death from cardiac arrest is a real crime! can law enforcement reduce time to cpr and first shock?

Death From Cardiac Arrest is a Real Crime! Can Law Enforcement

Reduce Time to CPR and First Shock?David B. Hiltz

Consultant-AdvocateTeam HEARTSafe

No relevant financial relationship(s) exist.

Presenter Disclosure Information

Law enforcement can play a pivotal role in reducing time to CPR and first shock. Let's take a look at the science, best practices and real world examples highlighting the lifesaving potential of

law enforcement response in sudden cardiac arrest.

G2000, 2005, 2010, & 2015 G2000, 2005, 2010, & 2015 ““CPR and AED use by public safety first responders CPR and AED use by public safety first responders (traditional and nontraditional) are recommended to (traditional and nontraditional) are recommended to increase survival rates for SCA (Class I)!increase survival rates for SCA (Class I)!

DOI: 10.1161/CIRCULATIONAHA.105.166554

Why LEA-D?Why LEA-D?• Often more LEA personnel than EMS Often more LEA personnel than EMS

personnel in a given community personnel in a given community • Patrol units poised to respond rapidly Patrol units poised to respond rapidly

to emergencies.to emergencies.• EMS often station-based, fewer in EMS often station-based, fewer in

numbernumber• LEA personnel often arrive at the LEA personnel often arrive at the

scene before EMS personnelscene before EMS personnelWhite RD. Patient outcomes following defibrillation with a low energy biphasic truncated exponential waveform in out-of-hospital cardiac arrest. Resuscitation. 2001;49:9-14.

Why LEA-D?Why LEA-D?• 81% of police departments respond 81% of police departments respond

to medical emergencies to medical emergencies • 50%provide some level of patient 50%provide some level of patient

care* care* • Defibrillation capability can greatly Defibrillation capability can greatly

enhance care renderedenhance care rendered

Cobb LA, Fahrenbruch CE, Walsh TR, et al. Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillation. JAMA. 1999;281:1182-8.

Why LEA-D?Why LEA-D?• Technology has made it possible for Technology has made it possible for

atypical responders to effectively use atypical responders to effectively use AEDsAEDs

• LEA personnel trained in CPR-AEDs LEA personnel trained in CPR-AEDs demonstrate comparable skill demonstrate comparable skill competencycompetency

White RD. Technological advances and program initiatives in public access defibrillation using automated external defibrillators. Curr Opin Crit Care. 2001;7:145-51.Davis EA, Mosesso VN. Performance of police first responders in utilizing automated external defibrillation on victims of sudden cardiac arrest. Prehosp Emerg Care. 1998;2:101-7.Riegel B. Training nontraditional responders to use automated external defibrillators. Am J Crit Care. 1998;7:402-10.

High Discharge Survival Rate After Out-of-Hospital VentricularHigh Discharge Survival Rate After Out-of-Hospital VentricularFibrillation With Rapid Defibrillation by Police and Paramedics Fibrillation With Rapid Defibrillation by Police and Paramedics Annals of Emergency Medicine , Volume 28 , Issue 5 , Pages 480 - 485Annals of Emergency Medicine , Volume 28 , Issue 5 , Pages 480 - 485R . White , B . Asplin , T . Bugliosi , D . HankinsR . White , B . Asplin , T . Bugliosi , D . Hankins

Conclusion: A high discharge-to-home survival rate was obtained with early defibrillation by both police and paramedics. When shocks resulted in ROSC, the overwhelming majority of patients survived (96%). Even brief time decreases (e.g., 1 minute) in call-to-shock time increase the likelihood of ROSC from shocks only, with a consequent decrease in the need for ALS intervention. Short call-to-shock time and ROSC response to shocks only are major determinants of a high rate of survival after VF.

Seven years' experience with early defibrillation by police and Seven years' experience with early defibrillation by police and paramedics in an emergency medical services system . paramedics in an emergency medical services system . Resuscitation , Volume 39 , Issue 3 , Pages 145 - 151Resuscitation , Volume 39 , Issue 3 , Pages 145 - 151R . WhiteR . WhiteConclusion: Both restoration of a functional circulation, without need for advanced life support interventions, and discharge survival without neurologic disability are very dependent upon the rapidity with which defibrillation is accomplished…

Law Enforcement Agencies and Out-of-Hospital Emergency Care . Law Enforcement Agencies and Out-of-Hospital Emergency Care . Annals of Emergency Medicine , Volume 29 , Issue 4 , Pages 497 - 503Annals of Emergency Medicine , Volume 29 , Issue 4 , Pages 497 - 503H . Alonso-Serra , T . Delbridge , T . Auble , V . Mosesso , E . DavisH . Alonso-Serra , T . Delbridge , T . Auble , V . Mosesso , E . Davis

Conclusion: Many law enforcement agencies are involved to some extent in providing out-of-hospital emergency medical care, and most of the agencies we surveyed would support additional medical training and new or expanded roles for themselves in EMS systems.

Providing automated external defibrillators to urban police officers in Providing automated external defibrillators to urban police officers in addition to a fire department rapid defibrillation program is not effective addition to a fire department rapid defibrillation program is not effective Resuscitation , Volume 66 , Issue 2 , Pages 189 - 196Resuscitation , Volume 66 , Issue 2 , Pages 189 - 196M . Sayre , J . Evans , L . White , T . BrennanM . Sayre , J . Evans , L . White , T . BrennanConclusion: Equipping police cars with AEDs in an urban area where the fire department-based first response system also carries defibrillators did not improve the hospital discharge survival rate for victims of OOH-CA.

Attitudes of Law Enforcement Officers Regarding Automated ExternalAttitudes of Law Enforcement Officers Regarding Automated ExternalDefibrillatorsDefibrillatorsAcademic Emergency MedicineAcademic Emergency Medicine, , Volume 9 Issue 7 Page 751-753, July 2002 Volume 9 Issue 7 Page 751-753, July 2002 William J. Groh MD, Miriam R. Lowe MS, Amanda D. Overgaard BS, William J. Groh MD, Miriam R. Lowe MS, Amanda D. Overgaard BS, Jeanie M. Neal MS, W. Craig Fishburn BS, Douglas P. Zipes MDJeanie M. Neal MS, W. Craig Fishburn BS, Douglas P. Zipes MD

Conclusion: Limited knowledge and negative attitudes of law enforcement officers regarding their involvement in treating OHCA and using AEDs are commonly present. These factors could result in barriers that negatively impact law enforcement AED programs.

LEA-D concept is endorsed in a joint LEA-D concept is endorsed in a joint position statement by the International position statement by the International

Association of Chiefs of Police (IACP) Association of Chiefs of Police (IACP) and the International Association of Fire and the International Association of Fire

Chiefs (IAFC)Chiefs (IAFC)

LAW ENFORCEMENT LAW ENFORCEMENT AGENCY DEFIBRILLATION AGENCY DEFIBRILLATION (LEA-D)(LEA-D)

A review of the published LEA-D studies (Rochester,A review of the published LEA-D studies (Rochester,Pittsburgh, and Indiana) indicates that significantPittsburgh, and Indiana) indicates that significantimprovements in survival were achieved in studyimprovements in survival were achieved in studycommunities with higher population density percommunities with higher population density persquare mile. square mile.

LAW ENFORCEMENT LAW ENFORCEMENT AGENCY DEFIBRILLATION AGENCY DEFIBRILLATION (LEA-D)(LEA-D)

Police AED Issues Forum panelists agreed that Police AED Issues Forum panelists agreed that Successful LEA-D programs possess certain Successful LEA-D programs possess certain attributes, which are elucidated in the NCED LEA-D attributes, which are elucidated in the NCED LEA-D Best Practices ChecklistBest Practices Checklist

ProgressProgress• Evidence continues Evidence continues

to support LEA-D to support LEA-D conceptconcept

• More LEA-D More LEA-D programs have been programs have been establishedestablished

• Lives are being Lives are being savedsaved

Ongoing IssuesOngoing Issues• What agencies should adopt?What agencies should adopt?

• IntegrationIntegration• Dispatch policiesDispatch policies• Medical oversightMedical oversight

• TrainingTraining• LiabilityLiability

• Program/system coordinationProgram/system coordination• Quality monitoringQuality monitoring

Newman et al. NCED POSITION STATEMENT: LAW ENFORCEMENT AGENCY DEFIBRILLATION

PREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3

1. The ability to respond 1. The ability to respond quickly quickly and reliably to and reliably to medical medical emergenciesemergencies

The mean LEA response interval (time from The mean LEA response interval (time from 9-1-1 call receipt to arrival at the scene) is9-1-1 call receipt to arrival at the scene) isless than 8 minutes.less than 8 minutes.The LEA unit arrives at least 2 minutes The LEA unit arrives at least 2 minutes

before before other designated emergency other designated emergency response units response units that provide defibrillation.that provide defibrillation.

The LEA agency continuously strives to The LEA agency continuously strives to minimize response intervals.minimize response intervals.



2. A supportive medical 2. A supportive medical response culture within the response culture within the

law enforcement agencylaw enforcement agencyLEA and local government leaders LEA and local government leaders

support the LEA-D concept and endorse support the LEA-D concept and endorse it it in writing.in writing.

Police officers and their advocates Police officers and their advocates (e.g., (e.g., unions) support the concept.unions) support the concept.

Methods for addressing psychological Methods for addressing psychological issues (e.g., critical incident stress issues (e.g., critical incident stress

debriefing) are established.debriefing) are established.Success is celebrated (e.g., through Success is celebrated (e.g., through recognition, awards).recognition, awards).



3. Strong champions who 3. Strong champions who serve serve as program as program advocatesadvocates

Strong champions, such as police officers, Strong champions, such as police officers, community leaders, and survivors, activelycommunity leaders, and survivors, activelypromote the program.promote the program.



4. Integration with the 4. Integration with the emergency medical emergency medical services services (EMS) system(EMS) system

Local EMS leaders support the program and Local EMS leaders support the program and endorse it in writing.endorse it in writing.Local EMS collaborates on program Local EMS collaborates on program

development and training.development and training.LEA-D protocols are integrated with EMS LEA-D protocols are integrated with EMS

protocols to ensure a seamless transfer ofprotocols to ensure a seamless transfer ofcare.care.



5. An effective, coordinated 5. An effective, coordinated dispatch systemdispatch system

All 9-1-1 call-takers undergo emergency All 9-1-1 call-takers undergo emergency medical medical dispatch (EMD) trainingdispatch (EMD) trainingDispatch protocols emphasize the priority of Dispatch protocols emphasize the priority of cardiac arrest callscardiac arrest callsComplaints that trigger designation as a Complaints that trigger designation as a probable probable cardiac emergency are carefullycardiac emergency are carefullyevaluated to avoid under- or overtriageevaluated to avoid under- or overtriageThe closest LEA and EMS units are dispatched The closest LEA and EMS units are dispatched simultaneously to cardiac arrest callssimultaneously to cardiac arrest callsCall processing time is minimized (9-1-1 call Call processing time is minimized (9-1-1 call receipt to dispatch interval <60 seconds)receipt to dispatch interval <60 seconds)



6. A proactive, hands-on 6. A proactive, hands-on medical directormedical director

The medical director is actively involved in The medical director is actively involved in program and protocol development, program and protocol development,

including including oversight of trainingoversight of trainingThe medical director oversees continuous The medical director oversees continuous quality improvement (CQI) processes and quality improvement (CQI) processes and reviews all responses to cardiac arrest and reviews all responses to cardiac arrest and

all all automated external defibrillator (AED)usesautomated external defibrillator (AED)usesThe medical director communicates The medical director communicates

frequently frequently with program personnel, including with program personnel, including officers and officers and dispatchers, and provides dispatchers, and provides feedback on specific feedback on specific casescases



7. A designated program 7. A designated program coordinatorcoordinator

A specific individual, the program A specific individual, the program coordinator, coordinator, is responsible for day-to-day is responsible for day-to-day operations and operations and program managementprogram management

The program coordinator is authorized to The program coordinator is authorized to act to act to ensure program effectivenessensure program effectiveness



8. Effective, competency-8. Effective, competency-based based initial and refresher initial and refresher trainingtraining

Training is accomplished through use of a Training is accomplished through use of a nationally recognized, competency-based, nationally recognized, competency-based, device-specific training program that device-specific training program that

emphasizes cardiopulmonary resuscitation emphasizes cardiopulmonary resuscitation (CPR) and AED skills acquisition and retention(CPR) and AED skills acquisition and retention

Refresher training is conducted regularly to Refresher training is conducted regularly to ensure continued competencyensure continued competency



CQI processes are established to ensure CQI processes are established to ensure excellenceexcellence

A data collection tracking process is A data collection tracking process is established to monitor response and outcome established to monitor response and outcome information and survival trendsinformation and survival trends

9. An effective CQI program 9. An effective CQI program that includes written that includes written

policies, data collection policies, data collection and and analysisanalysis



Have officers used their Have officers used their AED?AED?

AEDs UsedAEDs Used ## %%YesYes 8686 75.43975.439NoNo 2323 20.17520.175

UnknownUnknown 55 4.3864.386

(Total n=114)

Source: Massachusetts LEA Survey 2006

Why do you want to have Why do you want to have AED capabilities to your AED capabilities to your

department?department?• Their proven valueTheir proven value

• To better serve the residentsTo better serve the residents• To save livesTo save lives

• To save lives, including our ownTo save lives, including our own


What barriers are impeding What barriers are impeding your agency getting AED your agency getting AED

capability?capability?• Training CostsTraining Costs

• Need for policy changesNeed for policy changes• High equipment costHigh equipment cost

• Union / Collective Union / Collective bargaining issuesbargaining issues


What solutions have you What solutions have you found to overcome these found to overcome these

barriers?barriers?• Training compensated Training compensated

by contract by contract• Training is done as part Training is done as part

of in-service training at of in-service training at the police academythe police academy

• TBDTBD


OTHER CONSIDERATIONS?OTHER CONSIDERATIONS?

Recently, the Old Saybrook Department of Police Services, in cooperation with the Old Saybrook Ambulance Association and Middlesex Hospital has decided to move forward with several strategies to improve response, care and outcomes and are addressing community education, responder education, emergency system access and dispatch and research/quality improvement.

"We thoroughly understand that the fastest way to provide emergency cardiac care is for police officers who are already mobile and deployed throughout our community to be trained and to respond immediately with AEDs and other lifesaving skills and equipment. To enhance that the department is working with the AHA to enhance public and professional education, expand our public access AED program and assure the highest quality pre-arrival instructions given by our 9-1-1 dispatchers prior to the arrival of our police officer first responders". - Chief Michael Spera

Best Practice?Best Practice?

The Old Saybrook Department of Police Services provides all first responder services in the town of Old Saybrook. Recently, the department’s police officers / first responders have all completed 90 hours of training and have upgraded their credentials from Emergency Medical Responder to Emergency Medical Technician. Some of the unintended consequences include improved lines of communication between the first responders and paramedics. Additionally, there has been appreciable improvement in feedback about cases and an iterative process where the first responders are learning to better work with the paramedics and improve quality and timeliness of care.

"Our patrol division members were so passionate about upgrading their training that they voluntarily gave up their overtime and rearranged their vacation schedules to take the required 90 hours of training to earn their EMT certifications in order to provide a higher level of medical care to their patients. This has already resulted in improved cardiac care”. - Phil Coco, EMS Director/Instructor

Arresting V-Fib with Early Defibrillation All police cruisers are equipped with AEDs and rapid dispatch is supported by departmental policies and procedures. Additionally, there are 19 publically accessible AEDs in the community. Information regarding the type and location of these devices is integrated into the computer assisted dispatch system in Old Saybrook, and the readiness of the devices is monitored by the Department of Police Services.

“I have been so very impressed with the attention and commitment to improving recognition, response, care and outcomes in Old Saybrook. I commend Chief Spera, EMS Director Coco, and all the integrated agencies and supporters of this effort. This community can serve as an excellent role model for others”. – David Hiltz, NREMT-P, American Heart Association

SummarySummary

We need to influence more agencies We need to influence more agencies and individual officers not only to and individual officers not only to

adopt but to establish the system in a adopt but to establish the system in a manner that brings about the greatest manner that brings about the greatest degree of efficiency and effectivenessdegree of efficiency and effectiveness

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death from cardiac arrest is a real crime! can law enforcement reduce time to cpr and first shock?

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