Strengthening the Chain of SurvivalThe Role of the Emergency Dispatcher

November, 2011 Tom Rea

Harborview Medical CenterKing County EMS

Strengthening the Chain of SurvivalThe Role of the Dispatcher

Overview: Emergency dispatchers can have a meaningful impact on survival following cardiac arrest.

1. Public health perspective of cardiac arrest

2. Dispatcher interface with the chain of survival

3. Challenges of identification

4. Challenges of rescuer engagement

5. Details of CPR instruction

6. Summary

Objectives – Understand:

You must understand local circumstances ……….in order to achieve success.

Leonard Cobb Michael CopassMickey Eisenberg

A Fundamental Principle

Is there an opportunity for your community?

The Public Health Toll of Cardiac Arrest

The leading cause of death in the US is:

____ HIV

____ Stroke

____ Colon Cancer

____ Cardiac Arrest

____ Tuberculosis

The leading cause of death in the US is:

_1_ Cardiac Arrest

_2_ Stroke

_3_ Colon Cancer

_4_ HIV

_5_ Tuberculosis

How do we reduce death from cardiac arrest?

Links in the Chain of Survival

• Prompt activation of emergency care 9-1-1

• Early CPR

• Early Defibrillation

• Timely advanced care

• Timely post-resuscitation care

Early (Bystander) CPR…….?

A. Improves blood flow to the brain

B. Improves blood flow to the left ventricle

C. Helps prevent deterioration of VF to asystole

D. Improves the chance of survival

Early (Bystander) CPR…….?

A. Improves blood flow to the brain

B. Improves blood flow to the left ventricle

C. Helps prevent deterioration of VF to asystole

D. Improves the chance of survival

The rate of bystander CPR in most communities is..?

A. 10%

B. 25%

C. 50%

D. 70%

The rate of bystander in most communities is ...?

A. 10%

B. 25%

C. 50%

D. 70%

The rate of bystander in most communities is ...?

A. 10%

B. 25%

C. 50%

D. 70%

An effective therapy that is only partly implemented.

What are the roadblocksto bystander CPR?

A. Cardiac arrest is hard to recognize.

B. Rescuers do not have confidence to act.

C. CPR is technically too difficult.

A. Cardiac arrest is hard to recognize

B. Rescuers do not have confidence - fearful

C. CPR is technically too difficult

………….What to do?

What are the roadblocks

to bystander CPR?

Option 1: CPR Training Programs

The rate of bystander in most communities is ...?

A. 10%

B. 25%

C. 50%

D. 70%

Option 2: Dispatcher-Assisted CPR

Cardiac arrest is hard to recognize

Laypersons may not have confidence

CPR can be technically difficult

Yes……..but answer the question

Cardiac Arrest Recognition

Cardiac Arrest Recognition

A cardiac arrest patient is (True or False) :

1. Not responsive (not awake/ not conscious)

2. Not breathing

Cardiac Arrest Recognition

True - Not responsive (not awake/not conscious)

Sometimes - Not breathing

Cardiac Arrest Recognition

True - Not responsive (not awake/not conscious)

True - Not breathing……normally

Agonal gasps

Cardiac Arrest Recognition

Not responsive (not awake/not conscious)

Not breathing normally

Are we casting the net too widely?

Post-ictal, Hypoglycemia, Intoxication

No………….so prove it

True Arrest No arrest

Let’s apply the 2 question approach:

Not responsive (not awake/not conscious)

Not breathing normally

For every 100 true cardiac arrests you identify with the 2 question approach, you will also identify ? not in arrest?

True Arrest No arrest

A. 5B. 25C. 50D. 100E. 500

For every 100 true cardiac arrests you identify with the 2 question approach, you will also identify ? not in arrest?

True Arrest No arrest

A. 5B. 25C. 50

D. 100E. 500

Dispatcher Instructions: Who gets CPR?

True Arrest

Not responsive (not awake/not conscious)

Not breathing normally

No Arrest

True Arrest

Not responsive (not awake/not conscious)

Not breathing normally

No Arrest

Minimal risk of major injury

1 : 1000

Dispatcher Instructions: Who gets CPR?

Cardiac arrest is hard to recognize

Laypersons may not have confidence

CPR can be technically difficult

Challenges of Early CPR

Confidence predicts action

How do we gain confidence?

Education

Practice

Experience

How do we gain confidence?

Education

Practice

Experience

Encouragement

Cardiac arrest is hard to recognize

Laypersons may not have confidence

CPR can be technically difficult

Challenges of Early CPR

A.10 seconds

B. 20 seconds

C. 30 seconds

D. 60 seconds

The average time required to open the airway and provide 2 breaths for bystanders during the first cycle is…..?

Initial airway management

A.10 seconds

B. 20 seconds

C. 30 seconds

D. 60 seconds

The average time required to open the airway and provide 2 breaths for bystanders during the first cycle is…..?

Initial airway management

A. 5 seconds

B. 10 seconds

C. 15 seconds

D. 20 seconds

During subsequent cycles of CPR by the bystander, ventilations interrupt chest compressions …..?

Subsequent CPR cycles

A. 5 seconds

B. 10 seconds

C. 15 seconds

D. 20 seconds

During subsequent cycles of CPR by the bystander, ventilations interrupt chest compressions …..?

Subsequent CPR cycles

Eliminate ventilations

Focus on chest compressions

Mechanisms

Eliminate ventilations

Focus on chest compressions

15% 10%Hands Only Rescue Breathing

Survival

+ Chest Compressions

Seattle - King County experience (1978 - 1984)

The Story of Dispatcher Assisted CPR

50%

Bystander-initiated(no dispatch assist)

25%

Dispatcher program increased the rates of bystander CPR by……?A. 5%B. 10%C. 15%D. 20%

The Story of Dispatcher Assisted CPR

Bystander-initiated(no dispatch assist)

25%

Bystander CPR since initiation of dispatcher assistance (1985 - 2007)

50%

Bystander-initiated(no dispatch assist)

25%

Dispatcher-assisted

Potential to nearly double proportion who receive CPR

The Story of Dispatcher Assisted CPR

30%

20%

Conceptual Role of the Dispatcher

PassiveTransfer informationAllocate Resources

ActiveInterpret informationEngage Resources

Deliver Training

Dispatchers have a critical role in early activation and early CPR.

Summary

Dispatchers must: - interpret information (recognize the arrest)- engage the callers (instill confidence) - provide training (deliver CPR instructions)

Dispatchers can save lives.