VSA 2004Ottawa

Ottawa Base Hospital Dr. J. Maloney

Cardiac cause 441 452 412

Average age 69 68 66

Gender – female 35% 34% 31%other 65% 66% 69%

2002 2003 2004

Ottawa Cardiac Arrests Cardiac Arrests

VSA 2004Ottawa

Ottawa Base Hospital Dr. J. Maloney

Locations Residence Public65% (68%)

22% (13%)

Ottawa Cardiac Arrests Cardiac Arrests2004 2004 (03)(03)

Citizen CPR 25% (7.1%)

Defibrillator EMS Fire PAD 77% (68%) 18% (23%) 5% (7%)

Survival 5.4%

Citizen CPR 13%

2000 2001 2002

3.3%

8.7%

5.9%5.9%

12.9%12.9%

2003

6.6%6.6%

7.1%7.1%

2004

6.1%6.1%

25%25%

VSA 2004Ottawa

Ottawa Base Hospital Dr. J. Maloney

Ventricular Fibrillation

# V Fib cases 133

First to apply defibrillator

EMS 76%

Fire 17%

PAD 7%

Survived 12%

Ottawa Cardiac Arrests Cardiac Arrests20042004

If Citizen CPR (44)

First to apply defibrillator

EMS 68%

Fire 24%

PAD 8%

Survived 11%

VSA 2004Ottawa

Ottawa Base Hospital Dr. J. Maloney

Ottawa Cardiac ArrestsOttawa Cardiac Arrests

Cardiac arrest 60’s year old men (2/3)At home (3/4)Often witnessed (1/2)

The Big Picture

If witnessed in a residence,in Ottawa, witness starts CPR … 1 3

VSA 2004Ottawa

Ottawa Base Hospital Dr. J. Maloney

Ottawa Cardiac Arrests 2004

• Targeted increase fire tiered response• Maximize police response• PAD locations ??• Private PAD placement public places• Home defibrillation • Education re: AED application time • Strategic Targeted CPR

Increase survival … what to do??

VSA 2004Ottawa

Ottawa Base Hospital Dr. J. Maloney

Strategic Targeted CPR

Targeted• Families of cardiac patients• Seniors• Church CPR (Cardio Pulpit Resuscitation)• Nursing Homes Chronic care

Strategic• Use local stats in courses• Video• Web-based• Scenario based teaching

VSA 2004Ottawa

Ottawa Base Hospital Dr. J. Maloney

Strategic Targeted CPR

Training• Answer questions

It is not enough to teach CPRYou have to provide the key that “unlocks” themSomething that will make them act

• Use scenarios … when it really happens

it should not be the first time they see it

… help them see it !

VSA 2004Ottawa

Ottawa Base Hospital Dr. J. Maloney

YourCPR

Course

Strategic Targeted CPR

What’s the “GO”

(Goals & Objectives)

Teaching someone to • To recognize that chest pain may be cardiac• To recognize a stroke• To act … Call 911will save more lives than “Thump and Blow”

… and don’t forget teaching risk factorsthat is important too ! !

VSA 2004Ottawa

Ottawa Base Hospital Dr. J. Maloney

Base Hospital Paramedic Training• Fall 2000 - Intro ACP, ACS, ECG recognition• Spring 2001 - ACP ACLS• Spring 2002 - ECG recognition re-inforced• Fall 2002 - Intro Lytics• Spring 2003 - Lytics study• Fall 2003 - PCP ECG acqure, recognition• 2004 - heavy with STEMI• 2005 - heavy with STEMI

Ottawa STEMI

VSA 2004Ottawa

Ottawa Base Hospital Dr. J. Maloney

Cardiac chest pain > 30 min, < 12 hours

12 Lead ECG

Nearest ED

ST elevation borderlineor not clearly positive

OREvidence LBBB

ORPt is pre/post VSA

ST elevation clearly > 1 mmin 2 contiguous limb leads

ORST elevation clearly > 2 mm

in 2 contiguous precordial leads

Notify Heart Institute

“Positve STEMI, ETA”

Patient transported there directly

Ottawa STEMI

VSA 2004Ottawa

Ottawa Base Hospital Dr. J. Maloney

Within 2 hours of onsetIn Ottawa

Has …a. GCS>12 b. Stable Airway (i.e. not requiring airway support) c. Vitals Signs BP>90, Heart Rate >60 and < 120 d. Blood Sugar reading ≥ 4.0 mmol/L e. Age ≥ 45 yrs.

Does not have:a. Terminal illness (i.e. palliative care) b. Valid DNR c. History of seizures

Ottawa Stroke Bypass

VSA 2004Ottawa

Ottawa Base Hospital Dr. J. Maloney

Has …• Difficulty speaking• Unilateral arm weakness• Facial Droop.

Ottawa Stroke Bypass

Go directly to Ottawa Hospital General / Civic