Medical Emergency Response Planning Schools

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This presentation discusses MERPS as well as training students in CPR.

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  • This presentation will review key facets of the AHA Scientific Statement: Response to Cardiac Arrest and Selected Life-Threatening Medical Emergencies-The Medical Emergency Response Plan for Schools (MERPS) and help schools better prepare to respond to medical emergencies in the first minutes before the arrival of emergency medical services (EMS) personnel.
  • 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 relatively uncommon, but when they do occur, they require a planned, practiced, and efficient response. In order to maximize survival ,schools must develop effective medical emergency response plans.
  • In a survey of elementary and high school teachers in the Midwest, 18% of all teachers surveyed indicated that they personally provided some aspect of emergency care to more than 20 students each academic year, and 17% indicated that they had responded to1 life-threatening student emergency during their teaching Career. A survey of school nurses in New Mexico documented that each year, 67% of schools activated the EMS system for a student and 37% of the schools activated the EMS system for an adult.
  • In children and young adults, injuries cause more childhood deaths than all other diseases combined.9 Unless an injury involves commotio cordis (a sudden blow to the chest), injury deaths typically are associated with difficulty breathing or development of shock (low blood pressure) due to blood loss. In such cases, the heart often slows and then stops so that the cardiac arrest is a secondary (rather than a primary or sudden) event.12 Victims of injuries require early activation of EMS, support of breathing, and control of hemorrhage and are unlikely to need treatment with a defibrillator.
  • Because injuries are the most common life-threatening emergencies encountered in children and adolescents in or out of schools, teachers, school nurses and physicians, and athletic trainers should know the general principles of first aid (eg, how to ensure scene safety and assess responsiveness, how to use personal protective equipment when in contact with blood or other body fluids, when and how to phone the EMS system, and when it is acceptable to move a victim).
  • SCA is the sudden cessation of cardiac activity so that the victim becomes unresponsive, with no normal breathing and no signs of circulation. Unless the victim receives immediate CPR and other treatment to restore normal cardiac activity, he or she will die. Although the precise incidence of SCA in children is unknown, it is not a leading cause of death in children and young adults. Response to SCA is a major focus of this discussion. Although SCA is relatively uncommon in children and young adults, victims are more likely to survive SCA than prehospital traumatic cardiac arrest if they receive prompt support and treatment.
  • When SCA does occur in children and young adults, it may be precipitated by ventricular fibrillation (VF) or rapid ventricular tachycardia (pulseless VT). These abnormal heart rhythms in children are typically caused by inherited or congenital cardiac conditions or by acute medical problems that cause inflammation of the heart. Examples of conditions that may be familiar to school nurses, physicians, and parents include long-QT syndrome, hypertrophic cardiomyopathy, abnormal development of the coronary arteries, aortic dissection, myocarditis, and congenital aortic stenosis.19 Many of these conditions will not be detected during routine screening for school physicals or sports activities,20,21 so SCA may be the first sign of these problems. Vigorous exercise appears to act as a trigger for lethal arrhythmias.21 As in an adult, if a child develops SCA caused by VF or pulseless (rapid) VT, immediate bystander CPR and early defibrillation are needed.
  • 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. In the United States each year, SCA occurs with an estimated frequency of 1 per 1000 persons 35 years of age per year.34–37 These statistics can be used to estimate the risk of adult SCA for any location on the basis of the number of adults aged 35 and older typically present at that location and the number of hours they are present at that location per year (see Appendix 1). Note that the risk of SCA in adults is 100 to 200 times the estimated risk in children and adolescents and those under 35.21,24–26
  • Victims of SCA due to VF/VT can survive if bystanders and EMS providers act quickly. Bystanders must be able to recognize cardiac arrest, phone the EMS system, perform CPR, and use the AED. The AHA has depicted these rescue steps of early recognition, early access to the EMS system, early CPR, and early defibrillation as links in the Adult Chain of Survival38
  • School nurses, teachers, athletic trainers, coaches, and staff are responsible for the physical well-being of a large portion of the nation’s children for many hours each day. Schools now employ fewer nurses, and school nurses often rotate between schools, so some schools are without professional medical coverage for hours or days every week.7 Much of the responsibility for the physical care of students during a typical school day now rests with teachers, athletic trainers, coaches, and staff.
  • The goal of the Medical Emergency Response Plan for Schools initiative is to encourage every school to develop a program that reduces the incidence of life-threatening emergencies and maximizes the chances of intact survival from an emergency. Such a program will have the potential to save the greatest number of lives with the most efficient use of school equipment and personnel.
  • Establish a rapid communication system linking all parts of the school campus, including outdoor facilities and practice fields, to the EMS system. Establish protocols to clarify when the EMS system and other emergency contact people should be called. Determine the time required for EMS response to any location on campus and establish a method to efficiently direct EMS personnel to any location on campus. Create a list of important contact people and phone numbers with a protocol to indicate when each person should be called. Include names of experts to help with post event support.
  • Develop a response plan for all medical emergencies in consultation with the school nurse, the school or school athletic team physicians, athletic trainers, and the local EMS agency, as appropriate. EMS and emergency dispatchers (9-1-1 centers) should be made aware of the type of rescue equipment available at the school and its location. Practice the response sequence at the beginning of each school year and periodically throughout the year, and evaluate and modify it as needed.
  • Prevent injuries through safety precautions in classrooms and on the playground. Identify students, faculty, and staff with medical conditions that place them at risk for development of life-threatening conditions, and train and equip personnel to provide the appropriate response for those conditions.
  • Ensure that many teachers are trained as CPR and first aid instructors. Train school staff and graduating high school students in CPR. Teachers and staff trained in first aid should, at a minimum, be equipped and able to give first aid for life-threatening emergencies until EMS rescuers arrive.
  • If the school determines that a lay rescuer AED program is needed, school administrators and medical personnel should include the AED program in the school medical emergency response plan and practice and evaluate response to SCA using the AED. EMS and 9-1-1 centers should be notified of the specific type of AED and the exact location of the AED on the school grounds. Rescuers who are unfamiliar with the school can call 9-1-1 and receive instructions from 9-1-1 dispatchers to find and use the AED. AED programs should have the following elements: a. Medical/healthcare provider oversight b. Appropriate training of anticipated rescuers in CPR and use of the AED c. Coordination with the EMS system d. Appropriate device maintenance e. Ongoing quality improvement program A medical emergency response plan must start with development of a good system of communication. It also requires development and coordination of a planned and practiced response, risk reduction, and training and equipment.
  • CPR training implies an underlying commitment to fellow citizens and may encourage and model a willingness to provide assistance to victims of medical emergencies.
  • Any equipment is useless unless it is readily accessible in an emergency and rescuers are appropriately trained to use it. First aid and resuscitation equipment should be placed in a central, highly visible, and accessible location near a telephone, and all school faculty, staff, and students should know where the equipment is stored. If the school is large, it may be necessary to keep duplicate equipment in several areas. Because injuries are most likely to occur during athletic activities, the athletic facilities should be considered high priority areas for placement of equipment such as the first aid kit and spine backboards.
  • 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).
  • If an AED program is established at the school, the AED should be placed in a central location that is accessible at all times and ideally no more than a 1- to 1 1⁄2-minute walk from any location. The device should be secure and located near a telephone (eg, near the school office, library, or gymnasium) so that a rescuer can activate the EMS system and get the AED at the same time.
  • Legislative efforts to save the lives of children who develop life-threatening emergencies at schools should support an approach that is most likely to save the greatest number of lives. A planned program should be required, as should appropriate training and equipment. 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. Many school budgets are already stretched to provide basic education, achieve student test score goals, and meet the needs of a wide range of students, including those with special healthcare and learning needs. Unfunded mandates for emergency care in schools are likely to be met with minimal effort that does not include the development of planned and practiced responses and the training and retraining that are most likely to save lives. Policymakers must work with schools to ensure that long term solutions are enacted to be sure that programs are sustained indefinitely.
  • On any given day, as much as 20% of the combined US adult and child population can be found in schools. Life-threatening emergencies in schools are relatively uncommon, but when they do occur, they require a planned, practiced, and efficient response with provision of first aid and possible CPR and use of an AED. To maximize survival from a life-threatening emergency, schools must develop a medical emergency response plan designed to provide appropriate therapy within the first minutes of the emergency. The medical emergency response plan includes creation of an effective and efficient campus-wide communication system; (2) coordination, practice, and evaluation of a response plan with the school nurse and physician, athletic trainer, and local EMS agency; (3) risk reduction; (4) training in and equipment for CPR and first aid for the school nurse, athletic trainers, and teachers and CPR training for students; and (5) in schools with a documented need, establishment of an AED program.
  • Bystanders are the ones who most commonly initiate The Chain of Survival (call 911). Once called, even the best EMS systems in the U.S. have an average response time of about 4 minutes; for many it is closer to 7 minutes; for some it is over 10 minutes. No CPR for 4 minutes significantly reduces the chance of survival No CPR for 10 minutes means almost no chance of survival About 80% of all out-of-hospital cardiac arrests occur in the home, not in public spaces where trained first responders might be located. Relatives are the most frequent witnesses to cardiac arrests Communities and schools can train families
  • Play media clips. One with a favorable outcome, one without.
  • Medical Emergency Response Planning Schools

    1. 1. Response to Cardiac Arrest and Selected Life-Threatening Medical Emergencies Presented by The New England Community Strategies Council
    2. 2. <ul><li>American Heart Association Training </li></ul><ul><li>Programs Are Discussed In This </li></ul><ul><li>Presentation. </li></ul>Disclosures
    3. 3. ECC Mission <ul><li>Build healthier lives, free of cardiovascular diseases and </li></ul><ul><li>stroke by improving the Chain of Survival in every </li></ul><ul><li>community. </li></ul><ul><li>This is accomplished by improving the quality of </li></ul><ul><li>resuscitation provided by all rescuers and increasing the </li></ul><ul><li>probability that collapsed victims will receive prompt CPR. </li></ul>CPR Facts and Statistics Adobe PDF, File Size 76.0 KB
    4. 4. Preventing Unnecessary Death from SCA <ul><li>Bystander CPR rates are less than 30% </li></ul><ul><li>Many deaths from SCA can be prevented </li></ul><ul><li>Survival rates after </li></ul><ul><li>cardiac arrest almost </li></ul><ul><li>double when CPR is </li></ul><ul><li>initiated and access to </li></ul><ul><li>a defibrillator is provided </li></ul>
    5. 5. Educational Objectives <ul><li>Review and understand the related evidence based guidelines and recommendations </li></ul><ul><li>Learn about innovative strategies for the delivery of CPR education </li></ul><ul><li>Use these guidelines and recommendations in establishing response plans in schools </li></ul>
    6. 6. 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.
    7. 7. <ul><li>Life-threatening </li></ul><ul><li>emergencies in </li></ul><ul><li>schools are uncommon. </li></ul><ul><li>When they do occur, </li></ul><ul><li>they require a planned, </li></ul><ul><li>practiced, and efficient </li></ul><ul><li>response. </li></ul>
    8. 8. Case for Support <ul><li>School nurses, athletic </li></ul><ul><li>trainers, and </li></ul><ul><li>teachers are often </li></ul><ul><li>required to provide </li></ul><ul><li>emergency care. </li></ul>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.
    9. 9. Children and Adults <ul><li>School medical emergencies can involve students or adults. </li></ul><ul><li>All schools have adult faculty and staff, and most schools host large numbers of adults during extracurricular activities. </li></ul>
    10. 10. Injury vs. Illness Causes <ul><li>1. Prevention of injury and other causes of cardiac arrest </li></ul><ul><li>2. Early CPR </li></ul><ul><li>3. Early activation of the EMS system </li></ul><ul><li>4. Early advanced care </li></ul>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.
    11. 12. SCA in the Young <ul><li>A reality… </li></ul>
    12. 13. Ventricular Fibrillation <ul><li>Liberthson RR. Sudden death from cardiac causes in children and young adults. N Engl J Med . 1996;334:1039–1044. </li></ul><ul><li>Maron BJ, Thompson PD, Puffer JC, et al. Cardiovascular preparticipation screening of competitive athletes: addendum. An addendum to a </li></ul><ul><li>statement for health professionals from the Sudden Death Committee (Council on Clinical Cardiology) and the Congenital Cardiac Defects </li></ul><ul><li>Committee (Council on Cardiovascular Disease in the Young), AmericanHeart Association. Circulation . 1998;97:2294. </li></ul><ul><li>Maron BJ. Sudden death in young athletes. N Engl J Med . 2003;349:1064–1075. </li></ul>
    13. 14. SCA in Adults <ul><li>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 </li></ul><ul><li>The risk of SCA in adults is100 to 200 times the estimated risk in children and adolescents and those under 35 </li></ul>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.
    14. 15. Survival
    15. 16. Nurse? Not Always!
    16. 17. MERPS Elements <ul><li>1. Effective and efficient communication </li></ul><ul><li> throughout the school campus </li></ul><ul><li>2. Coordinated and practiced response plan </li></ul><ul><li>3. Risk reduction </li></ul><ul><li>4. Training and equipment for first aid and </li></ul><ul><li> CPR </li></ul><ul><li>5. Implementation of a lay rescuer AED </li></ul><ul><li> program </li></ul>
    17. 18. Effective Communications <ul><li>Establish a rapid communication </li></ul><ul><li>System linking all parts of the </li></ul><ul><li>school campus, including </li></ul><ul><li>outdoor facilities and practice </li></ul><ul><li>fields, to the EMS system </li></ul>Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers .
    18. 19. Coordinated Response Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers .
    19. 20. Risk Reduction <ul><li>Prevent injuries </li></ul><ul><li>Identify those at risk </li></ul><ul><li>Training and equipment </li></ul>
    20. 21. Training and Equipment Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers .
    21. 22. Sample First Aid Kit
    22. 23. AED Program <ul><li>Medical/healthcare provider oversight </li></ul><ul><li>Training and use of the AED </li></ul><ul><li>Coordination with the EMS </li></ul><ul><li>Device maintenance </li></ul><ul><li>Ongoing quality improvement </li></ul>
    23. 24. CPR Training
    24. 25. Accessibility Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers .
    25. 26. AED? <ul><li>“ EMS call–to-shock interval of 5 minutes </li></ul><ul><li>cannot be reliably achieved with </li></ul><ul><li>conventional EMS services…” </li></ul>
    26. 27. Calculating Risk
    27. 28. 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).
    28. 29. Location of AED Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products, models or manufacturers .
    29. 30. Estimation of Costs
    30. 31. 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
    31. 32. MERPS Conclusions <ul><li>The medical emergency response plan </li></ul><ul><li>includes: </li></ul><ul><li>1. Communication system </li></ul><ul><li>2. Coordination </li></ul><ul><li>3. Risk reduction </li></ul><ul><li>4. Training in and equipment </li></ul><ul><li>5. AED program when need identified </li></ul>
    32. 33. Staying Alive!
    33. 34. Teaching Students CPR <ul><li>To increase bystander CPR and accelerate CPR education, creative new approaches exist to reach a larger public audience </li></ul><ul><li>The development and validation of a 22-minute self-instructional CPR course has provided a tool for educating large numbers of school-aged children </li></ul><ul><li>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 </li></ul>
    34. 35. Reducing Barriers is Key <ul><li>Bystander CPR can substantially improve rates of survival from SCA </li></ul><ul><li>CPR is a highly accessible therapy that requires little medical training and no equipment when provided in its most basic form </li></ul><ul><li>Potential rescuers from school age to the elderly can learn CPR skills </li></ul><ul><li>Survival rates from witnessed SCA associated with ventricular fibrillation have been reported to be as high as 49% to 74% </li></ul><ul><li>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 </li></ul>http:// www.americanheart.org/presenter.jhtml?identifier =3054555
    35. 36. Why Train the Public? <ul><li>Once called, EMS systems in the </li></ul><ul><li>U.S. have an average response </li></ul><ul><li>time of about 4 to 7 minutes; </li></ul><ul><li>for some it is over 10 minutes </li></ul><ul><li>80% of all out-of-hospital </li></ul><ul><li>cardiac arrests occur in </li></ul><ul><li>the home </li></ul><ul><li>Relatives are frequent </li></ul><ul><li>witnesses to cardiac arrests </li></ul>
    36. 37. Students and CPR
    37. 38. CPR Anytime <ul><li>A personal, inflatable CPR manikin, “Mini Anne” </li></ul><ul><li>An American Heart Association Family & Friends ™ CPR booklet </li></ul><ul><li>CPR Skills Practice DVD </li></ul><ul><li>Accessories for the program </li></ul>
    38. 39. School Successes in Other Countries <ul><li>Funded by an insurance company foundation </li></ul><ul><li>50% of schools </li></ul><ul><li>2.5 multiplier </li></ul><ul><li>120,000 citizens* trained in under 6 weeks </li></ul><ul><li>* 2.2% of the total population </li></ul>Denmark schools program
    39. 40. School Successes in Other Countries <ul><li>Funded by donations through the Norwegian Air Ambulance </li></ul><ul><li>98% of schools </li></ul><ul><li>2.5 multiplier </li></ul><ul><li>200,000 citizens* trained in under 6 weeks! </li></ul><ul><li>* 4.3% of the total population </li></ul>Norway schools program
    40. 41. Schools in New England <ul><li>Boston, MA </li></ul><ul><li>Funded by the Boston Public Health Council and donations </li></ul><ul><li>>3,000 trained </li></ul><ul><li>2.5 multiplier </li></ul><ul><li>7,500 citizens* trained! </li></ul>
    41. 42. Schools in New England <ul><li>Providence, RI </li></ul><ul><li>Funded by donations through Heart Safe Foundation </li></ul><ul><li>>2,000 trained </li></ul><ul><li>2.5 multiplier </li></ul><ul><li>5,000 citizens* trained! </li></ul>
    42. 43. Schools in New England <ul><li>Westborough, MA </li></ul><ul><li>Funded by the Metro West Community Healthcare Foundation </li></ul><ul><li>300 students in a day </li></ul><ul><li>2.5 multiplier </li></ul><ul><li>750 citizens* trained! </li></ul>
    43. 44. Teaching Students CPR Conclusion <ul><li>To increase bystander CPR and accelerate CPR education, creative new approaches exist to reach a larger public audience </li></ul><ul><li>The development and validation of a 22-minute self-instructional CPR course has provided a tool for educating large numbers of school-aged children </li></ul>
    44. 45. When IT Happens… Which Story Will be YOURS ?

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