law enforcement role in response to sudden cardiac arrest

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The relevance of time to CPR and defibrillation to survival is well established. Furthermore the effectiveness of law enforcement agency (LEA) defibrillation strategies is well demonstrated. Despite this, few LEA have committed to the necessary policy change, training and purchase of equipment. This presentation will review LEA defibrillation best practices as well as results from a survey of LEA in Massachusetts. In reviewing this information the participants will gain insight into LEA attitudes towards resuscitation and aid in the advancement of efforts to utilize LEA in the delivery of lifesaving interventions.

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  • 1. In the next hour, we will:Learn about the evidence supporting LEA defibrillation strategies and LEA defibrillation best practices including examples of effective implementation...Discuss advancement of LEA defibrillation strategies and help save lives.

2. Guidelines 2005CPR and AED use by public safety first responders(traditional and nontraditional) are recommended toincrease survival rates for SCA (Class I)!DOI: 10.1161/CIRCULATIONAHA.105.166554 3. Why LEA-D? Often more LEA personnel than EMSpersonnel in a given community Patrol units poised to respond rapidlyto emergencies. EMS often station-based, fewer innumber LEA personnel often arrive at thescene before EMS personnelWhite RD. Patient outcomes following defibrillation with a low energy biphasic truncated exponentialwaveform in out-of-hospital cardiac arrest. Resuscitation. 2001;49:9-14. 4. Why LEA-D? 81% of police departments respond to medical emergencies 50%provide some level of patient care* Defibrillation capability can greatly enhance care renderedCobb LA, Fahrenbruch CE, Walsh TR, et al. Influence of cardiopulmonary resuscitation prior to defibrillationin patients with out-of-hospital ventricular fibrillation. JAMA. 1999;281:1182-8. 5. Why LEA-D? Technology has made it possible foratypical responders to effectively useAEDs LEA personnel trained in CPR-AEDsdemonstrate comparable skillcompetencyWhite RD. Technological advances and program initiatives in public access defibrillation using automatedexternal defibrillators. Curr Opin Crit Care. 2001;7:145-51.Davis EA, Mosesso VN. Performance of police first responders in utilizing automated external defibrillationon 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. 6. High Discharge Survival Rate After Out-of-Hospital VentricularFibrillation With Rapid Defibrillation by Police and ParamedicsAnnals of Emergency Medicine , Volume 28 , Issue 5 , Pages 480 - 485R . 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 andparamedics in an emergency medical services system .Resuscitation , Volume 39 , Issue 3 , Pages 145 - 151R . White Conclusion: 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 7. Law Enforcement Agencies and Out-of-Hospital Emergency Care .Annals of Emergency Medicine , Volume 29 , Issue 4 , Pages 497 - 503H . Alonso-Serra , T . Delbridge , T . Auble , V . Mosesso , E . Davis Conclusion: Many law enforcement agencies are involved to some extent inproviding out-of-hospital emergency medical care, and most of the agencieswe surveyed would support additional medical training and new or expandedroles for themselves in EMS systems.Providing automated external defibrillators to urban police officers inaddition to a fire department rapid defibrillation program is not effectiveResuscitation , Volume 66 , Issue 2 , Pages 189 - 196M . Sayre , J . Evans , L . White , T . Brennan Conclusion: 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. 8. Attitudes of Law Enforcement Officers Regarding Automated ExternalDefibrillatorsAcademic Emergency Medicine, Volume 9 Issue 7 Page 751-753, July 2002William J. Groh MD, Miriam R. Lowe MS, Amanda D. Overgaard BS,Jeanie M. Neal MS, W. Craig Fishburn BS, Douglas P. Zipes MDConclusion: Limited knowledge and negative attitudes of lawenforcement officers regarding their involvement in treating OHCA andusing AEDs are commonly present. These factors could result inbarriers that negatively impact law enforcement AED programs. 9. LEA-D concept is endorsed in a joint position statement by the International Association of Chiefs of Police (IACP)and the International Association of FireChiefs (IAFC) 10. LAW ENFORCEMENT AGENCYDEFIBRILLATION (LEA-D)A review of the published LEA-D studies (Rochester,Pittsburgh, and Indiana) indicates that significantimprovements in survival were achieved in studycommunities with higher population density persquare mile. 11. LAW ENFORCEMENT AGENCYDEFIBRILLATION (LEA-D)Police AED Issues Forum panelists agreed thatSuccessful LEA-D programs possess certainattributes, which are elucidated in the NCED LEA-DBest Practices Checklist 12. Progress Evidence continues to support LEA-D concept More LEA-D programs have been established Lives are being saved 13. Some Ongoing Issues What agencies should adopt? Integration Dispatch policies Medical oversight Training Liability Program/system coordination Quality monitoring 14. Newman et al. NCED POSITION STATEMENT: LAW ENFORCEMENT AGENCY DEFIBRILLATIONPREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3 15. Anecdotes Agency removes AEDs because theydid not work on dogs ABCs are alive and well? State efforts did notinclude dispatch policies 16. 1. The ability to respond quicklyand reliably to medicalemergencies The mean LEA response interval (time from 9-1-1 call receipt to arrival at the scene) is less than 8 minutes. The LEA unit arrives at least 2 minutes before other designated emergency response units that provide defibrillation. The LEA agency continuously strives to minimize response intervals.Newman et al. NCED POSITION STATEMENT: LAW ENFORCEMENT AGENCY DEFIBRILLATIONPREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3 17. 2. A supportive medicalresponse culture within thelaw enforcement agency LEA and local government leaders support the LEA-D concept and endorse it in writing. Police officers and their advocates (e.g., unions) support the concept. Methods for addressing psychological issues (e.g., critical incident stress debriefing) are established. Success is celebrated (e.g., through recognition, awards).Newman et al. NCED POSITION STATEMENT: LAW ENFORCEMENT AGENCY DEFIBRILLATIONPREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3 18. 3. Strong champions who serveas program advocates Strong champions, such as police officers, community leaders, and survivors, actively promote the program.Newman et al. NCED POSITION STATEMENT: LAW ENFORCEMENT AGENCY DEFIBRILLATIONPREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3 19. 4. Integration with the emergency medical services (EMS) system Local EMS leaders support the program and endorse it in writing. Local EMS collaborates on program development and training. LEA-D protocols are integrated with EMS protocols to ensure a seamless transfer of care.Newman et al. NCED POSITION STATEMENT: LAW ENFORCEMENT AGENCY DEFIBRILLATIONPREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3 20. 5. An effective, coordinateddispatch system All 9-1-1 call-takers undergo emergency medical dispatch (EMD) training Dispatch protocols emphasize the priority of cardiac arrest calls Complaints that trigger designation as a probable cardiac emergency are carefully evaluated to avoid under- or overtriage The closest LEA and EMS units are dispatched simultaneously to cardiac arrest calls Call processing time is minimized (9-1-1 call receipt to dispatch interval