Strengthening the Chain of Survival The Role of the Emergency Dispatcher

1
Strengthening the Chain of SurvivalThe Role of
the Emergency Dispatcher

• November, 2011
• Tom Rea
• Harborview Medical Center
• King County EMS

2
Strengthening the Chain of SurvivalThe Role of
the Dispatcher
Overview Emergency dispatchers can have a
meaningful impact on survival following cardiac
arrest.
Objectives Understand

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

3
A Fundamental Principle
You must understand local circumstances .in
order to achieve success.
Mickey Eisenberg
Michael Copass
Leonard Cobb
4
Is there an opportunity for your community?
5
The Public Health Toll of Cardiac Arrest
6
The leading cause of death in the US is
____ HIV ____ Stroke ____ Colon
Cancer ____ Cardiac Arrest ____ Tuberculosis
7
The leading cause of death in the US is
_1_ Cardiac Arrest _2_ Stroke _3_ Colon
Cancer _4_ HIV _5_ Tuberculosis
8

• How do we reduce death from cardiac arrest?

9
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

10
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
11
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
12
The rate of bystander CPR in most communities
is..?

1. 10
2. 25
3. 50
4. 70

13
The rate of bystander in most communities is ...?

1. 10
2. 25
3. 50
4. 70

14
The rate of bystander in most communities is ...?

1. 10
2. 25
3. 50
4. 70

An effective therapy that is only partly
implemented.
15
What are the roadblocksto bystander CPR?

• Cardiac arrest is hard to recognize.
• Rescuers do not have confidence to act.
• CPR is technically too difficult.

16
What are the roadblocksto bystander CPR?

• Cardiac arrest is hard to recognize
• Rescuers do not have confidence - fearful
• CPR is technically too difficult

.What to do?
17
Option 1 CPR Training Programs
18
The rate of bystander in most communities is ...?

1. 10
2. 25
3. 50
4. 70

19

• Option 2 Dispatcher-Assisted CPR

20
Yes..but answer the question
Cardiac arrest is hard to recognize Laypersons
may not have confidence CPR can be technically
difficult
21
Cardiac Arrest Recognition
22
Cardiac Arrest Recognition
A cardiac arrest patient is (True or False)
1. Not responsive (not awake/ not conscious)
2. Not breathing
23
Cardiac Arrest Recognition
True - Not responsive (not awake/not conscious)
Sometimes - Not breathing
24
Cardiac Arrest Recognition
True - Not responsive (not awake/not conscious)
True - Not breathingnormally
Agonal gasps
25
Cardiac Arrest Recognition
Not responsive (not awake/not conscious) Not
breathing normally
26
Are we casting the net too widely?
Post-ictal, Hypoglycemia, Intoxication
27
No.so prove it
Lets apply the 2 question approach Not
responsive (not awake/not conscious) Not
breathing normally
True Arrest No arrest
28
For every 100 true cardiac arrests you identify
with the 2 question approach, you will also
identify ? not in arrest?

1. 5
2. 25
3. 50
4. 100
5. 500

True Arrest No arrest
29
For every 100 true cardiac arrests you identify
with the 2 question approach, you will also
identify ? not in arrest?

1. 5
2. 25
3. 50
4. 100
5. 500

True Arrest No arrest
30
Dispatcher Instructions Who gets CPR?
Not responsive (not awake/not conscious) Not
breathing normally
True Arrest
No Arrest
31
Dispatcher Instructions Who gets CPR?
Not responsive (not awake/not conscious) Not
breathing normally
Minimal risk of major injury 1 1000
True Arrest
No Arrest
32
Challenges of Early CPR
Cardiac arrest is hard to recognize Laypersons
may not have confidence CPR can be technically
difficult
33
Confidence predicts action
34
How do we gain confidence?
Education Practice Experience
35
How do we gain confidence?
Education Practice Experience Encouragement
36
Challenges of Early CPR
Cardiac arrest is hard to recognize Laypersons
may not have confidence CPR can be technically
difficult
37
The average time required to open the airway and
provide 2 breaths for bystanders during the first
cycle is..?

1. 10 seconds
2. 20 seconds
3. 30 seconds
4. 60 seconds

Initial airway management
38
The average time required to open the airway and
provide 2 breaths for bystanders during the first
cycle is..?

1. 10 seconds
2. 20 seconds
3. 30 seconds
4. 60 seconds

Initial airway management
39
During subsequent cycles of CPR by the bystander,
ventilations interrupt chest compressions ..?

1. 5 seconds
2. 10 seconds
3. 15 seconds
4. 20 seconds

Subsequent CPR cycles
40
During subsequent cycles of CPR by the bystander,
ventilations interrupt chest compressions ..?

1. 5 seconds
2. 10 seconds
3. 15 seconds
4. 20 seconds

Subsequent CPR cycles
41
Eliminate ventilations Focus on chest
compressions
Mechanisms
42
Eliminate ventilations Focus on chest
compressions
Survival
15 10 Hands Only Rescue Breathing
Chest Compressions
43
Seattle - King County experience (1978 - 1984)
The Story of Dispatcher Assisted CPR
50
25
Bystander-initiated (no dispatch assist)
44
Dispatcher program increased the rates of
bystander CPR by?A. 5B. 10C. 15D. 20
The Story of Dispatcher Assisted CPR
25
Bystander-initiated (no dispatch assist)
45
Bystander CPR since initiation of dispatcher
assistance (1985 - 2007)
The Story of Dispatcher Assisted CPR
50
Dispatcher-assisted
20
25
Bystander-initiated (no dispatch assist)
30
Potential to nearly double proportion who receive
CPR
46
Conceptual Role of the Dispatcher
Passive Transfer information Allocate Resources
Active Interpret information Engage
Resources Deliver Training
47
Summary
Dispatchers have a critical role in early
activation and early CPR.
Dispatchers must - interpret information
(recognize the arrest) - engage the callers
(instill confidence) - provide training
(deliver CPR instructions)
Dispatchers can save lives.