heartsafe community
DESCRIPTION
HEARTSafe Communities exist in many areas of the US and abroad. HEARTSafe helps communities save lives by improving response and care for cardiac arrest victims.TRANSCRIPT
Traffic Signs and the Traffic Signs and the HEARTHEARTSafeSafe Community ProgramCommunity Program--
An Innovative An Innovative
David B. Hiltz, [email protected]
Cell: 401-524-0858
An Innovative An Innovative Approach to Saving Lives?Approach to Saving Lives?
OBJECTIVES
•Review case for support•Review case for support•Explain describe HEARTSafe•Examine unique program attributes•Expose attendees to HEARTSafe concept•Inspire and enable proliferation•Be a part of improving outcomes
Communities must be recognized as “ultimate coronary care units” in order to effectively increase survival and improve outcomes from sudden death. Community wide interventions that will improve overall quality and increase the likelihood of early bystander initiated CPR and prompt defibrillation are critical aspects of any effort to reduce death and disability from out-of-hospital cardiac arrest. The optimal strategy is one that actively engages a community at all levels. HEARTSafe programs have effectively advanced a full spectrum of survival priorities spanning signs and symptoms, EMD, bystander CPR, early defibrillation strategies (including LEA), early STEMI identification and ACLS education.��The HEARTSafe Community Program is a population and criteria based incentive program that is designed to help municipalities of all sizes to plan, develop, and implement chain of survival and systems change strategies. The presenters will provide a review of the development and progressive growth of HEARTSafe in MA, Ireland, ME, CT, NYS, RI and beyond.��This presentation will examine unique program attributes relating to interagency collaboration, media engagement and best practices in application. Our goal is to expose ECCU attendees to the concept of HEARTSafe and inspire and enable them to design, implement and promote similar programs in more locations across the world. Learn how to a criteria and incentive based program can influence, promote, and guide chain of survival and systems change activities. Learn how to incorporate the HEARTSafe conceptual model for localized adaptation and implementation.
“Sudden death from ischemic heart disease has been described as the most important medical emergency and 'since 60 to 70 percent
American Heart Association (1980). Standards and guidelines for cardiopulmonary resuscitation and emergency cardiac care.Journal of the American Medical Association, 244, 453-509.
the most important medical emergency and 'since 60 to 70 percent of sudden deaths caused by cardiac arrest occur before hospitalization, it is clear that the community deserves to beregarded as the ultimate coronary care unit”
Here is a poignant excerpt from the American Heart Association (1980) standards and guidelines for cardiopulmonary resuscitation and emergency cardiac care published in JAMA: “Sudden death from ischemic heart disease has been described as the most important medical emergency and 'since 60 to 70 percent of sudden deaths caused by cardiac arrest occur before hospitalization, it is clear that the community deserves to be regarded as the ultimate coronary care unit” Age old question: How do we actually get a community to see this as a priority and begin work to improve odds of favorable outcome?
“Although technology, such as that incorporated in automated external defibrillators (AEDs), has contributed to increased survival from cardiac arrest, no initial intervention can be delivered to the victim of cardiac arrest unless bystanders are ready, willing, and able to act. Moreover, to be successful, the actions of bystanders able to act. Moreover, to be successful, the actions of bystanders and other care providers must occur within a system that coordinates and integrates each facet of care into a comprehensivewhole, focusing on survival to discharge from the hospital.”
(Circulation. 2010;122[suppl 3]:S640 –S656.)© 2010 American Heart Association, Inc.
Here is what I think a very valuable and insightful snippet from the Executive Summary of the American Heart Association’s revised Guidelines for CPR and ECC. It reads: “Although technology, such as that incorporated in automated external defibrillators (AEDs), has contributed to increased survival from cardiac arrest, no initial intervention can be delivered to the victim of cardiac arrest unless bystanders are ready, willing, and able to act. Moreover, to be successful, the actions of bystanders and other care providers must occur within a system that coordinates and integrates each facet of care into a comprehensive whole, focusing on survival to discharge from the hospital.” And so, once again, more questions: “How do we get more citizens prepared and willing to perform CPR?” Additionally, how can communities garner support for localized efforts to improve outcomes?
“Many more people could potentially survive out-of-hospital cardiac arrest if regional systems of cardiac resuscitation were
(Circulation. 2010;121:709-729.)© 2010 American Heart Association, Inc.
cardiac arrest if regional systems of cardiac resuscitation were established.”
This American Heart Association Policy Statement, we get a good sense for the value of creating systems of care for cardiac arrest victims. The statement: “Many more people could potentially survive out-of-hospital cardiac arrest if regional systems of cardiac resuscitation were established.” Once again begs the question of translation into clinical practice and operational policy. Where do we go with this information? More: Abstract—Out-of-hospital cardiac arrest continues to be an important public health problem, with large and important regional variations in outcomes. Survival rates vary widely among patients treated with out-of-hospital cardiac arrest by emergency medical services and among patients transported to the hospital after return of spontaneous circulation. Most regions lack a well-coordinated approach to post– cardiac arrest care. Effective hospital-based interventions for out-of-hospital cardiac arrest exist but are used infrequently. Barriers to implementation of these interventions include lack of knowledge, experience, personnel, resources, and infrastructure. A well-defined relationship between an increased volume of patients or procedures and better outcomes among individual providers and hospitals has been observed for several other clinical disorders. Regional systems of care have improved provider experience and patient outcomes for those with ST-elevation myocardial infarction and life-threatening traumatic injury. This statement describes the rationale for regional systems of care for patients resuscitated from cardiac arrest and the preliminary recommended elements of such systems. Many more people could potentially survive out-of-hospital cardiac arrest if regional systems of cardiac resuscitation were established. A national process is necessary to develop and implement evidence-based guidelines for such systems that must include standards for the categorization, verification, and designation of components of such systems.
“To maximize the chance of a successful resuscitation outcome,CPR must be started as soon as possible after a victimof SCA collapses. Improved survival rates depend on a publictrained and motivated to recognize the emergency, activateEMS or the emergency response system, initiate high-qualityEMS or the emergency response system, initiate high-qualityCPR, and use an AED if available.”
(Circulation. 2008;117:000-000.)© 2008 American Heart Association, Inc.
Knowing the critical value of bystander initiated CPR, the American Heart Association published this Scientific Statement in 2008. Stating the obvious in this case: “To maximize the chance of a successful resuscitation outcome, CPR must be started as soon as possible after a victim of SCA collapses. Improved survival rates depend on a public trained and motivated to recognize the emergency, activate EMS or the emergency response system, initiate high-quality CPR, and use an AED if available.” Yet again, this well intended statement begs the question again: How can we get more citizens trained an willing to perform CPR on another person in their ultimate time of need? More: To maximize the chance of a successful resuscitation outcome, CPR must be started as soon as possible after a victim of SCA collapses. Improved survival rates depend on a public trained and motivated to recognize the emergency, activate EMS or the emergency response system, initiate high-quality CPR, and use an AED if available. Ample evidence has shown that CPR works. “Pushing hard and pushing fast” maintains a small but critical amount of blood flow to the brain and heart that can significantly improve the chance of survival for victims of SCA. Performance of high-quality bystander CPR can be increased through widespread dissemination of self instructional CPR courses, effective public education about the low risks of performing CPR, continuous CPR quality-improvement processes for lay and professional rescuer programs, and meaningful legislative initiatives designed to support and encourage layperson action during an emergency. Through these actions, which are intended to encourage and broaden CPR training, thousands of additional lives can be saved every year.
Gosh…I used to know CPR….. He looks like a
lawyer…
Someone else will help…right?
Can I catch a I think he is
Huh?
Can I catch a disease just by
looking?
I think he is breathing…
The stare of death while waiting for the star of life remains a common occurrence in OOH cardiac arrest. Is this what you typically observe in your community? If yours is anything like most, the answer is yes. Perhaps we need to laugh to keep from screaming…knowing that we are talking about real human beings who are dying prematurely from sudden cardiac death. Quality science, a robust portfolio of educational programs, talented and passionate ECC educators and campaigns such as Hands-Only CPR. There are a lot of tools out there that can make a difference… But do these need some “housing” or “coupling”?
The “incentive”
Here we have an illustration of the incentive. To be honest, I was not convinced that this was the trick to community engagement, at least during the period of time when we were developing the strategy and associated assets. Could it possibly be true? Today, I see these signs and find that they are a source of constant inspiration and embodiment of hope…hope of saving lives. The process: After completing the process of inventory and/or activities needed to meet designation criteria, the municipality submits the application to their EMS Region and the Department of Public Health. Following approval, a designation date is established and the community is awarded a wall plaque and 2 traffic grade road signs. In many cases, the designation results in a media opportunity as well as increased dialog between the municipality, the EMS region, and the State. Let’s take a look at some HEARTSafe programs across the US…
Massachusetts HEARTSafe
•July 2002•Population and criteria based•Population and criteria based•Basic criteria (4 link COS)•More than 50% of 351 cities and towns designated
The inaugural HEARTSafe program established in Massachusetts was launched in 2002 and is both population and criteria based. The criteria used in Massachusetts are citizen CPR-AED training, public access to defibrillation program establishment, defibrillation capable designated first responders, advanced care and an ongoing plan to improve survival. What I find interesting is that there is no centralized housing, per se, for the promotion and dissemination of HEARTSafe. In some cases, the application can be found and downloaded from one of the 5 regional EMS websites… There is a video PSA, but it has not been widely viewed by the general public. In the 8 year history of HEARTSafe in MA, only two mailings have occurred in addition to a HEARTSafe Summit that was held for 250 community stakeholders back in may of 2004. This illustrates the pervasive nature of HEARTSafe…it seems to have a life of it’s own… To date, more than 50% of Massachusetts communities have achieved HEARTSafe designation.
Heartbeats Explained
By assigning Heartbeats, the aggregate total can be adjusted based on total population. This makes it possible adjusted based on total population. This makes it possible to “scale” for communities of all sizes.
Heartbeats also permit “weighting” for certain criteria such as citizen CPR.
Many HEARTSafe programs incorporate the use of heartbeats or points. There is typically an aggregate total score requirement, in addition to point assignments for achievements in individual categories of criteria. For instance, a large municipality gets fewer points for each citizen CPR course than a smaller community would…
HEARTSafe Ireland
•Modeled after the Massachusetts program•Broader application•Broader application
As I understand, representatives from the Irish Heart Foundation attended a concurrent session, much like this one at ECCU 2004 in New Orleans. Shortly thereafter, the Foundation established there own HEARTSafe program. The Irish program model bears a great deal of similarity to the MA program, and places great emphasis on early defibrillation (in addition to training and advanced care). This is not a surprise, based on the promise of early shock and the defibrillation “theme” of the then current guidelines fro CPR and ECC. Additionally, the Foundation did a great job of “packaging” the program fro implementation in that country.
Maine HEARTSafe
•Criteria and population based•Initiated in 2006•Initiated in 2006•Bronze, Silver, Gold and Platinum designations•Over 50% of population living in designated communities•Some promising research
The Maine Cardiovascular Health Program, and the Maine Emergency Medical Services office have partnered to assist Maine cities and towns in improving the chances that anyone suffering a cardiovascular-related event will have the best possible chance for survival and recovery. Again, the Maine model is a recognition program based on the "Chain of Survival“. Their purpose is to recognize the excellent work being done by Emergency Medical Services (EMS) programs throughout Maine, and to provide further opportunities to enhance community partnerships, resources and services to improve cardiovascular health, and decrease deaths due to cardiovascular-related events, including SCA, Heart Attack and Stroke. In order to be designated a Maine HeartSafe Community, applicants must meet certain criteria that help improve cardiovascular health and decrease death and disability associated with cardiovascular events. The criteria are as follows: The EMS program, and/or their community partners must offer CPR (cardiopulmonary resuscitation) training to their community members. The EMS program, and/or their community partners must offer cardiovascular-related education and/or awareness activities in their community. At least one emergency response designated vehicle must be equipped with an Automated External Defibrillator (AED). Placement of at least one permanent AED with AED-trained personnel in public or private areas where many people are likely to congregate or be at higher risk for cardiac arrest (such as shopping malls, large employers, airports, etc.). Advanced Cardiac Life Support is dispatched to all priority medical emergencies, either as primary responders, or as ALS backup. ALS backup may occur on-scene, en-route, or at the hospital Emergency Department. The EMS program has an ongoing process to evaluate and improve the "Chain of Survival" in their community. Maine did a fabulous job in engaging the EMS community and designed a number of great assets such as a heartbeat calculation reference table, survivor stories, FAQ document, a map of HEARTSafe designated communities and incorporation of recognition into their annual EMS week event.
Connecticut HEARTSafe
•Established in 2006•Massachusetts program identical twin•Massachusetts program identical twin•Exponential growth•New resource CD/DVD
The Connecticut HEARTSafe program was established in in 2006 and like the Massachusetts program, its is both population and criteria based. The criteria used in Massachusetts and Connecticut is virtually identical and includes citizen CPR-AED training, public access to defibrillation program establishment, defibrillation capable designated first responders, advanced care and an ongoing plan to improve survival. In the Connecticut example, the Connecticut Department of Health has established a clearing house for the application and all associated assets. The Connecticut program differs from the Massachusetts program in that a primary strategy there ahs been engagement of local boards of health in promoting activities and designation. Additionally, designated towns in Connecticut receive ten rather than two signs for posting on their roadways. There is a video PSA that was adapted from Massachusetts and has been widely disseminated through public health networks as a means to promote the program. To date, more than 50% of Massachusetts communities have achieved HEARTSafe designation.
HEARTSafeHEARTSafe CommunitiesCommunities
Here is a map of Connecticut’s designated HEARTSafe Communities. In addition to seeing the location of over 60 HEARTSafe Communities, you can also get a sense for the “peer influence” that HEARTSafe appears to have on cities and towns.
Rhode Island HEARTSafe
•Most comprehensive criteria to date•EMD*•EMD*•Citizen CPR•LEA-D•Early defibrillation strategies•EMS 12 lead ECG and ACLS education
•Established 2010•Trial project complete: 2 municipalities designated
Now let’s take a look at the Rhode Island HEARTSafe program. This program is particularly meaningful to me as I live there… After gaining buy in from the Rhode Island Health Department, a diverse group of stakeholders was convened and some fairly robust criteria established for communities including EMD, a greater priority and weight for citizen CPR education, early defibrillation strategies and 12 lead ECG capability and ongoing ACLS education for EMS providers. Pilot testing has been completed and two municipalities have achieved designation. Each designated community in Rhode Island receive two HEARTSafe signs with an option to purchase more. The Rhode Island HEARTSafe application includes a number of reference assets such as information on EMD, the AHA Bystander CPR statement, and systems of care fro STEMI patients.
Dutchess County HEARTSafe
•Criteria based•Initiated in 2007•Initiated in 2007•Targets •40 community and municipal organizations designated
Let’s talk about programs in the great state of New York. As the story goes, a Deputy Commissioner for NYS DPH was vacationing on Cape Cod and saw an Entering HEARTSafe Cape Cod sign when crossing on of the two bridges to that part of the state and was more than slightly curious. As a result, there was an exchange of information regarding HEARTSafe but alas, nothing formative came of these discussions. Dr. Michael Caldwell, the County Health Commissioner in Dutchess County, NY…who was also serving as the President of NACCHO, was exposed to HEARTSafe and decided to establish as a county-wide program rather than one with a statewide focus.
Ulster County HEARTSafe
•Initiated 2008•Identical twin- Dutchess County•Identical twin- Dutchess County•Recreated “Bob” video
The Ulster County program is truly identical to that of Dutchess County. But have earned additional distinction in producing what I believe to be a highly effective video PSA that has potential to generate increased interest in learning CPR and contributing to localized HEARTSafe efforts.
Allina HEARTSafe
•Started in 2001•First designation in 2009•First designation in 2009•Criteria and population based•3rd designation
Allina Hospitals & Clinics is a not-for-profit system of hospitals, clinics and other health care services, providing care throughout Minnesota and western Wisconsin. Allina owns and operates 11 hospitals, more than 90 clinics, and health care services, including home care, hospice and palliative care, oxygen and medical equipment, pharmacies and emergency medical transportation.
Danbury Hospital
•Employee campaign•Employee campaign•First HEARTSafe region in Connecticut•Enabling early defibrillation •CPR education for care givers of at-risk
DANBURY -- With heart attacks, the rule is simple and straightforward: Get medical help as soon as possible. Call an ambulance. Don't attempt to get to the hospital on your own. But in cases of sudden cardiac arrest, when the heart goes into arrhythmias and stops pumping blood to the body, that time element becomes enormously compressed. "You need to use a defibrillator to get the heart beating within four to six minutes,'' said Matt Cassavechia, director of emergency medical services at Danbury Hospital. "You need to have EMTs on the scene within eight to 10 minutes.'' But getting defibrillators, and the people who know how to use them into the community, is difficult. The machines are expensive, and the people who are trained to use them must be on the scene. But Danbury Hospital employees are on the case. The hospital's Family Campaign -- funded by employee donations -- has given $210,000 this year toward a campaign that will, among other things, put 70 defibrillators into the community, and train people to use them. The hospital is trying to choose where to place them. Groups can apply to the hospital to receive a defibrillators until Oct. 15. "We want to put them in the best place,'' Cassavechia said. "The best fit is high-use places, like schools, community centers, senior centers.'' The state Department of Public Health has recognized the entire region for its efforts to educate people about how best to respond to a heart attack. Last month, the state declared the 10 towns of the Housatonic Valley Council of Elected Officials a HEARTSafe region -- the first time an entire group of communities has won this recognition. Dr. Andrew Keller, chairman of cardiology at Danbury Hospital, said the hospital is trying to educate people to call an ambulance if they think they're having a heart attack. "If you stop people on the street, everyone agrees: You call an ambulance,'' Keller said. "But it turns out that when people are having heart attacks, only 50 percent do that. The reasons people give for driving themselves to the hospital reflect thrifty thinking and wallets. "People say they don't want to bother the EMTs,'' Keller said. "They say they're embarrassed to have an ambulance in their driveway. Worst of all, they worry about the cost.'' Calling 911 would save lives, Keller said. The defibrillators, which can be used on the scene to shock people's hearts back into action, will do so as well. "Every link in the chain has to be robust,'' Cassavechia said.
JUST WHAT THE DOCTOR ORDERED:
“Defibrillators headed for police cars”
JUST WHAT THE DOCTOR ORDERED: The Warwick Police Department recently added seven AEDs (automated external defibrillators) to the department's supply of life-saving equipment. Seen at yesterday's press conference are from left: Dr. Paul McKenney, Captain Raymond GallucciJr., Col. Stephen McCartney, Dr. Joseph Spinale, chief of cardiology at Kent Hospital and the president of the Kent HeartSafe Foundation and Mayor Scott Avedisian.
September 30, 2010
Mayor Scott Avedisian, Dr. Joseph Spinale, chief of cardiology at Kent Hospital and president of the Kent HeartSafe Foundation, along with Colonel Stephen McCartney, announced yesterday that two of the machines will be located in the Police Station and five will be issued to police cruisers. ��The Police Department bought three of the AEDs, including carry cases, pads, infant-child key, prep kits, wall mounts and training and tool kits. The HeartSafe Foundation paid for another four. According to Capt. Raymond Gallucci Jr., of the department's professional standards division, all officers are being trained in their use. All of the city’s fire engines and rescue trucks are already equipped with the devices, according to Dr. Spinale. ��This is the latest component of the city’s ongoing efforts as a HeartSafe Community that the foundation hopes will improve the 4 percent survival rate for people stricken with cardiac arrest in Warwick, which is now the same as national statistics. ��“What we hope to do is get the survival rate up to 20 or even 30 percent,” said Dr. Spinale. “We now have around 9.5 cardiac arrests a month, so you can see that getting the average survival rate up to 20 or 30 percent means a lot of lives will be saved.” The HeartSafe certification is effective for three years, expiring in January 2013. To earn this recognition, Warwick had to achieve 700 points (or “heartbeats”) by meeting a number of criteria meant to strengthen the so-called cardiac “Chain of Survival.” These included cardiopulmonary resuscitation (CPR) training programs; placement of AEDs throughout the community; trained first responders with AEDs on emergency vehicles; effective emergency response plans for municipal and school buildings; and a demonstrated commitment to continually evaluate the community's response to cardiac emergencies. Warwick earned 1,255 heartbeats. ��Spinale noted that 95 percent of cardiac arrests in Warwick occur at home or in the workplace, making widespread community CPR and AED training, along with placement of that equipment in many public places, particularly important. ��Mayor Avedisian said he has been after the Rhode Island Airport Corporation to make the AEDs they already have to be more accessible to the public, saying that they have been less than enthusiastic in that regard. ��Dr. Spinale agreed that the airport is the ideal place to improve survival rates. ��“They have the personnel, they have the security cameras. I can’t think of a better place to be noticed if you are going into cardiac arrest,” said Spinale. “I look forward to the day when these [AEDs] are as common as fire extinguishers in public buildings.” ��Everyone at the press conference agreed that survival would increase even more if everyone had training in CPR or using AEDs. For information about training, or starting a training program at your company or organization, visit www.warwickri.com or e-mail [email protected] or call Pat Seltzer 468-4103.����Read more: Warwick Beacon - Defibrillators headed for police cars
Causal relationship…Where is your data?
Don’t let the absence of evidence spoil a perfectly good idea!
Observations
•Power of the signs•“Uptake” and proliferation•“Uptake” and proliferation•Many common elements•Evolution•Adaptability•Ease of integration•Supportive charactersistics
So, you want to start a HEARTSafe Program?
Well, my friends have put it so well, I can’t resist. Visit you doctor, your pharmacist and your bartender…and in that order! If afterwards, you are still inclined to pursuit, here is what I recommend…
“Open up the can”
Read and comprehend the revised Guidelines for CPR and ECC. Google HEARTSafe Communities and do some information gathering…begin dreaming, that’s right, dreaming about eliminating barriers in you systems and how you might “house” inside a HEARTSafe campaign.
Gather your best players
Gather your best players (or cooks for that matter). Past experience shows that a mix of public safety, hospital, members of the business community, and public health officials works well. Bring them together to discuss the issues around cardiac arrest. Don’t be afraid to talk about real issues…with the system of care for cardiac arrest patients. Remember, it is not the fault of the individuals or agencies, but rather an inherited system that is not optimized.
Get Health onboard early
If you missed it already, let me reaffirm the importance of getting your health department onboard early in the game. Almost all HEARTSafe programs use State or County Health Departments as designating agencies. They will be on your side…present the issues related to sudden cardiac arrest as a public health issue…and show them how a community lead efforts, under the guidance of the State Health Department, to improve response and outcomes.
Establish the criteria!
Discussion of issues will lead to the establishment of criteria. Weigh the criteria based current recommendations and importance. Localize the criteria and heartbeats to address the changes that can lead to improved system performance. MAKE THE PROGRAM YOUR OWN.
Don’t forget…
You know more and are wiser than the HEARTSafe programs that have already been established. In the presence of the current evidence, I would strongly encourage the inclusion of emergency medical dispatch and therapeutic hypothermia. Additionally, with the increasing use of ePCRs and the implementation of NEMSIS at the State level, criteria addressing data collection and use as part of CQI.
Design your assets
Given the “open source” nature of all things HEARTSafe, I would encourage future HEARTSafe programs to invest in asset design. My experience has been that agencies who have implemented HEARTSafe to be very generous in sharing resources for refinement and recirculation in newer and evolving programs. A few dollars and some foresight will go a long way when promoting and implementing HEARTSafe.
Launch!
When launching your program, have the following lined up: A few communities who have already “talked it up” and are excited and ready to implement. Often, these will be previously progressive communities and systems and can serve as role models for those who follow. Webinize your assets. Work with your stakeholders to create a media event and subsequent advisory. You will want a BANG for your launch. Involve survivors, prominent cardiologists and emergency medicine physicians. Do not be disappointed in seemingly slow progress. If you set the program up well and have good champions, the program will take root. Bumps in the ride should be anticipated, and efforts to implement may be prompted by by unfortunate but real tragedy.
Your questions are invited!Your questions are invited!
Let’s entertain questions and comments from the group.
And have some fun along the way!
PLAY BLOOPER ROLL FROM CONNECTICUT PSA VIDEO SHOOT
And have some fun along the way!
If time allows, show blooper roll.