Presenter Disclosure Information

• Edward R. Stapleton

• FINANCIAL DISCLOSURE:

• No relevant financial relationship exists

• No Unlabeled/Unapproved Uses in

Presentation

Greetings from Stony Brook

Subsequent “Easy-to-carry” defibrillator (7 pounds) containing a miniature capacitor developed by NASA for rocketry and introduction of the “Pantridge Plan”

How far we have come in

47 years! • Friday Grocery clerk

• Monday Ambulance Attendant

• First EMT course 1967

• Combat Medic in Vietnam 1968

• First group of Paramedics in New York City in 1974-75

6

Edward R. Stapleton, EMT-Paramedic Associate Professor of Emergency Medicine

Department of Emergency Medicine School of Medicine

Stony Brook University

Sudden Cardiac Arrest • 350,000 die from SCA annually

–Most occur outside hospital

–SCA may be the first sign of heart

disease

–AHA promotes chain of survival

Copyright restrictions may apply.

Incidence and Outcome of EMS-Treated Out-of-Hospital Cardiac Arrest

Suffolk County vs. Seattle

2012 • In multiple studies:

– Bystander CPR increases survival

by 2-3 Fold

• Suffolk Out of Hospital Survival

– 4.4%

• Suffolk Bystander CPR rate

– 19%

– Unknown number of persons trained

• Seattle Bystander Rate of CPR

– 58%

– 60% of the population is trained in CPR

Training and Simulation

• Video Presentation: Code Management

• Review of the Latest Science of Resuscitation

• Perfusion Targeted Resuscitation

• Demonstration and Practice

with Mechanical CPR

• Monitoring During Cardiac

Arrest with ETCO2 and

Cerebral Oximetry

• Use of Therapeutic

Hypothermia in Prehospital Care

• Repeated Simulation Practice

in Code Management

• Introduction to the use of

Ultrasound in Cardiac Arrest

Ultrasound

“The Enlightening Carrot”

14

Therapeutic Hypothermia

Therapeutic Hypothermia

• 6 of 13 patients at

were treated with

Therapeutic

Hypothermia

• 5 out of the 7

patients who did

not receive TH -

were not eligible

for TH

Cath Lab and PCI

11/13 patients

with ROSC

immediately

transported to

cardiac

catheterization

lab

8/11 patients

needed a PCI

Door to Balloon 2013

18

183 Code H cases through our ED January 1, 2013 – December 31, 2013

1st EKG

performed

in Hospital

100 Cases 54.6%

1st EKG

performed

Prior to

Arrival (PTA)

83 Cases 45.4%

Confidential and required to be collected and maintained pursuant to Public Health Law 2805, Sections J, K, L, and M and Education Law 6527. Prepared by Decision Support Services

Code H Door to Balloon times from SBUMC

ED EKG prior to arrival time comparison

Confidential and required to be collected and maintained pursuant to Public Health Law 2805, Sections J, K, L, and M and Education Law 6527. Prepared by Decision Support Services

Code H Door to Balloon times from SBUMC

ED EKG prior to arrival time comparison

All Code H Cases 1/1/2013 – 12/31/2013

Note:The difference between Average D2B with 1st EKG

performed in Hospital vs. 1st EKG PTA is statistically sig.

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

10 minutes Myths about CPR and AED use

10 Minutes Benefits of CPR and AED Use

5 minutes Video Hands-Only CPR

12 minutes Practice in Pairs with Video

3 minutes Summary

Characteristics of “Model”

2

12

18 8 1

1

11 10

12

12

SBVAC

SBFD

4

4 cardiac arrests

from out of area

were excluded

from map.

Areas of Evaluation/Action

Citizen CPR Dispatch

PAD EMS

Data

Program Emphasis 1. Community CPR and AED

2. Perfusion through quality chest compressions

a. Guided by physiologic data

b. Use of mechanical CPR

3. Minimal interruption of chest compressions

a. During defibrillation

b. During intubation and other procedures

4. Control of ventilation rates

5. Meticulous teamwork

6. Importance of quality post resuscitation care

a. Therapeutic Hypothermia

b. PCI

Data Collection

Dispatch and Response Times

35

Vital Signs and ETCO2

36

Vital Signs

Time : : : :

BP

Pulse

Resps

LOC

Glucose

SpO2

ETCO2 #

Severity

GCS

EKG

Medications and Treatments

37

Treatment

O2: NRB BVM NC ET CT IV: KVO Lock WO

King Airway IO-BIG/T IO-EZ/T Successful Y N

Res-Q-Pod IO-BIG/H IO-EZ/H Successful Y N

Treatment Dosage S/O? Ordered Admin Rte EKG HR

NTG 0.4 mg : SL

NTG 0.4 mg : SL

NTG 0.4 mg : SL

ASA 324 mg : PO

Albut/Atrov 1 unit : Neb

Albuterol 1 unit : Neb

D50 25 grams : IV

Narcan :

Fluid : IV

CPAP :

AED :

T.Hypotherm :

PCI Notified STEMI :

Patient Name _________________________________________ :

Address _____________________________________________ :

_____________________________________________ :

Remarks ____________________________________________ :

____________________________________________________ :

____________________________________________________ :

____________________________________________________ :

____________________________________________________ :

:

:

:

:

Prehospital Data Collection

38

ET/CT Confirmation

Tech Details:

ET/CT/K placement confirmed by (check all that apply):

Auscultation Direct visualization Disposable colormetric ETCO2

Electronic Capnography Esophageal Detection Device Other

ET/CT/K secured by (check all that apply):

Commercial tube holder Tape Tie Head immobilization

ET/CT/K placement at hospital confirmed as:

Tracheal Esophageal Oropharyngeal None ED Details:

ET/CT/K placement at ED confirmed as:

Tracheal Esophageal Oropharyngeal None

ET/CT/K placement confirmed by (check all that apply):

Auscultation Direct visualization Disposable colormetric ETCO2

Electronic Capnography Esophageal Detection Device Chest X-Ray

Complications (check all that apply):

Dental trauma Oropharyngeal trauma Right mainstem intubated

Emesis aspiration Accidental extubation Other _______________

Person at ED confirming placement ____________________ Title ___________

Details of Arrest

39

Tech Details:

Participation:

EMS-BLS EMS-ALS PD PAD

Location of arrest:

Home Public place __________________

Vehicle Healthcare facility Ambulance

Arrest witnessed by:

Family/Friend Bystander PD EMS

Healthcare provider

Time of collapse ____:____ Time CPR initiated ____:____

Initial CPR by:

Family/Friend Bystander PD EMS

Healthcare provider

Resuscitation not attempted by EMS due to:

DNR Obvious death Pulse present

Prehospital status:

ROSC Time ____:____ CPR continued

Field pronouncement Time ____:____

Status at ED:

ROSC CPR continued Expired

CPR assist devices Lucas Autopulse

Manual CPR

Follow-up with Hospital

• Died in E.D.

• Admit and died

• Discharged alive

• Therapeutic

hypothermia

• PCI

• CPC (starting)

40

Suffolk County and SB

Cardiac Arrest Survival

2011 -2013

3.0%

6.5%

4.4%

7.6%

5.90%

12.60%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

County-Wide Survival SB Survival

2011

2012

2013

Column1

P=0.008