The Present

CINZ Symposium, 8 November 2013, Palmerston North

Kevin Nation

Ages and Stages

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Conflicts of Interest •  Financial

•  Executive Officer of the New Zealand Resuscitation Council •  Receive remuneration for services to Council •  Employee of Waikato District Health Board •  Contractor to Waikato Clinical School

•  Intellectual •  Chair, CORE Instructors of New Zealand (CINZ) •  Member ILCOR Basic Life Support Task Force

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CPR • Simplification! • Absence of responsiveness and “normal” breathing = CPR •  “Centre” of the Chest • Push hard, Push fast

•  30:2

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“Unwilling or unable”

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Airway Management  • Preference for L.M.A • E.T. is for “experts”

• Waveform capnography is good

• Oxygen?

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Anticipate and Plan

CPR

2 min

Adrenaline

Shock ? CPR

Decision Point •  What is the rhythm?

•  If organised is there an output?

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“Plan actions before interrupting compressions”  •  Continue compressions •  Get ready to check pulse •  Get ready to give adrenaline •  Charge the defibrillator •  Stop CPR •  Organised rhythm? YES •  Pulse? NO •  Start CPR •  Give adrenaline

< 10 seconds

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Members •  Australasian College for Emergency

Medicine •  Australian and New Zealand

College of Anaesthetists •  Australian and New Zealand

Intensive Care Society •  CORE Instructors of New Zealand •  New Zealand Nurses Organisation •  New Zealand Red Cross •  Paediatric Society of New Zealand •  Private Emergency Care

Association of New Zealand

•  Royal Australasian College of Physicians

•  Royal Australasian College of Surgeons

•  The Royal New Zealand College of General Practitioners

•  St John •  Surf Life Saving New Zealand •  New Zealand College of Midwives •  New Zealand Defence Force

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Mission and Vision Our mission To be the standard setting body for resuscitation in New Zealand/Aotearoa. Our vision That people in New Zealand/Aotearoa will have: •  Access to resuscitation practice and education that is consistent and of a high

standard •  The best possible outcome from immediate threats to life and limb.

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Strategic Plan 2008 The five-year Strategic Plan (2008) identified six strategic priorities: 1.  A sound Council structure 2.  A sound administrative support structure 3.  Secure funding 4.  Recognition by Government and the health sector as the standard setting

body for resuscitation in New Zealand 5.  A recognised presence in the community 6.  A system to enable standardized collection of national resuscitation data.

A review of strategic priorities occurred in 2011.

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The Big-ticket projects •  Course Manual Review •  Education Framework Review •  Review of the website •  ILCOR Guideline Review •  ANZCOR •  Conference 2014 PLUS… Routinely filling orders, responding to enquiries, managing the accounts, training instructors, and enhancing communications and marketing capability.

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ILCOR

ANZCOR

NZRC ARC

AHA ERC HSFC RCSA IAHF RCA

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International Liaison Committee on Resuscitation (ILCOR)

• Does not produce guidelines • Reviews evidence

•  Task Force Worksheets •  PICO Format •  GRADE •  SEERS

• Makes recommendations •  CoSTR •  Simultaneous release in Circulation and Resuscitation

 

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ILCOR Guidelines 2015

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ILCOR Taskforces •  Acute Coronary Syndrome •  Basic Life Support •  Advanced Life Support •  Paediatric Life Support •  Neonatal Life Support •  Education ,Implementation and Teams

•  First Aid

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Task Force

TFQO EVREV

EVREV

TFQO EVREV

EVREV

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Population Intervention Comparator Outcome

 Example: In adult and paediatric patients with cardiac arrest (prehospital (OHCA), in hospital (IHCA)) (P), does the use of another specific C:V ratio (I), compared with standard care (30:2) (C), improve outcome (eg ROSC, survival) (O)?

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Consensus on Science Recommendation

•  There was no high level of evidence supporting other CV ratio compared to current standard 30:2

•  Therefore, the CV ratio of 30:2 is still recommended

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ANZCOR

•  Trans-Tasman alignment • Evidence based • Expert opinion • Alignment

•  ARC •  RCUK •  ERC •  AHA

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CoSTR Documents Scientific Underpinning

“May do”

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CoSTR Documents Scientific Underpinning

“May do”

Council Guidelines Practical Translation of Science

“Should do”

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CoSTR Documents Scientific Underpinning

“May do”

Council Guidelines Practical Translation of Science

“Should do”

Training Materials

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NZRC Model Rescuer Levels

Untrained

Trained

1st Responder

1st Health

2nd Health

3rd Health

Medical

Specialist

Lay Rescuers

Health  Professional  

Medical Provider

Teacher, Lawyer, Shop assistant

General Public

Police, Life guard, Fire fighter

Competent Nurse, Technician

Proficient Nurse, Paramedic

Expert Nurse, Advanced paramedic

Non Specialist Doctors

Emergency Physician, Intensivist

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NZRC Model

Tiered Education System

 TEAM

 Outcome

Rescuers

Untrained

Trained

1st Responder

1st Health

2nd Health

3rd Health

Medical

Specialist

Existing Skill

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Tiered Product

Line

 Sales  

TEAM

 Profit

Market

Consumer 1

Consumer 2

Consumer 3

Consumer 4

Consumer 5

Consumer 6

Consumer 7

Consumer 8

Preference

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BMW Levels B

MW

1 S

erie

s • White • RWD • A/C

• A hatch BM

W 2

Ser

ies • White • RWD • A/C

• A coupe BM

W 3

Ser

ies • White

• RWD • A/C

• Car or wagon

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BMW Levels B

MW

4 S

erie

s •  White •  RWD •  A/C

•  A coupe

BM

W 5

Ser

ies •  White •  RWD •  A/C

•  A corporate sedan or wagon B

MW

6 S

erie

s •  White •  RWD •  A/C

•  A grand coupe

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BMW Levels B

MW

7 S

erie

s • White • RWD •  A/C

•  Limousine B

MW

8

• White •  AWD •  A/C

• Concept Hybrid

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CORE in NZ (2012) •  325 CORE Instructors

•  Provisional Instructors •  5 x Instructor Courses with 37 candidates

•  73 ECI candidates revalidated

•  2416 evaluations from 362 CORE courses

•  1570 evaluations from 220 modular courses

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CORE Course Evaluations (2012)

Mod 4

Level 4 Level 5

Level 6

Level 7

Evaluations

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Waikato DHB Model

Waikato DHB Resuscitation Education Model

Draft November 2012

EMPLOYMENT GROUP CERTIFICATION LEVEL (and frequency) COURSE CONTENT

Adult Collapse Certificate(2 Yearly Certificate)

NZRC Modular CORE CerificateLevel 4

(2 Yearly Certificate)

NZRC CORE Level 5-7

(2 Yearly Certificate)

NZRC CORE Resuscitation Skills Level 7

(3 Yearly Certificate)

Adult Collapse AED Module(2.0 hrs)

MCC 4 Adult Collapse Module(4.0 hrs)

Adult + Paediatric Collapse Module(6.0 hrs)

NZRC CORE Certificate Course(11.0 hrs)

NZRC CORE Skills Course(4.5 hrs)

Non-Clinical and Administration Staff

Nurses and TechniciansAll Hospital and Community

Nurses, including Mental Health

Unit Nurses and Specialist Technicians

incl. CCU, ICU, HDU, ED, & others

Medical StaffCompulsory for 1st Yr House

Surgeons. SHOs/RMOs as per their dept needs.

Senior Medical Staff

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WDHB

0

20

40

60

80

100

120

2011 2012 2013 (est) 2014(pred)

Level 2 MCC 4 CORE

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WDHB Course Participants

0

200

400

600

800

1000

1200

1400

2011 2012 2013 (est) 2014 (pred)

L 2 MCC 4 CORE

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WDHB SMO Resuscitation

Year 2012 2013 2014 (pred) Courses 4 5 7 Attendees 40 50 70

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“science to sensibility” 2014

Professor Gavin Perkins Professor Bob Berg

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Summary – the present •  International presence • Strong trans-Tasman relationship • National exposure through CORE •  Time of growth • Conference 2014

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Questions