2. 1
Table of Contents:
Explanation Letter……………………………………………………………....Page 2
Cover Letter……………………………………………………………………..Page 3
Proposal………………………………………………………………....………Page 4
Introduction……………………………………………………………...Page 4
Needs Statement……………………………………………………….Page 5
Letter of Inquiry…………………………………………………………………Page 10
Request for Proposal Information…………………………………………….Page 11
Literature Review……………………………………………………………… Page 12
Supporting Materials…………………………………………………………...Page 16
Letter of Support
Cited Sources…………………………………………………………………...Page 17
3. 2
Explanation Letter
Group members:
Kelsey Heindel heindel.kels@uwlax.edu (414) 313-9492
Rachel Zibrowski zibrowsk.rach@uwlax.edu (608) 769-3451
Dear Deb, Katie, and Tom:
This grant writing process allowed us the opportunity to partner with the Tri- State
and Tri- State Regional Ambulance. Our direct contact, Mr. Tom Tornstrom, guided us
in beginning our grant writing process together. Initially, we met with Tom to gain more
knowledge about Tri- State and what they do to serve La Crosse and its surrounding
cities. We were informed of the need for mechanical CPR devices in two cities, Viroqua
and Prairie du Chien, that currently do not have these life saving devices. Due to longer
transportation time to the nearest hospital (most often Gundersen), the need for
mechanical CPR devices is much greater for these cities, yet they are the remaining
cities without the device. After meeting with Tom and discussing the needs for the grant,
other details of the product, and what they are looking for, we began our research. Our
research consisted of data and information collection on the LUCAS-2 automatic chest
compression device, and how effective it has been in other places that are using it in
terms of cardiac arrest 911 runs. We reviewed various articles and used this information
to our advantage helping make our case for this grant. Katie Berkedal also played an
integral role in our grant writing process; she helped with our initial search for funders
and helped edit our first run at a proposal for a Walgreens grant. While we are currently
without funders, we created other components in generic form to complete the binder
for our community based organization. It was a great experience to work alongside Tom
and Katie in starting this original grant; we gained knowledge and skills that we will use
in the future. This process was a great test of our communication with not only one
another, but also other partners in a project that have the same goal as you. Although,
we have not reached all of our initial goals, we made major progress for the funding of
these two devices, and we hope the funds are received in the near future as some lives
could be depending on it.
Sincerely,
Kelsey Heindel & Rachel Zibrowski
Grant Writers
4. 3
Cover Letter
April 20, 2015
Name, Title (Grantmaker Contact)
Foundation, Bank, Corporation (Grantmaker)
Address
City, State, Zip Code
RE: Walgreens
Tri-State and Tri-State Regional Ambulance are pleased to submit this request for your review.
We look forward to your partnership in our cooperative efforts to improve the safety of
transportation of cardiac arrest patients and medical personnel and better the results of post-
cardiac arrest care.
Our proposal requests $28,990 to launch the use of two LUCAS-2 automatic chest compression
devices in the two remaining cities (Viroqua and Prairie du Chien) that are in critical need for
these two devices.
Tri-State and Tri-State Regional Ambulance are exceptional at providing the best cardiac arrest
care for their patients in all of the Tri-State region. The LUCAS-2 system is successful with
providing greater opportunity for quick discharge of the patient from post- cardiac care and safer
transport for EMS. This Walgreens grant supports the Tri-State and Tri-State Regional
Ambulance objectives to promote community safety for all persons involved in cardiac
incidence, both patient and EMS personnel.
Since 1970, Tri-State and Tri-State Regional Ambulance have been the help before the hospital,
making 16,000 ambulance runs per year. Your investment in our automatic chest compression
product will enable us to continue to effectively serve our community and its cardiac arrest
patients, specifically those in Viroqua and Prairie du Chien; these two cities alone have had 28
cardiac arrests in the last 3 years.
Thank you for your interest in Tri-State and Tri-State Regional Ambulance. We envision building
upon our collaborative success by bettering the care of cardiac arrest patients and decreasing
the risk of EMS injury with your help.
Sincerely,
Tom Tornstrom, M.B.A., Paramedic
Executive Director,
Gundersen Tri-State Ambulance and Tri-State Regional Ambulance
5. 4
PROPOSAL COMPONENTS
Needs Statement
Introduction
Tri-State and Tri-State Regional Ambulance have been the greater Coulee
Region’s number one supporter of life, 24/7, since 1970. Tri State and Tri-State
Regional Ambulance, both non- profit organizations, are the primary 911 responders for
much of La Crosse, Trempealeau, Vernon and parts of other surrounding cities,
including Viroqua and Prairie du Chien. This leaves them dedicating their services to
roughly 3,000 square miles and 200,000 people. They are the help before the hospital,
with highly trained staff of 60 paramedics and 15 EMTs making around 16,000
ambulance runs per year. Safety is their main focus, not only for patients riding in their
vehicle, but also for the medical team during the transportation. They want to ensure
they are able to perform their jobs to the best of their ability, as many lives depend on it.
This focus on safety has carried into 2015 with hopes of funding for two mechanical
CPR devices for the remaining two cities that need them in their quick response
vehicles.
Mechanical CPR devices have been highly dependable and successful in the
cities already putting them to use. The “effective and uninterrupted chest compressions
are considered critical for the outcome of cardiac resuscitation (Acute Cardiac Care,
2013).” Safety for the medical personnel and patient can be achieved with these life
saving devices as it is dangerous for both parties to be performing and receiving CPR
while in a fast moving vehicle (external forces such as acceleration and changes in
direction pose for increased injury risk). These factors can be eliminated with seat belt
6. 5
use by medical personnel and the automatic chest compression via the battery operated
CPR device for the patient.
Needs Statement
The absence of the LUCAS-2 automatic chest compression device in ambulance
vehicles creates a problem for the medical personnel when responding to cardiac arrest
911 calls. However, this problem is amplified in the cities of Viroqua and Prairie du
Chien due to the extended transportation time to the nearest medical facility. Most of the
911 calls from these two areas are taken to Gundersen Health Systems in La Crosse,
which leaves the patient and the medical personnel with a 32 mile drive (45 minutes)
from Viroqua and a 58 mile drive (over 60 minutes) from Prairie du Chien. A person
suffering from cardiac arrest has their life on the line within this time limit and it is up to
the single medic to properly administer CPR for the duration of the trip. This is a difficult
task, but vital to the patient’s survival as it greatly increases the chances of the patient
being discharged from the hospital.
Another problem that can be eliminated by the use of an automated chest
compression device is the amount of staff that is available for 24 hour 911 calls. The
ambulance is not fully staffed on a 24/7 basis, leaving one medic in the back to perform
all the necessary responsibilities. With an automatic CPR device, the medic can assist
the patient in other ways- not having to worry about performing accurate and efficient
CPR for over a 45-minute time span. With over 124 cardiac arrests within the tri-state
area in 2014, the use of an automatic chest compression device would better the health
status of these populations and assist the medical personnel in doing their job the best
that they can.
7. 6
Recent reviews have compared the use of manual and mechanical CPR
methods during cardiac arrest events. The research has shown that mechanical CPR
devices perform uniform compressions on a consistent basis, for example the LUCAS-2
system “showed very constant performance with very low variability (Acute Cardiac
Care, 2013).” This increases the rate of survival across the board for all patients, as
“effective and uninterrupted chest compressions are considered critical for the outcome
of cardiac resuscitation (Acute Cardiac Care, 2013).” These devices are not only useful
for the precise and consistent delivery of CPR, but are often used to aid medical
professionals in that they perform automated compressions allowing the the medical
staff to perform other vital actions uninterrupted (Health Policy Advisory Committee on
Technology, 2013).
The need for the LUCAS-2 system within these two cities is based on two key
factors: transportation and lack of personnel. The problem on the local level appears to
be that they are not as equally staffed as other surrounding cities, and rely on police
officers, who are only certified to perform basic CPR and carrier AED devices, to be
their first responders. With the automatic CPR device, these two glaring problems can
be eliminated.
Rides from these cities can range from 20 minutes to over 60 minutes of
transport time. The staffing shortage in these towns means there is typically only one
medical staff member riding in the ambulance. The procedures that need to be
performed during this long length of time are difficult to complete with only one available
medic. To avoid detrimental side effects, the single medic must continue with CPR, a
continuous procedure that must be done manually. While CPR is being administered,
8. 7
there are no available hands to complete or monitor anything vital signs because CPR
is of the highest priority. The goal behind the mechanical CPR device is to “represent a
reliable alternative to manual CPR in a moving vehicle during emergency evacuation
(Acute Cardiac Care, 2013).” These machines free up the hand’s of medical staff to
complete other necessary life saving procedures; “it needs less human resources and
might be much safer for EMS- personnel (Acute Cardiac Care, 2013).”
The major barriers for clients to utilize services are the accessibility and the
acceptability of the automatic chest compression devices. Barriers in the community
that impact change in the problem area, or keep clients from service, is that there are
not many medical personnel that are staffed in smaller cities like Viroqua and Prairie du
Chien, and they primarily use one medical personnel (aside from the driver) in the
ambulance with the patients. This brings a new area of concern for not only the patient’s
safety, but the safety of the medical personnel as well. The medical personnel have
many responsibilities in the ambulance in order for the patient to survive, and CPR
requires constant contact with the patient. When there is only one medical personnel
riding in the ambulance and they have to perform CPR, there is a limited chance for the
patient to receive other treatments. This is the main reason why automatic chest
compression devices are a vital component to these cities, not only for the safety and
the life of the patients, but for the medical personnel as well.
9. 8
Barriers to Service:
● Accessibility:
○ Cost= $14,495 per device
○ Hours of operation= 45 minutes on rechargeable battery
○ Transportation= Comes with carrying case for easy
transportation
○ Language capability= Comes with training pamphlets for
paramedics to use and train with
● Acceptability:
○ The LUCAS-2 system is well known and is widely accepted
throughout the United States
○ It has been used and shown to save lives here in the Tri
State area
Accessibility is an important factor when considering this device. It is a device
that is important to these two specific areas (Viroqua and Prairie du Chien) because
they do not have first responders who help out in cardiac arrest situations. They are the
only two communities, out of the many communities served by Tri-State, that do not
have first responders. They depend on the police department, when they are available,
to serve as their first responders. The police officers are only certified to use and carry
AED devices and perform basic CPR. The LUCAS-2 devices are costly, especially
when asking for more than one, which is a barrier to the usage of these devices. They
operate on 45 minutes of battery life, an average time for the device, which fits the
transport time of 20 to 60 minutes to Gundersen Hospital, respectfully. The device is
10. 9
easily packaged into a carrying case that comes with the device when purchased,
making it easily portable.
Many studies have been done to prove the efficiency of these devices, and
provide the consistent delivery of CPR to the patients in need. While not all cities may
need these devices, they are vital to Viroqua and Prairie du Chien, due to the fact that
they are lacking in staffed medical personnel. The lack in personnel has been proven to
be a problem, because the ambulance is then only staffed with one medic. As we have
previously mentioned, this single medic is responsible for many duties which all work
together to keep the patient alive. These two devices will be of vital importance to these
medics because it creates a safer environment not only for the patient, but for the
medics as well, allowing them to perform the duties they need, while still wearing a
seatbelt. These devices are making news throughout the United States because of their
life saving technique, and they are becoming widely used due to their reliability leaving
medical personnel more time to focus on other necessities during transport time.
11. 10
Letter Of Inquiry
235 Causeway Blvd
La Crosse,WI 54603
Phone: 608.784.8827
Fax: 608.782.4522
www.tristateambulance.org
March 12th, 2015
Walgreens
Dear Walgreens:
The Tri-State and Tri-State Regional Ambulance seeks support of $28,990.00 from the
Walgreens Company for equipment devices for two cities, Viroqua and Prairie du Chien, in the
Tri-State Region. We would be grateful for the support we receive from Walgreens, and think
this proposal may be of comparable interest to your company. We think this project is very much
aligned with the Walgreens Company’s goals in the field of medical equipment and serving the
surrounding communities.
Our organization, established in 1970, is serving as the sole 911 advanced life support provider
for the Tri-State community with our services: over 45 paramedics and 20 EMTs staffed 24
hours a day. Recently, we were honored to announce the availability of the PulsePoint app in La
Crosse County. The PulsePoint app alerts registered users in the event of a sudden cardiac
arrest in a public place within the immediate area and provides responders the location of near
by AEDs. Along with the availability of this application, we have been noticed as the national
leader with some of the highest cardiac arrest survival rates and airway proficiency rates,
exceeding the average by over 15% increased proficiency.
The project for which we request funds will make a difference in the lives of the patients
suffering from cardiac arrest in Viroqua and Prairie du Chien as they are without first
responders. The use of automatic CPR will also provide help to the medical personnel (First
Responders, Paramedics, EMTs) in the following way: the devices are needed to deliver safe,
effective, and efficient CPR to the patients while keeping the medical personnel safe and
available to provide other life saving tasks. We expect the following concrete results: improved
efficiency in CPR, higher cardiac survival rates, and increased rates of discharge from the
hospital.
We will be glad to submit a full proposal with additional information for your further review.
Sincerely,
Tom Tornstrom, M.B.A., Paramedic
Executive Director, Gundersen Tri-State and Tri-State Regional Ambulance
13. 12
Literature Review
Annotated Bibliographies
#1
Brooks, SC., Hassan, N., Bigham, BL., Morrison, LJ. (2014) Mechanical versus manual
chest compressions for cardiac arrest. Cochrane Database of Systematic
Reviews, (2), 1-47. Retrieved April 13, 2015. Art. No.: CD007260. DOI:
10.1002/14651858.CD00 7260.pub3.
Cardiopulmonary Resuscitation, more commonly known as CPR, is used on
patients suffering from sudden cardiac arrest. This occurs when an individual’s heart
stops beating. Cardiac arrests are responsible for a significant amount of morbidity and
mortality. The North American Incidence of Emergency Medical Services treated
cardiac arrest is about 52.1 persons per 100,000 population. The ultimate goal of CPR
is to reach the return of spontaneous circulation, that is, breathing, coughing, or
movement and a palpable pulse and measurable blood pressure, as early as possible to
avoid organ damage and heart dysfunction. CPR involves precise rhythmic
compressions to the chest of the cardiac arrest victim, which mimics the pumping action
of the heart. Therefore, CPR is not only important for getting blood circulation back
through the heart, but also that blood circulation reaches the other vital organs as well,
thus increasing the chances for survival. Proper and consistent CPR has shown to
improve the chance that the heart will restore itself and that the cardiac arrest patient
will survive.
Over time, machines have been developed to aid in CPR. They have been
developed to assist in the chest pumping using automated mechanisms whether
through piston powered or battery powered. The reason behind the development was
the thought that they would deliver much more effective pumping actions than human
laborious CPR, because these machines do not get worn out or tired when performing
the rigorous actions that CPR requires.
To make these devices efficient, they need to be consistent in depth, rate, and
compressions without interruptions. The importance of these factors is a determinant of
the survival of the cardiac arrest patient. If CPR is administered by someone who is
poorly trained, it may affect the outcome of the patients survival, thus making a stronger
case for the mechanical device. Which, data shows, delivers consistency in depth, rate,
and compression efficiency without error or interruptions.
The trials and data collected in this article refer to the 1166 participants observed
in different trials. These trials were not all of equal participants. Some trials found no
evidence that mechanically delivered CPR is any different than manually delivered
CPR. But that doesn’t mean that mechanical CPR is any less effective than manual
CPR. Some of the smaller trials produced results saying that patients who received
14. 13
mechanical CPR had their hearts restarted quicker and more efficiently, including many
to the point of leaving the hospital, in comparison to patients who received chest
compressions manually. The article stresses that there is not enough data to show that
mechanical is better than manual and vice versa, but at the same time, the evidence
against mechanical CPR is not proven. The current research comparing mechanical to
manual supports that there are design problems in the trials producing different
evidence in each trial, and because of this, several current trials are underway to help
answer if mechanical CPR is more effective and efficient than manual CPR.
15. 14
#2
Fox, J., Fiechter, R., Gerstl, P., Url, A., Wagner, H., Luscher, T.F., &…Wyss, C.A.
(2013). Mechanical versus manual chest compression CPR under ground
ambulance transport conditions. Acute Cardiac Care, 15(1), 1-6. doi:
10.3109/17482941. 2012. 735675
The article, Mechanical versus manual chest compression CPR under ground
ambulance transport conditions, studies the idea that mechanical chest compression
devices could “offer the possibility to transport cardiac arrest patients with ongoing CPR
and might shorten significantly the time delay to post- resuscitation care (Fox et al.
2013).” Using a manikin they simulated cardiac arrest that needed continuous chest
compressions during a difficult transport. It concluded that the LUCAS CPR device is a
reliable substitute to manual CPR in an ambulance during transport and emergency
evacuation- “it needs less human resources and is safer for the EMS personnel (Fox et
al. 2013).” The use of these devices could lower the number of EMS fatalities; roughly
74% of emergency medical service fatalities are due to transportation incidence (Fox et
al. 2013). The strength of this article stems from the use of similar populations and
resuscitation situations, unlike other case studies and case series done in the past. This
article was beneficial to our research in terms of concluding that mechanical chest
compression via the LUCAS system is a reliable, safe alternative to manual CPR in a
moving ambulance.
16. 15
#3
Smekal, D., Lindgren, E., Sandler, H., Johansson, J., & Rubertsson, S. (2014). CPR-
related injuries after manual or mechanical chest compressions with the lucas
device: A multicentre study of victims after unsuccessful resuscitation. Official
Journal of the European Resuscitation Council.
This article aims to answer the question regarding patient safety when using the
mechanical CPR device due to indications of injury revealed in past studies that stated
no difference in incidence of injury between manual and mechanical CPR. The study
was based on autopsies of passed cardiac arrest patients done by various pathologists.
This article was intended for medical personnel who will be using the automatic CPR
device in the future or have been using it and are questioning its safety in terms of rib
and sternal fractures. This study should not be compared to past studies, as it was
conducted differently (order and checklist of autopsy criteria and the number of
pathologists used) limiting the source’s usefulness. This study had value in
understanding the chance of injuries (rib and sternal fractures) in both manual and
mechanical CPR during out-of-the-hospital cardiac arrest. Although, the final results did
not deem mechanical CPR as risk- free, it is more reliable in its functioning and provides
more safety for the medical personnel involved. They could not “draw definitive
assumptions” when computing results and comparing with “those previously presented”
but the article still held value in our research of comparing mechanical and manual CPR
(Smekal et al. 2014).
17. 16
Supporting Material
Letter of Support
Example Letter of Support Format:
● Unique and written from the point of view of your collaborator(s) or consultant(s)
● Printed on institutional letterhead and signed by the appropriate party (someone
authorized to make the commitment of support)
● Addressed either to the PI of the proposal or to the granting agency – check the
guidelines of the specific grant
● Address any specific guidelines (e.g., particular assurances) required by the funding
agency or the university, as outlined in the Request for Application (RFA) or as
requested by your Research Administrator
● Follow any other guidelines (e.g., page limits) required by the funding agency
First Paragraph (1-3 sentences)
● Statement of support for the product – use words that convey enthusiasm
● Identify the product by name/title
Examples:
“I am pleased to support your product proposal titled xxx.”
“Your proposal to do xxx has my enthusiastic support.”
Body Paragraphs (1-3 paragraphs, or more as necessary)
● If applicable, state how the goals/objectives of the collaborator(s)/consultant(s) are well-
aligned with the success and service of this product. What is the collaborator’s
motivation to work with you?
● State as specifically as possible the role of the consultant(s)/collaborator(s) in the
process
● State why this collaborator/consultant is the appropriate person/organization
● What is their relevant experience/expertise? Have they previously worked with you? Do
they have a successful track record?
● Do they have specialized equipment or reagents? Other resources?
*If you have worked with this collaborator before, be sure to say so! It demonstrates that a
productive relationship has already been established.
Last Paragraph (1-3 sentences)
● Include a cordial closing. The level of formality should be determined by the level of
personal relationship between the PI and the collaborator/consultant. If you know each
other very well, it can be less formal.
Examples:
“I look forward to collaborating with you on this work.”
“Best of luck with your grant application.”
18. 17
Cited Sources
Brooks, S. C. (2014). Mechanical versus manual chest compressions for cardiac arrest.
Cochrane Database Of Systematic Reviews,(2), doi:10.1002/14651858.CD0 07
260.pub3
Fox, F., Fiechter, R., Gerstl, P., Url, A., Wagner, H., Luscher, T., Eriksson, U. & Wyss,
C. (2013). Mechanical versus manual chest compression CPR under ground
ambulance transport conditions. Acute Cardiac Care, 1-5.
Health Policy Advisory Committee on Technology (HealthPACT). (2013). Queensland
Health. Retrieved from: http://www.health.qld.gov.au/healthpact/
Mechanical Chest Compression Devices for Patients Experiencing Cardiac Arrest.
(2013). Retrieved from: http://www.health.qld.gov.au/healthpact/docs/update
s/WP15 3_update.pdf
Office of Research Development (2015). How to write an effective letter of support.
Tufts University. Retrieved from:
http://viceprovost.tufts.edu/grantwriting/resources/letter-of-support/
Smekal, D., Lindgren, E., Sandler, H., Johansson, J., & Rubertsson, S. (2014). CPR-
related injuries after manual or mechanical chest compressions with the lucas
device: A multicentre study of victims after unsuccessful resuscitation. Official
Journal of the European Resuscitation Council.
