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Strengthening the Chain of Survival

The Role of the Emergency Dispatcher

November, 2011
Tom Rea
Harborview Medical Center
King County EMS

Strengthening the Chain of Survival
The 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

A Fundamental Principle

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

Leonard Cobb Mickey Eisenberg Michael Copass

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 .

Improves blood flow to the left ventricle C.? A.Early (Bystander) CPR……. Improves the chance of survival . Helps prevent deterioration of VF to asystole D. Improves blood flow to the brain B.

Improves blood flow to the brain B. Improves the chance of survival .Early (Bystander) CPR……. Helps prevent deterioration of VF to asystole D.? A. Improves blood flow to the left ventricle C.

50% D.The rate of bystander CPR in most communities is. 10% B. 25% C..? A. 70% .

.. 10% B. 25% C.? A.The rate of bystander in most communities is . 50% D. 70% .

? A.. 10% B. . 70% An effective therapy that is only partly implemented. 25% C. 50% D..The rate of bystander in most communities is .

C.What are the roadblocks to bystander CPR? A. Cardiac arrest is hard to recognize. B. . CPR is technically too difficult. Rescuers do not have confidence to act.

fearful C. Cardiac arrest is hard to recognize B.What to do? .What are the roadblocks to bystander CPR? A. Rescuers do not have confidence . CPR is technically too difficult ………….

Option 1: CPR Training Programs .

25% C. 70% . 50% D.The rate of bystander in most communities is .? A. 10% B...

Option 2: Dispatcher-Assisted CPR .

.Yes…….but answer the question Cardiac arrest is hard to recognize Laypersons may not have confidence CPR can be technically difficult .

Cardiac Arrest Recognition .

Not breathing . Cardiac Arrest Recognition A cardiac arrest patient is (True or False) : 1. Not responsive (not awake/ not conscious) 2.

Cardiac Arrest Recognition True .Not breathing .Not responsive (not awake/not conscious) Sometimes .

Not breathing……normally Agonal gasps .Not responsive (not awake/not conscious) True . Cardiac Arrest Recognition True .

Cardiac Arrest Recognition Not responsive (not awake/not conscious) Not breathing normally .

Hypoglycemia.Are we casting the net too widely? Post-ictal. Intoxication .

No………….so prove it Let’s apply the 2 question approach: Not responsive (not awake/not conscious) Not breathing normally True Arrest No arrest .

you will also identify ? not in arrest? A. 25 C. 50 True Arrest No arrest D.For every 100 true cardiac arrests you identify with the 2 question approach. 5 B. 100 E. 500 .

25 C. 500 . 50 True Arrest No arrest D. you will also identify ? not in arrest? A. 100 E.For every 100 true cardiac arrests you identify with the 2 question approach. 5 B.

Dispatcher Instructions: Who gets CPR? Not responsive (not awake/not conscious) Not breathing normally True Arrest No Arrest .

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 .

Challenges of Early CPR Cardiac arrest is hard to recognize Laypersons may not have confidence CPR can be technically difficult .

Confidence predicts action .

How do we gain confidence? Education Practice Experience .

How do we gain confidence? Education Practice Experience Encouragement .

Challenges of Early CPR Cardiac arrest is hard to recognize Laypersons may not have confidence CPR can be technically difficult .

? A. 30 seconds D. 60 seconds . 20 seconds C.The average time required to open the airway and provide 2 breaths for bystanders during the first cycle is….10 seconds Initial airway management B..

The average time required to open the airway and provide 2 breaths for bystanders during the first cycle is….? A. 60 seconds .. 20 seconds C.10 seconds Initial airway management B. 30 seconds D.

? A.. 20 seconds . 5 seconds Subsequent CPR cycles B.During subsequent cycles of CPR by the bystander. ventilations interrupt chest compressions …. 10 seconds C. 15 seconds D.

10 seconds C. 5 seconds Subsequent CPR cycles B.? A.During subsequent cycles of CPR by the bystander. ventilations interrupt chest compressions …. 15 seconds D. 20 seconds ..

Eliminate ventilations Focus on chest compressions Mechanisms .

Eliminate ventilations Focus on chest compressions Survival 15% 10% Hands Only Rescue Breathing + Chest Compressions .

1984) 50% 25% Bystander-initiated (no dispatch assist) .King County experience (1978 .The Story of Dispatcher Assisted CPR Seattle .

20% 25% Bystander-initiated (no dispatch assist) . 15% D. 10% C. 5% B.The Story of Dispatcher Assisted CPR Dispatcher program increased the rates of bystander CPR by……? A.

The Story of Dispatcher Assisted CPR Bystander CPR since initiation of dispatcher assistance (1985 .2007) 50% 20% Dispatcher-assisted 25% 30% Bystander-initiated (no dispatch assist) Potential to nearly double proportion who receive CPR .

Conceptual Role of the Dispatcher Passive Active Transfer information Interpret information Allocate Resources Engage Resources Deliver Training .

interpret information (recognize the arrest) .provide training (deliver CPR instructions) Dispatchers can save lives.engage the callers (instill confidence) . Summary Dispatchers have a critical role in early activation and early CPR. . Dispatchers must: .