The Chain of Survival - You all know about it, but do the leaders in your EMS system UNDERSTAND and ACKNOWLEDGE the critical role your dispatchers play in the success of the chain of survival in your community? Pass Survivor Coin around
First Link Early Access to 911
Dispatchers are the first contact the
patient or reporting party has
with EMS system.
Presenter
Presentation Notes
When people call 911 to report a medical emergency, they are upset and frightened. The dispatcher is the first human they speak to. Dispatchers gather vital information about where to send help, they calm the reporting party, and they document critical times and event details that occur BEFORE the first responders are even out of bed or have set down their cup of coffee.
Second Link Early CPR
Dispatchers
help bystanders
perform CPR prior
to arrival of
EMS Responders
Third Link Early Defibrillation
Dispatchers tell bystanders that an AED is nearby and offer help, as needed.
Fourth Link Early ACLS
Dispatchers must
quickly triage to
determine if ALS is needed.
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Presentation Notes
If you have a tiered response system, as we do, dispatchers are the gatekeepers for our most limited and expensive resource – Advanced Life Support. If the dispatcher does not correctly identify critical nature of the emergency, ALS may not be dispatched promptly. If you don’t send ALS immediately for a cardiac arrest, you have wasted valuable minutes.
Fifth Link Post Resuscitative Care
Can Dispatchers Help??
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Presentation Notes
Not typically. They may put Airlift Northwest on standby, but they don’t play a pivotal role in this final link in the Chain of Survival.
4 out of 5
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Presentation Notes
So I give the dispatchers 4 out of 5. They have a an active, extremely important role in 4 of the 5 links in the chain of survival.
BLS
ALS
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Presentation Notes
Which of the other areas of your system, BLS or ALS, play a role in 4 of the links of the Chain of Survival?
Correct Answer?
None of the Above
BLS
ALS
Early CPR Early Defib
Early ALS (maybe)
Early CPR (maybe) Early ALS Early Post
Resuscitative Care
Presenter
Presentation Notes
BLS contributes to Early CPR, Early Defib and early ALS if they are responsible for requesting ALS from the scene. ALS impacts Early ALS and Early Post Resuscitative Care by quickly delivering a stable patient to the hospital.
Should we institute Dispatcher Assisted CPR?
Presenter
Presentation Notes
You may hear dispatch administrators in your community say “Our dispatchers send help quickly and already have too much to do. Why add another responsibility and new task which will take more time?”.
That’s equal to the capacity of Safeco field times four.
die from cardiac arrest in the US each year, making it a leading cause of death
250,000
time to cpr and shock
su
rviv
al
Time is Critical
Survival decreases by 10% for every
minute treatment is delayed
Presenter
Presentation Notes
Every minute counts. Survival decrease by 10% for every minute treatment is delayed. The average BLS response time is 4-6 minutes in our community. An assertive dispatcher with good skills can get a bystander performing CPR is less than 1 minute.
How often is CPR performed by bystanders?
Much less than we might imagine...
Only 25%
of the time
Presenter
Presentation Notes
We must ask ourselves, “Have our efforts at training large numbers of citizens been successful?” Are we training the right people? Our efforts to provide targeted training have failed. Thankfully, we have very strong Dispatcher CPR and our Bystander CPR rates are nearly 60% of all arrests. If you are putting all of your eggs in your BLS basket, you are missing huge opportunities to increase the percentage of CA that have bystander CPR. A 2008 community survey of 1000 randomly selected residents in Seattle showed that 79% of respondents reported having taken a CPR class at least one time. However, over half (53%) reported taking their most recent CPR class more than 5 years ago. Even people who have attended a class, may not remember how to perform CPR and need help.
Quick and efficient call handling
Rapid Dispatch BLS
Immediate recognition of cardiac arrest
Dispatch of ALS
Recognize presence of Public Access AED
Quick and efficient delivery of CPR
DISPATCH
Keys to Success
Presenter
Presentation Notes
Key elements of success for dispatcher assisted CPR Quick and efficient call handling is important in all medical emergencies, but especially in cardiac arrest. Rapid Dispatch – in our system we send BLS to everything except the most low acuity calls, so you may as well get them out the door quickly Immediate Recognition of CA – this step is critical, must time can be wasted here if dispatchers are not trained and highly skilled. .
Identification of Patients in Cardiac Arrest
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Presentation Notes
The most critical role of the dispatcher, quick and accurate identification of the patient in cardiac arrest.
Sounds easy….right??
Patient is turning blue? Chest is not rising or falling? No sounds of breathing? No pulse?
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Presentation Notes
But WAIT… Let’s go back to that
Patient is turning blue? Chest is not rising or falling? No sounds of breathing? No pulse?
Presenter
Presentation Notes
The dispatcher cannot see, nor hear, ANY of this. The can’t see the patient turning blue. They can’t see the chest rising or falling. Rarely can they hear the sounds of breathing, and when they CAN it is often the confusing nature of agonal respirations. The dispatcher can’ take a pulse, and most lay rescuers don’t know how to do it correctly. Those of you who have clinical experience, you can walk thru the door and take one look at the patient and your gut feeling is “this patient is dead”
Get location info; Identify patients in cardiac arrest: - Unconscious - Not breathing “normally”
All Caller Interview
Determine if AED is at scene: - ask caller; or - use Premise Info
Presenter
Presentation Notes
One of the most valuable things you can do is give your dispatchers the tools to quickly identify cardiac arrest.
26 seconds: Is he breathing normally?” 35 seconds: Identified Cardiac Arrest and the need for CPR
All Caller Interview
14 seconds: “Is he conscious?”
40 seconds: Positions the patient
Good Example
54 seconds: Starting CPR
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Presentation Notes
This is a very good example of using the All Caller Interview to quickly identify cardiac arrest and get CPR started quickly Play audio #1 – A good one 325 – edited (54 seconds)
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Presentation Notes
Unfortunately it’s not always that easy. This is where the Wild things can lurk. There are many things that can make the process not go smoothly. Play audio 2 – It’a not as easy as it sounds (1 min, 39 seconds) Caller describes patient as talking at first, then is reluctant to answer questions. Call Receiver asks the right questions but the caller is just not helping. The patient was not in cardiac arrest in cardiac arrest, but you can see how difficult it can be for the dispatcher to figure out what is going on.
Common Delays
Research has shown that delays are COMMON and PREDICTABLE!
Most frequent causes of DELAY:
1) Asking unnecessary questions 2) Omitting the word “normally” 3) Patient positioning issues
Good training can help!!
Presenter
Presentation Notes
Play audio 3 – Case one color edited – 10112010 (1 min, 40 seconds) Sub Optimal, Dispatcher afraid to move forward. While painful to listen to, use these audio’s in class as tools for training. 82 YO Male, eyes open? Color? Breathing? Color again? 1:17 Health Issues? 1:28 Diabetic? 2:00 Blinking eyes 2:22 Doesn’t look like he is beathing at all 3:20 Do you want to do CPR?
Agonal Respirations
“The Spoiler” • Agonal respirations frequently mistaken
for breathing by the caller • Agonal respirations occur in 40% of out of
hospital cardiac arrests. - 56% in cases in VF - 34% in cases in non VF
• Survival is higher for patients who show signs of agonal respirations Clark, et.al., Annals of Emerg Med, 1992
Presenter
Presentation Notes
The presence of agonal respirations often delays CPR. Because agonal respirations are associated with increased survival, prompt recognition is critical.
Agonal Breathing Sounds
Presenter
Presentation Notes
Play audio #4 – Talking to patient, then collapse, then agonals (2:14 seconds) This patient calls in with chest pain, collapses on the phone and you can immediately begin to hear heavy breathing and then very good examples of agonal respirations. Agonals begin very close together and then get much farther apart as time passes. Hand out audio recording CD
Agonal Respirations
RP’s often give many clues
Call Receiver missed need for CPR and did not explore numerous descriptions of agonals breathing: - “she’s making a lot of noise” - “she’s out of it” - “not coherent” - “moaning right now” - “staring into space” - “making all kinds of weird noises” - “moaning and everything else”
Presenter
Presentation Notes
Play audio #5 – Completely missed need for CPR and agonals (2 min, 11 seconds)
Excellent Call Example
14 Seconds – Conscious? Barely Breathing. 24 Seconds - Snoring Sounds? 33 Seconds – We are going to start CPR… 46 Seconds – Positioning the patient 1 Minute – Chest Compression Only CPR
Brothers, Olympic Mountains - Washington
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Presentation Notes
Play audio #6 – Call Audio 122941 (1 min, 58 seconds) Let’s put it all together
Dispatcher Assisted CPR is Safe!
Injuries are NOT
frequent.
Encourage dispatchers to be aggressive.
Presenter
Presentation Notes
CPR Instructions are frequently given when the patient is not in cardiac arrest, but Injuries are NOT frequent. In a study of injuries related to CPR, 247 hospital charts were reviewed, only 6 patients had a potentially serious complication from CPR. Encourage dispatchers to be aggressive. Cast a wide net and you will catch more cardiac arrests.
Return what you learn
Training
Protocol
Quality Improvement
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Presentation Notes
The cycle of Protocol revision, Training and Quality improvement is never ending, don’t ever expect to “be finished”. We developed our first protocol in 1981, 30 years ago, and we are still doing this cycle continuously. Quality Improvement/Case Review is critical. QI Case Selection. Don’t just review ALL cardiac arrests;�or ALL CPR Instructions given; Feedback to Dispatchers/Supervisors Revise Protocol, if needed Return what you learn to your training curriculum to complete the cycle. This is a part of Measure, Improve
In Summary
Dispatchers Must Be: • Fast • Aggressive • Not Afraid
Your System Must: • Review Everything • Train to a high
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