the shocking truth about cops and defibrillation

The Shocking Truth The Shocking Truth About Cops and About Cops and DefibrillationDefibrillation

Conflict of InterestConflict of Interest

HiltzHiltz No disclosuresNo disclosures

GreenhalghGreenhalgh No disclosuresNo disclosures

ObjectivesObjectives

• Learn about the evidence supporting LEA Learn about the evidence supporting LEA defibrillation strategies and LEA defibrillation strategies and LEA defibrillation best practices including defibrillation best practices including examples of effective implementation. examples of effective implementation.

• Review results of a survey of LEA in Review results of a survey of LEA in Massachusetts in order to better Massachusetts in order to better understand LEA attitudes towards understand LEA attitudes towards resuscitation. resuscitation.

• Discuss advancement of LEA defibrillation Discuss advancement of LEA defibrillation strategies and help save lives. strategies and help save lives.

Guidelines 2005 Guidelines 2005

““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)!

This is NOT a new

recommendation

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 personnel

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


• 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.


• 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.

Literature ReviewLiterature Review• High Discharge Survival Rate After Out-of-Hospital High Discharge Survival Rate After Out-of-Hospital

Ventricular Fibrillation With Rapid Defibrillation by Police Ventricular Fibrillation With Rapid Defibrillation by Police and Paramedics and Paramedics

Annals of Emergency Medicine , Volume 28 , Issue 5 , Pages 480 - Annals of Emergency Medicine , Volume 28 , Issue 5 , Pages 480 - 485485

R . White , B . Asplin , T . Bugliosi , D . HankinsR . White , B . Asplin , T . Bugliosi , D . HankinsConclusion: 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 (eg, 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.

Literature ReviewLiterature Review• Seven years' experience with early defibrillation by police Seven years' experience with early defibrillation by police

and paramedics in an emergency medical services and paramedics in an emergency medical services system . system .

Resuscitation , Volume 39 , Issue 3 , Pages 145 - 151Resuscitation , Volume 39 , Issue 3 , Pages 145 - 151

R . WhiteR . 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…

Literature ReviewLiterature Review• Law Enforcement Agencies and Out-of-Hospital Emergency Law Enforcement Agencies and Out-of-Hospital Emergency

Care . Care .

Annals of Emergency Medicine , Volume 29 , Issue Annals of Emergency Medicine , Volume 29 , Issue 4 , Pages 497 - 5034 , Pages 497 - 503

H . Alonso-Serra , T . Delbridge , T . Auble , V . Mosesso , H . Alonso-Serra , T . Delbridge , T . Auble , V . Mosesso , E . DavisE . 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.

Literature ReviewLiterature Review• Providing automated external defibrillators to urban police Providing automated external defibrillators to urban police

officers in addition to a fire department rapid defibrillation officers in addition to a fire department rapid defibrillation program is not effective . program is not effective .

Resuscitation , Volume 66 , Issue 2 , Pages 189 - 196Resuscitation , Volume 66 , Issue 2 , Pages 189 - 196

M . Sayre , J . Evans , L . White , T . BrennanM . 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.

Literature ReviewLiterature Review• Attitudes of Law Enforcement Officers Regarding Automated Attitudes of Law Enforcement Officers Regarding Automated

External DefibrillatorsExternal Defibrillators

Academic Emergency MedicineAcademic Emergency Medicine, , Volume 9 Issue 7 Page 751-753, July Volume 9 Issue 7 Page 751-753, July 2002 2002

William J. Groh MD, Miriam R. Lowe MS, Amanda D. Overgaard William J. Groh MD, Miriam R. Lowe MS, Amanda D. Overgaard BS, BS,

Jeanie M. Neal MS, W. Craig Fishburn BS, Douglas P. Zipes MDJeanie M. Neal MS, W. Craig Fishburn BS, Douglas P. Zipes MDConclusion: 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.

IACP and IAFCIACP and IAFC

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 and the International Association of Fire 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.

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.

Great reference

paper

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

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 ChecklistNCED no longer

intact but recommendation

s remain

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

Some Ongoing IssuesSome Ongoing 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

And add union resistance in some cases

AnecdotesAnecdotes

• Agency removes AEDs because they Agency removes AEDs because they did not work on dogsdid not work on dogs

• State efforts did not State efforts did not

include dispatch policiesinclude dispatch policies

ABC’s are alive and well.

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.

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

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

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 of

care.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 dispatch (EMD) trainingmedical dispatch (EMD) training

Dispatch 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 cardiac emergency are carefullyprobable cardiac emergency are carefullyevaluated to avoid under- or overtriageevaluated to avoid under- or overtriageThe closest LEA and EMS units are The closest LEA and EMS units are

dispatched 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

10. An effective CQI 10. An effective CQI program program that includes that includes written written policies, data policies, data collection and collection and analysisanalysis



Massachusetts LEA SurveyMassachusetts LEA Survey

What do police agencies think?What do police agencies think?

Massachusetts LEA SurveyMassachusetts LEA Survey

Survey BackgroundSurvey Background• Target group:Target group: Massachusetts Massachusetts

Municipal Law Municipal Law EnforcementEnforcement

• Survey conducted:Survey conducted: Spring/Summer Spring/Summer 20062006

• # of surveys distributed# of surveys distributed 351351

• # of surveys returned# of surveys returned 124 (35.33%)124 (35.33%)

• Of those returnedOf those returned– with AEDS :with AEDS : 114 (91.94%)114 (91.94%)– without AEDs: without AEDs: 1110 (08.06%)10 (08.06%)

AED UnitsAED Units

684+ AEDs are 684+ AEDs are placed in total within placed in total within

the departments the departments that returned their that returned their

surveyssurveys

Some departments gave vague responses as to actual number of units but stated that they had them – these departments were counted as having “1”

Source: Massachusetts LEA Survey 2006

ManufacturerManufacturer # of # of UnitsUnits

% of % of TotalTotal

Medtronic/Physio-ControlMedtronic/Physio-Control 345345 50.4450.44

ZollZoll 8989 13.0113.01

PhilipsPhilips 7979 11.5511.55

Cardiac ScienceCardiac Science 6868 9.949.94

LaerdalLaerdal 3333 4.824.82

SurvivaLinkSurvivaLink 1414 2.052.05

Defib TechDefib Tech 11 0.150.15

UnknownUnknown 5555 8.048.04

Total:Total: 684684 100.00100.00

Types of AED UnitsTypes of AED Units


FactorFactor # # Life saving potential / statistical data on savesLife saving potential / statistical data on saves 3737

First on scene / other services delayedFirst on scene / other services delayed 2929

Donations / GrantsDonations / Grants 1818

RequirementRequirement 1111

Community influence / “Right thing to do”Community influence / “Right thing to do” 77

FD influenceFD influence 33

Union influenceUnion influence 22

Improved technologyImproved technology 11

ResearchResearch 11

No answerNo answer 55

(Total n=114)


Factors in getting AED Factors in getting AED UnitsUnits

Towns with AEDs - Towns with AEDs - CommentsComments

• Proven value of AED devicesProven value of AED devices• Better serve residents and visitors of Better serve residents and visitors of

community successfully community successfully implemented AED program in implemented AED program in neighboring townneighboring town

• The number of lives that can be The number of lives that can be saved by using AED'ssaved by using AED's

• Would like to bring AED to save livesWould like to bring AED to save lives• The need to service our communityThe need to service our community• The potential to save lives, including The potential to save lives, including

our staffour staffSource: Massachusetts LEA Survey 2006

Obstacles Encountered Obstacles Encountered in in

Getting AEDsGetting AEDsObstacleObstacle # #

FinancialFinancial 4646

NoneNone 4646

Union / Collective BargainingUnion / Collective Bargaining 2020

Training IssuesTraining Issues 1010

AttitudeAttitude 33

FD CompatibilityFD Compatibility 11

Maintenance ConcernsMaintenance Concerns 11

UnknownUnknown 22


How Were Obstacles How Were Obstacles Overcome?Overcome?

Obstacles overcome by:Obstacles overcome by: # # GrantsGrants 1919

DonationsDonations 1616

Contractual – Union BargainingContractual – Union Bargaining 99

Department fundsDepartment funds 77

Department educationDepartment education 66

Contractual – StipendContractual – Stipend 66

Contractual – MandatoryContractual – Mandatory 33

EMS EMS 22

Public educationPublic education 22

Time/patienceTime/patience 22

UnknownUnknown 11

N/AN/A 1717

No responseNo response 3535


Do officers receive Do officers receive compensation for being compensation for being

trained?trained?

CompensatedCompensated??

## %%

YesYes 5252 45.645.6

NoNo 5858 50.850.8

N/AN/A 44 3.513.51


Type of compensation Type of compensation receivedreceived

TypeType ## %%$100$100 22 3.8463.846

$150$150 11 1.9231.923

$200$200 11 1.9231.923

$250$250 22 3.8463.846

$300$300 11 1.9231.923

$400$400 33 5.7695.769

$475$475 11 1.9231.923

$500$500 33 5.7695.769

$725$725 11 1.9231.923

$750$750 11 1.9231.923

TypeType ## %%$325 (x1)$325 (x1) 11 1.9231.923

0.5%0.5% 11 1.9231.923

1.0%1.0% 66 11.5311.5388

2.5%2.5% 11 1.9231.923

1% (x1)1% (x1) 11 1.9231.923

Unknown %Unknown % 33 5.7695.769

NoneNone 11 1.9231.923

Unknown $Unknown $ 1818 34.6134.6155


(Total n=52)


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

AEDs UsedAEDs Used ## %%YesYes 8686 75.43975.439

NoNo 2323 20.17520.175


(Total n=114)


Have officers had any Have officers had any “saves” using their AED?“saves” using their AED?

Patient SavesPatient Saves ## %%YesYes 5252 60.46560.465

NoNo 1818 20.93020.930


(Total n=86)

Respondent self-reported “saves”

Some departments claimed multiple saves but did not give a number – only credited with “1” save for this report


Has your agency had Has your agency had any training issues? any training issues?

Any Any Issues?Issues?

## %%

YesYes 1111 9.6499.649

NoNo 7171 62.28162.281


(Total n=114)


What were the training What were the training issues?issues?

IssueIssue ## %%Yearly in-service trainingYearly in-service training 66 54.5454.54

55

FinancialFinancial 22 18.1818.1822

Learning new protocolsLearning new protocols 11 09.0909.0900

Using obsolete equipmentUsing obsolete equipment 11 09.0909.0900

Unknown / UnspecifiedUnknown / Unspecified 11 09.0909.0900

(Total n=11)


Is you community Is you community ““HEARTHEARTSafe”?Safe”?

HEARTHEARTSafeSafe??

## %%

YesYes 4646 40.35140.351

NoNo 2727 23.68423.684


In-ProcessIn-Process 77 06.14006.140(Total n=114)


Can the AHA help?Can the AHA help?

Help?Help? ## %%YesYes 1818 14.28614.286

NoNo 6767 53.17553.175

No responseNo response 4141 32.53932.539

(Total n=126)


Summary of help sought Summary of help sought from the AHA from the AHA

• Advocate the government to provide Advocate the government to provide AEDsAEDs

• Donate equipment and/or moneyDonate equipment and/or money• Guidelines on unit maintenanceGuidelines on unit maintenance• Work to get the unit cost decreasedWork to get the unit cost decreased• Provide information on funding and Provide information on funding and

grant opportunities/sourcesgrant opportunities/sources


Would you recommend Would you recommend getting AEDs to another getting AEDs to another

Chief LEO?Chief LEO?RecommendRecommend

??## %%

YesYes 9797 85.08885.088

NoNo 33 2.6322.632


N/AN/A 22 1.7541.754(Total n=114)


Does your department Does your department want to have AED want to have AED

capabilities?capabilities?

Want AEDs?Want AEDs? ## %%YesYes 77 70.00070.000

No ResponseNo Response 33 30.00030.000

(Total n=10)


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 To better serve the

residentsresidents• To save livesTo save lives• To save lives, To save lives,

including our staffincluding our staff


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 Training

compensated compensated by contractby contract

• Training is done as Training is done as part of in-service part of in-service training at the training at the police academypolice academy

• TBDTBD


Is there anything that the Is there anything that the AHA could do to make it AHA could do to make it

easier for you or to assist easier for you or to assist you in breaking down some you in breaking down some

of these barriers?of these barriers?• As Chief I would welcome a visit from the As Chief I would welcome a visit from the

American Heart Association. However, it American Heart Association. However, it is the union who needs to be convincedis the union who needs to be convinced

• PotentiallyPotentially• Because of a budget crisis a visit would Because of a budget crisis a visit would

not influence the decision at this timenot influence the decision at this time• Not at this timeNot at this time


Limitations of this studyLimitations of this study

• Study focused on agency Study focused on agency perspectives vs. perspectives vs. individual perspectivesindividual perspectives

• Regional focus / attitudesRegional focus / attitudes• Influence of person Influence of person

completing surveycompleting survey• Interpretation of survey Interpretation of survey

questionsquestions

• Repeat the survey to Repeat the survey to see current activities, see current activities, issues, and trendsissues, and trends

• Conduct the same Conduct the same survey in other survey in other geographical locationsgeographical locations

• Conduct a survey with Conduct a survey with individual officers to get individual officers to get a personal perspectivea personal perspective

Future study needs / Next Future study needs / Next stepssteps

SummarySummary

We need to influence more We need to influence more agencies and individual agencies and individual

officers not only to adopt officers not only to adopt but to establish the system but to establish the system

in a manner that brings in a manner that brings about the greatest degree of about the greatest degree of efficiency and effectivenessefficiency and effectiveness

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the shocking truth about cops and defibrillation

Health & Medicine

early defibrillation

rapid defibrillation

defibrillation capability

aeds lea personnel

survey of lea

lea attitudes

number lea personnel

public access defibrillation