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TRANSCRIPT
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”
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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
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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
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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
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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