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As part of the lead up to World Heart Day, the forum aims to address challenges and identify ways organisations and networks can reach best in class rates for survival throughout New Zealand. Guest speakers, David Hiltz and Professor Ian Jacobs are key opinion leaders from international best in class survival communities. We are also delighted to bring you Sir Richard Hadlee, himself a cardiac arrest survivor, as the dinner speaker. The forum will bring these and many other thought leaders together to engage in networking and directed discussion on ways to improve the chain of survival.
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TRANSLATING SCIENCE INTO ACTIONS:IMPROVING CARDIAC ARREST OUTCOMES IN NEW ZEALAND
HEARTSafe Forum For ChangeAuckland, NZ
David B. Hiltz, NREMT-P
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A NECESSARY COMBINATION!
SURVIVAL is the
BENCHMARK for
EMS PERFORMANCE
REGRETABLY…
WE HAVE SOME THINGS IN COMMON
THE MENACE OF SUDDEN CARDIAC ARREST
LOOKING AND SOUNDING FAMILIAR?
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CPR Component Challenges to Improving Quality
Recognition Failure to recognize gasping as sign, unreliable Pulse Detection
Initiation of CPR Low Bystander CPR response Rate, Incorrect Dispatch instructions
Compression Rate Slow compression Rate
Compression Depth Shallow compression Depth
Chest Wall Recoil Rescuer Leaning on Chest
ISSUES SUMMARY 1LOOK LIKE THIS?
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CPR Component Challenges to Improving Quality
Compression Interruptions Excessive interruptions for pulse check, Ventilations, defibrillation, intubation, IV access, other
Ventilations Ineffective ventilations, prolonged interruptions in compressions , excessive ventilations (esp with airway)
Defibrillation Prolonged time to defibrillate avail, prolonged interruptions in chest compressions pre- and post shocks
Team Performance Delayed rotation, leading to rescuer fatigue and decay in compression quality, poor communication among rescuers leading to unnecessary interruptions in compressions
ISSUES SUMMARY 2LOOK LIKE THIS?
THE PEOPLE AREN’T THE PROBLEM!
Many Systems Ideal System
No Data Data Collected
No Plan Quality Improvement Plan
Fragmented Efforts Holistic Approach
Partially Implemented Guidelines
Fully Implemented Guidelines
SYSTEM ISSUESLOOK LIKE THIS?
IMPROVED SURVIVAL
IMPLEMENTATION??LOOK LIKE THIS?
WE NEED A HOLISTIC AND INTERGRATED APPROACH
SURVIVALRECOGNITION
CITIZEN CPRRAPID DEFIB QCPR
POST ROSC
EVOLVING CRITERIA
HEARTBEATS-POPULATION BASED
BRAGGING RIGHTS!
NO FORMAL STRUCTURENO BOARD OF DIRECTORS
NO STAFF
NEARLY 9 MILLION PEOPLELIVING AND WORKING IN HEARTSafe COMMUNITIES
HAVING CHAMPIONS IS ESSENTIAL
IN DEALING WITHANTI-CHAMPIONS!
LOCALIZATIONFOR NEW ZEALAND?
A FEW STEPS (AND A FEW ISSUES)
IN ENDING“SURVIVAL ENVY”
RECOGNITION AND RESPONSETO EARLY WARNING SIGNS?
http://www.youtube.com/watch?v=xZdq-bZ0cV8
TELEPHONE CPR
CITZEN CPR?
LAW ENFORCEMENT
DID YOUR LAST CARDIAC ARRESTLOOK LIKE THIS?
PRACTICE LIKE YOU PLAY?
12 LEADS FOR ACS/POST ROSC?
THERAPEUTIC HYPOTHERMIA?
A CULTURE OF QUALITY?LOOK LIKE THIS?
AN ITERATIVE PROCESS
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HOW ARE HOSPITALS DOING ON THEIR END?
TRANSITION:HIGH PERFORMANCE CPR:
SEATTLE STYLE
“Quality CPR is a means to improve survival from cardiac arrest. Scientific studies demonstrate when CPR is performed according to guidelines, the chances of successful resuscitation increase substantially. Minimal breaks in compressions, full chest recoil, adequate compression depth, and adequate compression rate are all components of CPR that can increase survival from cardiac arrest. Together, these components combine to create high performance CPR (HP CPR)”
A QUICK REVIEWOF RELATED SCIENCE
DELAYS AND INTERRUPTIONS KILL!
HAVING QUALITY TIME ON THE CHESTIS ESSENTIAL
PRACTICED TEAMWORKMAKES A DIFFERENCE!
EACH PERSON HAS AN ASSIGNED ROLE
AND PRACTICES AGAIN AND AGAIN!
THE MENACE OF SUDDEN CARDIAC ARREST
DRUGS WITH A PROVEN BENEFIT IN RESUSCITATION
HOVERING
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PIT CREW LEADERAIRWAY LEADERDEFIB-IV/IO-MEDSCPR CHIEFCPR DEPUTY CHIEF
*VARIABLE PLAYER
PRE-ASSIGNED ROLES
PRACTICELIKEYOUPLAY
CAN’T WE SOLVE OUR PROBLEMS WITH TECHNOLOGY?
Our Definition!
A provider‐centric process designed to standardize the debriefing process to assist
clinicians in thinking about what they did, how they did it, and how
they can improve.
TRANSITION:Structured and Supported Debriefing
Structured elements include three specific debriefing phases with related goals, actions, and
time estimates.
Structured and Supported Debriefing
B
Thoughtful discussion after an attempted resuscitation is important to facilitate the sorting out of events
as well as gaining insight on what happened and why
We often learn better through self‐discovery
and self‐analysis than by other methods!
•Have long term view•Patients and patience•INSTANT GRATIFICATION!
IMPLEMENTATION
BOY, I AM REALLY
LOOKING FORWARD TO
THE DEBRIEFING
ON THIS CASE!
PROVIDERS NEED TO EXPRESS
THEMSELVES AND THEIR FEELINGS…
AND THIS IS A GREAT FORUM FOR
THAT!
B
B
Team leader trained in Structured
and Supported Debriefings
B
SCONE DIPLOMACY!
NOT PUNATIVE!
B
ROLE OF FACILITATOR
•PROVIDE SAFE ENVIRONMENT FOR SHARING EXPERIENCES
•DRAW OUT INFORMATION AND EXPERIENCES
•CONTENT DIRECTED BY THE CREW
•NEVER JUDGE!
INSTRUMENTED MANIKINS
B
PAVE THE ROAD TO IMPROVED SURVIVAL!
HEARTSafe MORRINSVILLE?
David B. Hiltz401-524-0858
FOLLOW AMERICAN HEART ASSOCIATION-PUBLIC SAFETYAND HEARTSafe Community
ON TWITTER, FACEBOOK and SLIDESHARE
