Post on 08-Aug-2020
transcript
Greetings from Stony Brook
Presenter Disclosure Information
• Edward R. Stapleton
• FINANCIAL DISCLOSURE:
• No relevant financial relationship exists
• No Unlabeled/Unapproved Uses in
Presentation
CITIZEN CPR IN THE U.S.: PAST, PRESENT AND FUTURE
Edward R. Stapleton, EMT-P
Associate Professor of Emergency Medicine
Director of Prehospital Education
Department of Emergency Medicine
School of Medicine
Stony Brook University
History of CPR Education and Implementation
0 1 2 3 4 5 6 7 8 9
Time
Larsen MP, et al. Ann
Emerg Med 1993;22:1652-58
SURVIVAL
Chances of success reduced
7% to 10% each minute
100
90
80
70
% 60
Success 50
40
30
20
10
Chain of Survival Strategies in the United States
Barriers to CPR and PAD
Fear of lawsuits
Fear of action
Lack of prioritization in people’s lives
Fear of infectious disease (traditional CPR)
Lack of knowledge regarding benefit
Access to CPR courses and cost
Mass Media CPR
CPR in the Schools
Public Access Defibrillation Target Groups
Mass Training Workplace Training
Dispatcher CPR
CPR Anytime
Hands Only Mass Training Kiosk CPR
Computer Interactive Internet Training
Dispatch-Assisted CPR Initiatives
Simplified CPR arrest recognition (unresponsive, not breathing normally)
Emphasis on providing dispatch-assisted CPR instructions with Hands Only CPR
Training programs
CPR instruction CQI programs
Reduction in time to first compression
Quality of Training
Opportunity Knocks!
Hands-Only
The rate of survival to hospital discharge
5.2% if no CPR was given
7.8% for conventional CPR
13.3% for the hands-only method
The odds of survival with conventional CPR were not significantly different from no CPR.
Overall survival increased from 3.7% in 2005 to 9.8% in 2009, a difference that was significant at P<0.001.
Arizona Hands Only CPR
Bobrow, et al. Chest compression only by lay rescuers and survival from out-of-hospital
cardiac arrest . JAMA 2010;304(13): 1447-1454.
CPR in the Schools
• Student health professional – High school model
– 11-12 grade students become instructor
– Train lower grades
• Real life training – Middle school model
– Student provider training
MASS MEDIA:
THE ULTIMATE CPR CLASSROOM
Check for
responsiveness
Phone 911
Press Hard
Press Fast
“Instructors… are we really needed?”
Effectiveness of a 30-min CPR self-instruction program
for lay responders: a controlled randomized study
Mean percentage of compressions with adequate depth, as measured by manikin.
Lynch B, et al. Resuscitation 2005. Oct;67(1):31-43.
• Healthcare Providers – Multiplier = 2.3
• Families of high risk patients difficult to recruit, multiplier = 1.6
• Middle school (NY) – easy to recruit, multiplier = 2.1
• High school (MN), easy to recruit, multiplier = 3.8
CPR Anytime at Stony Brook Distribution Efficiency: Determining the “Multiplier“
CPR Kiosk
• Hands-Only CPR permits a minimalist approach
• Self Instruction has proven to be very effective
• Video-based education with manikins have demonstrated more favorable results
• DFW Pilot project underway
Compress
Harder!
Compress
Faster!
Goal:100
88
Characteristics of “Model”
• Placed in large waiting areas in private booth – Hospital lobbies – DMV
• High graphics resolution with large screen TV
• Minimal Maintenance • Push button operating
system • Incentives?
– i.e. Starbucks coupons
Characteristics of “Model”
• Placed in large waiting areas in private booth – Hospital lobbies – DMV
• High graphics resolution with large screen TV
• Minimal Maintenance • Push button operating
system • Incentives?
– i.e. Starbucks coupons
“Manikins… are they really needed?”
“CPR: It’s About Time”
1986
Schluger J, Hayes JG, Turino GM, Fishman S, Fox AC.
The effectiveness of film and videotape in teaching
cardiopulmonary resuscitation to the lay public.
N Y State J Med. 1987 Jul;87(7):382-5.
Schluger J, Hayes JG, Turino GM, Fishman S, Fox AC. The effectiveness of film and videotape in
teaching cardiopulmonary resuscitation to the lay public. N Y State J Med. 1987 Jul;87(7):382-5.
Bobrow Video Hands-Only Study Immediate vs. 2-Month Delay
• C-group (control group)
• Subjects received no training intervention.
• UBV-group (ultra-brief video)
• Subjects viewed a 60-second ultra-brief
video produced by the AHA without skill
practice.
• BV-group (brief video)
• Subjects viewed a 5-minute AHA video
without skill practice.
• BVP-group (brief video with practice)
• Subjects viewed an 8-minute AHA video
with CPR practice during the viewing.
Bobrow, B, et al. The Effectiveness of Ultrabrief and Brief Educational Videos for Training Lay
Responders in Hands-Only Cardiopulmonary Resuscitation: Implications for the Future of Citizen
Cardiopulmonary Resuscitation Training. Circulation: Cardiovascular Quality and Outcomes
Issue: Volume 4(2), March 2011, p 220–226
Amanda Daisy Heard, MD; Edward Stapleton, EMT-P; Catherine Silberstein;
Henry Thode, PhD; Mark Henry, MD.
Department of Emergency Medicine,
Stony Brook University, Stony Brook, NY
Characteristics of Strategy
Develop video that is 90% compress hard and fast!
Very clear images of compressions
10% assessment and call 911
Test effectiveness
Video would have to be continuously aired
A short run would not have a significant effect
The Plan
Partner with Mass media Outlets
ABC, NBC, CBS
Identify costs associated with 1 minute CPR training video aired continuously over time
Seek reduced rates (PSA)
See grant funding to support initiative
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
Pulse Point
Recently added it to our system
Rescuer registers with program
GPS Tracks location
Notifies if you are nearby
Advises you where AEDs are
located
Management of Public Access Defibrillation
Limit the bureaucracy
Have a facilitating structure
Ideally with a healthcare institution
Download of AED data and follow-up
Critical to patient management
May determine need for AICD