Greetings from Stony Brook - Aventri€¦ · The rate of survival to hospital discharge 5.2% if no...

Greetings from Stony Brook

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• Edward R. Stapleton

• FINANCIAL DISCLOSURE:

• No relevant financial relationship exists

• No Unlabeled/Unapproved Uses in

Presentation

CITIZEN CPR IN THE U.S.: PAST, PRESENT AND FUTURE

Edward R. Stapleton, EMT-P

Associate Professor of Emergency Medicine

Director of Prehospital Education

Department of Emergency Medicine

School of Medicine

Stony Brook University

History of CPR Education and Implementation

0 1 2 3 4 5 6 7 8 9

Time

Larsen MP, et al. Ann

Emerg Med 1993;22:1652-58

SURVIVAL

Chances of success reduced

7% to 10% each minute

100

90

80

70

% 60

Success 50

40

30

20

10

Chain of Survival Strategies in the United States

Barriers to CPR and PAD

Fear of lawsuits

Fear of action

Lack of prioritization in people’s lives

Fear of infectious disease (traditional CPR)

Lack of knowledge regarding benefit

Access to CPR courses and cost

Mass Media CPR

CPR in the Schools

Public Access Defibrillation Target Groups

Mass Training Workplace Training

Dispatcher CPR

CPR Anytime

Hands Only Mass Training Kiosk CPR

Computer Interactive Internet Training

Dispatch-Assisted CPR Initiatives

Simplified CPR arrest recognition (unresponsive, not breathing normally)

Emphasis on providing dispatch-assisted CPR instructions with Hands Only CPR

Training programs

CPR instruction CQI programs

Reduction in time to first compression

Quality of Training

Opportunity Knocks!

Hands-Only

The rate of survival to hospital discharge

5.2% if no CPR was given

7.8% for conventional CPR

13.3% for the hands-only method

The odds of survival with conventional CPR were not significantly different from no CPR.

Overall survival increased from 3.7% in 2005 to 9.8% in 2009, a difference that was significant at P<0.001.

Arizona Hands Only CPR

Bobrow, et al. Chest compression only by lay rescuers and survival from out-of-hospital

cardiac arrest . JAMA 2010;304(13): 1447-1454.

CPR in the Schools

• Student health professional – High school model

– 11-12 grade students become instructor

– Train lower grades

• Real life training – Middle school model

– Student provider training

MASS MEDIA:

THE ULTIMATE CPR CLASSROOM

Check for

responsiveness

Phone 911

Press Hard

Press Fast

“Instructors… are we really needed?”

Effectiveness of a 30-min CPR self-instruction program

for lay responders: a controlled randomized study

Mean percentage of compressions with adequate depth, as measured by manikin.

Lynch B, et al. Resuscitation 2005. Oct;67(1):31-43.

• Healthcare Providers – Multiplier = 2.3

• Families of high risk patients difficult to recruit, multiplier = 1.6

• Middle school (NY) – easy to recruit, multiplier = 2.1

• High school (MN), easy to recruit, multiplier = 3.8

CPR Anytime at Stony Brook Distribution Efficiency: Determining the “Multiplier“

CPR Kiosk

• Hands-Only CPR permits a minimalist approach

• Self Instruction has proven to be very effective

• Video-based education with manikins have demonstrated more favorable results

• DFW Pilot project underway

Compress

Harder!

Compress

Faster!

Goal:100

88

Characteristics of “Model”

• Placed in large waiting areas in private booth – Hospital lobbies – DMV

• High graphics resolution with large screen TV

• Minimal Maintenance • Push button operating

system • Incentives?

– i.e. Starbucks coupons

Characteristics of “Model”

• Placed in large waiting areas in private booth – Hospital lobbies – DMV

• High graphics resolution with large screen TV

• Minimal Maintenance • Push button operating

system • Incentives?

– i.e. Starbucks coupons

“Manikins… are they really needed?”

“CPR: It’s About Time”

1986

Schluger J, Hayes JG, Turino GM, Fishman S, Fox AC.

The effectiveness of film and videotape in teaching

cardiopulmonary resuscitation to the lay public.

N Y State J Med. 1987 Jul;87(7):382-5.

Schluger J, Hayes JG, Turino GM, Fishman S, Fox AC. The effectiveness of film and videotape in

teaching cardiopulmonary resuscitation to the lay public. N Y State J Med. 1987 Jul;87(7):382-5.

Bobrow Video Hands-Only Study Immediate vs. 2-Month Delay

• C-group (control group)

• Subjects received no training intervention.

• UBV-group (ultra-brief video)

• Subjects viewed a 60-second ultra-brief

video produced by the AHA without skill

practice.

• BV-group (brief video)

• Subjects viewed a 5-minute AHA video

without skill practice.

• BVP-group (brief video with practice)

• Subjects viewed an 8-minute AHA video

with CPR practice during the viewing.

Bobrow, B, et al. The Effectiveness of Ultrabrief and Brief Educational Videos for Training Lay

Responders in Hands-Only Cardiopulmonary Resuscitation: Implications for the Future of Citizen

Cardiopulmonary Resuscitation Training. Circulation: Cardiovascular Quality and Outcomes

Issue: Volume 4(2), March 2011, p 220–226

Amanda Daisy Heard, MD; Edward Stapleton, EMT-P; Catherine Silberstein;

Henry Thode, PhD; Mark Henry, MD.

Department of Emergency Medicine,

Stony Brook University, Stony Brook, NY

Characteristics of Strategy

Develop video that is 90% compress hard and fast!

Very clear images of compressions

10% assessment and call 911

Test effectiveness

Video would have to be continuously aired

A short run would not have a significant effect

The Plan

Partner with Mass media Outlets

ABC, NBC, CBS

Identify costs associated with 1 minute CPR training video aired continuously over time

Seek reduced rates (PSA)

See grant funding to support initiative

Mohamed Shah

A Case History of Effective

Public Access Defibrillation

Mohamed Shah

Sudden collapse at school

CPR started

Mohamed Shah AED at the school

Mohamed Shah

Mohamed was Shocked within 3 minutes

Mohamed Shah

Rhythm present with pulse return

Mohamed Shah

0

20

40

60

80

100

1 min. 3 min. 6 min. 10

min.

Survival

14

min.

Sample Floor Plan “O’Hare Model”

2 minutes

300 meters

2 minutes

300 meters

Pulse Point

Recently added it to our system

Rescuer registers with program

GPS Tracks location

Notifies if you are nearby

Advises you where AEDs are

located

Management of Public Access Defibrillation

Limit the bureaucracy

Have a facilitating structure

Ideally with a healthcare institution

Download of AED data and follow-up

Critical to patient management

May determine need for AICD