definition! A provider‐centric process designed to standardize the debriefing process to assist clinicians in thinking about what they did, how they did it, and how they can improve.
    36. 36. Structured and Supported DebriefingStructured elements include three specific debriefing phases with related goals, actions, and time estimates.
    37. 37. Thoughtful discussion after an attempted resuscitation is important to facilitate the sorting out of events as well as gaining insight on what happened and whyWe often learn better through self‐discovery and self‐analysis than by other methods!
    38. 38. IMPLEMENTATION •Have long term view •Patients and patience•INSTANT GRATIFICATION!
    39. 39. BOY, I AM REALLY LOOKING FORWARD TO THEDEBRIEFING ON THIS CASE!
    40. 40. PROVIDERS NEED TO EXPRESS THEMSELVES AND THEIR FEELINGS…AND THIS IS A GREAT FORUM FOR THAT!
    41. 41. Team leader trained in Structured and SupportedDebriefings
    42. 42. SCONE DIPLOMACY!
    43. 43. NOT PUNATIVE!
    44. 44. ROLE OF FACILITATOR•PROVIDE SAFE ENVIRONMENT FOR SHARING EXPERIENCES •DRAW OUT INFORMATION AND EXPERIENCES•CONTENT DIRECTED BY THE CREW •NEVER JUDGE!
    45. 45. INSTRUMENTEDMANIKINS
    46. 46. PAVE THE ROAD TOIMPROVED SURVIVAL!
    47. 47. HEARTSafe MORRINSVILLE?

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