The Payoff: Lessons Learned and Lives Saved Reports from a Community Program

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The Payoff Lessons Learned and Lives Saved -
Reports from a Community Program

• ECCU
• Stuart Berger, MD

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Early 1999 in Southeastern Wisconsin

• A series of deaths or near deaths is asymptomatic
  young people
• January - Adam Lemel basketball, autopsy shows
  ARVD
• February - Mark basketball, autopsy shows L
  coronary artery from R sinus of Valsalva
• March - Antonio basketball, autopsy shows HCM
• April - Amanda syncope with basketball, echo
  shows L coronary artery from R sinus of Valsalva,
  surgery to repair

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Do Children and Adolescents Have SCA?

• January 1999-Present
• Southeastern Wisconsin
• Total population of 2.0 million
• 35 episodes of sudden cardiac arrest in children
  and adolescents
• 25 deaths
• 10 survivors
• Mean age at time of SCA 14.2 years

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Do Children and Adolescents Have SCA?

• January 1999-Present
• 35 episodes of SCA
• 25 Deaths
• HCM 12
• ARVD 1
• LCA from R 4
• Unknown 8
• 10 Survivors
• LQTS 7
• LCA from R 1
• HCM 1
• Aortic Stenosis (known) 1

No access for further study
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Prevention

• As a result of our experience in Southeastern
  Wisconsin we have had a large interest in school
  CPR-PAD programs
• We have felt that there is a need to coordinate
  this effort and make sure it is done with proper
  planning, training, and in-concert with school
  medical emergency response planning

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Project ADAM WisconsinAutomated
Defibrillatorsin Adams Memory

• -An initiative to prevent SCA and SCD (Primary
  Secondary)
• -Commenced November 1999
• -School CPR-AED Program

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Project ADAM-Goals

• Education-Warning signs, family history,
  screening, drug abuse
• High school students should learn CPR prior to
  graduation
• CPR-AED Programs in high schools in the state of
  Wisconsin

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Project ADAM - Partners

• Childrens Hospital of Wisconsin
• Medical College of Wisconsin
• American Heart Association
• American Red Cross
• Department of Public Instruction
• EMS-C
• National Safety Council

• Paramedics
• MCW Adult ER Physicians
• Community Hospitals
• Parent advocates - The Lemels, PHW, Rachel M
• School nurses association
• Coaches, athletic directors
• Sports Medicine
• Orthopedics

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Project ADAM

• Powerpoint Presentations/Meetings -Education
• Students
• Teachers
• School Boards
• Parents
• Coaches/Athletic Directors
• School Nurses
• Physicians and health care professionals

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Project ADAM

• The Manual/DVD
• Step-by-step how-to programmatic approach
• AEDs What are they?
• CPR Importance
• Training
• Primary Prevention - Warning signs
• Funding
• CHW scholarship money available
• School fundraising, etc.
• Ongoing education and maintenance

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Results
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Project ADAM

• Project ADAM - Progress to Date
• gt700 schools in Wisconsin have CPR-AED programs
  and are trained to use them
• 21 schools in the state
• Milwaukee Public School System
• 148 out of 156 schools
• Affiliate programs in other states -Georgia,
  Florida, Pennsylvania (Alabama, Delaware, New
  Hampshire, Arkansas, others)

-Football -Sr. Centers
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Project ADAM and affiliates established
programs Interest/planning for future affiliate
programs
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Project ADAM

• Wisconsin
• Debra Klich
• Becky Neumann-Schwabe
• Karen Bauer
• Patti and Joe Lemel
• Many others
• Pennsylvania
• Vicki Vetter
• Danielle Main
• Rachel Moyer

• Georgia
• Robert Campbell
• Allison Ellison
• Florida
• Gus Ramos
• Bronwen Ramos

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CPR/AED or Related Saves in Children/Adolescentsa
nd Adults
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Saves - Project ADAM

• April 1999 - 15 y.o. girl
• January 2004 - 57 y.o. basketball coach
• April 2005 - 64 y.o. man watching a jazz concert
• April 2005 - 72 y.o. man watching softball game
• December 2004 - 15 y.o. football player lifting
  weights
• December 2005 60 y.o. man exercising at JCC
• October 2006 56 y.o. man safety assistant at
  MPS middle school
• April 2007 14 y.o. boy known AS, stretching
  during adaptive PE
• March 2008 - 41 y.o. man spectator at a
  basketball game in Colgate, Wisconsin

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Criticisms, Barriers, Arguments Against School
CPR-AED Programs
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Criticisms and Questions

• Cost
• Cost-effectiveness
• Liability
• Safety
• Low incidence of VF in children
• Not all arrests occur in school
• Resuscitation success is low in athletes that
  have SCA

There are reasonable answers to all of the
criticism and questions.
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Cost Defrayment

• Childrens Hospital of Wisconsin Foundation grant
  provides start-up funding for schools (800 each)
• Schools and fundraising
• Matching grant funding from local philanthropic
  organizations
• Masonic foundation
• Others

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Matthew

• Almost 14 y.o. with known homograft aortic
  stenosis
• S/P homografts x 2
• Initial diagnosis severe neonatal AI, probably a
  result of BE

• 80 mm Hg echo gradient through LVOT
• Need for homograft replacement scheduled when
  school is out 5/31/07
• Was stretching prior to adaptive gym 4/27/07

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2.
1.
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-Mechanical aortic valve 5/2/07 -Head MRI normal
CPR-AED Program Dedicated, committed staff School
emergency response plan Practice, practice,
practice
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What Lessons Have We Learned?

• It is critical to collaborate/partner with the
  community AHA, Red Cross, school nurses,
  athletic directors, school administration, etc.

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What Lessons Have We Learned?

• It is critical to collaborate/partner with the
  community AHA, Red Cross, school nurses,
  athletic directors, school administration, etc.
• It is important to have reasonable answers to
  barriers and criticisms

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What Lessons Have We Learned?

• It is critical to collaborate/partner with the
  community AHA, Red Cross, school nurses,
  athletic directors, school administration, etc.
• It is important to have reasonable answers to
  barriers and criticisms
• It is important to have funding opportunities and
  partnerships

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What Lessons Have We Learned?

• It is critical to collaborate/partner with the
  community AHA, Red Cross, school nurses,
  athletic directors, school administration, etc.
• It is important to have reasonable answers to
  barriers and criticisms
• It is important to have funding opportunities and
  partnerships
• Housing the support at a Childrens Hospital
  makes sense

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What Lessons Have We Learned?

• It is critical to collaborate/partner with the
  community AHA, Red Cross, school nurses,
  athletic directors, school administration, etc.
• It is important to have reasonable answers to
  barriers and criticisms
• It is important to have funding opportunities and
  partnerships
• Housing the support at a Childrens Hospital
  makes sense
• Impossible without a dedicated, great support
  staff including community partners/champions

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What Lessons Have We Learned?

• It is critical to collaborate/partner with the
  community AHA, Red Cross, school nurses,
  athletic directors, school administration, etc.
• It is important to have reasonable answers to
  barriers and criticisms
• It is important to have funding opportunities and
  partnerships
• Housing the support at a Childrens Hospital
  makes sense
• Impossible without a dedicated, great support
  staff including community partners/champions

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• Whoever saves a single life, it is as if he or
  she saved an entire world.

Talmud Sanhedrin 45
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THANK YOU!!