An Opportunity for a

Law Enforcement

Agency to

Save Lives

Written by David Hiltz, American Heart Association and Phil Coco, Old Saybrook Department of Police Services

Half of men and women in western society with serious coronary artery disease experience their first signs of the disease in a dramatic way—sudden cardiac arrest.

Whether a victim lives or dies at this point depends on whether the collapse is witnessed, if the people who are there are trained and willing to perform CPR, and

whether the arrest has occurred in a system that can bring about early arrival of needed resources and timely execution of evidence based interventions.

Many have recognized the need to improve community systems of emergency cardiovascular care to optimize patient survival. The "Chain of Survival" represents the current approach to improving recognition, response, care and outcomes.

The American Heart Association estimates that if communities could achieve a 20% survival rate, an estimated 50,000 lives could be saved each year. One potential

strategy for delivering early CPR and rapid defibrillation in the out of hospital setting includes the utilization of law enforcement agency (LEA) personnel.

Indeed, in many communities, LEA units are frequently on patrol and can respond immediately to emergencies. With this in mind, LEA can often arrive on scene before

EMS units and begin time sensitive treatments. Furthermore LEA has an established role as ―guardians of public safety‖.

Old Saybrook Police: Leading Efforts to Improve Emergency Care

Recently, the Old Saybrook Department of Police

Services, in cooperation with the Old Saybrook Ambulance Association and Middlesex Hospital has decided to move forward with several strategies to

improve response, care and outcomes and are addressing community education, responder education, emergency system access and dispatch

and research/quality improvement.

Transforming Police Emergency Medical Responders into Emergency Medical Technicians in Old Saybrook

The Old Saybrook Department of Police Services provides all

first responder services in the town of Old Saybrook. Recently, the department’s police officers / first responders have all completed 90 hours of training and have upgraded their

credentials from Emergency Medical Responder to Emergency Medical Technician. As part of this program, each member has done a 10 hour ride-along with a Middlesex Hospital paramedic.

This ride-along program has been very beneficial. Some of the unintended consequences include improved lines of

communication between the first responders and paramedics. Additionally, there has been appreciable improvement in feedback about cases and an iterative process where the first

responders are learning to better work with the paramedics and improve quality and timeliness of care.

"We thoroughly understand that the fastest way to provide emergency cardiac care is for police officers who are already mobile and deployed throughout our community to be trained and to respond immediately with AEDs and other lifesaving skills and

equipment. To enhance that the department is working with the AHA to enhance public and professional education, expand our public access AED program and assure the highest quality pre-arrival instructions given by our 9-1-1 dispatchers prior to the arrival

of our police officer first responders". - Chief Michael Spera

"Our patrol division members were so passionate about upgrading their training that

they voluntarily gave up their overtime and rearranged their vacation schedules to take the required 90 hours of training to earn their EMT certifications in order to provide a higher level of medical care to their patients. This has already resulted in improved

cardiac care‖. - Phil Coco, EMS Director/Instructor

Optimizing 9-1-1

The Old Saybrook Department of Police Services

is also acutely aware of the need for an effective 9-1-1 system and serves the public safety answering point for all 9-1-1 calls that are

initiated in the town. Each emergency dispatcher is trained and certified as an Emergency Medical Dispatcher (EMD) by the National Academy of

Emergency Dispatch. On May 1st the department launched a new initiative to earn the National Academy of Emergency Dispatch Accredited

Center of Excellence status. To achieve this, a department must meet or exceed twenty standards that ensure that the community is

receiving the best possible services from the dispatch center in terms compliance to strict protocols including their ability to properly identify

patients in need of CPR and to provide instructions to insure proper CPR begins even before the professional first responders arrive.

To support this effort, the department has begun using a computerized version of the Advanced Medical Priority Dispatch System – known as ProQA.

The department’s EMS director is a nationally certified EMD instructor and quality assurance reviewer. Beginning on June 1, 2011, the

department will begin a process of reviewing 100% of all requests for emergency medical service handled by OSPD ECC EMDs. Their compliance to

protocol will be measured using the established scoring standards as published by the National Academy of Emergency Dispatch with feedback

provided to each EMD. Their goal is to reach accreditation level compliance to protocol and meet or exceed all twenty standards.

Integration with EMS

Officers from the Old Saybrook Department of Police

Services enjoy an excellent relationship with the Old

Saybrook Ambulance Association, who provides

emergency service and transportation to area hospitals.

The Old Saybrook Ambulance Association is a volunteer,

non-profit organization that is on call 24 hours each day.

The Police Department, Ambulance Association

and Middlesex Hospital EMS collaborate to the

fullest extent to enhance multi-agency

response, coordination of care and outcomes.

Citizen CPR

Immediate bystander recognition of cardiac arrest

and 9-1-1 activation are critical. In many communities, these actions may be significantly delayed. Initial care in the first critical minutes

after SCA, including performance of CPR and potential use of an automated external defibrillator

(AED) depends on the actions of people near the

victim. Knowing that CPR is a highly accessible therapy that requires little medical training and

no equipment when provided in its most basic form, the Old Saybrook Department of Police Services is committed to developing and initiating a Hands-Only Citizen CPR

campaign, and improve bystander CPR rates in the community. The Old Saybrook Department of Police Services also provides resuscitation education to those who seek it as an Authorized Provider of American Heart Association ECC Programs.

Arresting V-Fib with Early Defibrillation

All police cruisers are equipped with AEDs and rapid

dispatch is supported by departmental policies and procedures. Additionally, there are 19 publically accessible AEDs in the community. Information regarding

the type and location of these devices is integrated into the computer assisted dispatch system in Old Saybrook, and the readiness of the devices is monitored by the

Department of Police Services.

Playing a Role in STEMI There is improved feedback about cases and the first responders have been trained to help the paramedics

prepare patients for paramedic assessment including being sure that all patients presenting with coronary

symptoms have had their shirts removed prior to paramedic arrival to facilitate faster 12-lead EKG. The first responders have also been trained to set up the 12-lead

EKG for the paramedic, to apply the cardiac monitor and set-up IV equipment while the paramedic performs other tasks as our system is a single paramedic system. This is

all designed to expedite care and facilitate faster transfer to a PCI center when appropriate.

Measuring and Improving

In another cooperative effort with the local ambulance service, Middlesex Hospital and the American Heart Association, the police department EMS division is working to

establish standards to determine the town’s cardiac arrest save rate. Using a three year retrospective study of cases along with an ongoing study of prospective cases we will establish the rate, control chart changes made within the EMD and EMS programs and

try to identify positive trends. This will allow the group to measure the impact of future programs and enable modifications and the sharing of results as appropriate.

―Middlesex Hospital EMS has been proudly supporting the efforts of the Old Saybrook Department of Police Services to improve cardiac arrest outcomes. By assisting with

data collection and deploying quality improvement resources, we are confident all the tools necessary are available to achieve this great goal.‖ - Jim Santacroce, Middlesex Hospital EMS Manager

HEARTSafe

Appropriately, Old Saybrook has submitted an application to be designated by the Connecticut Department of Public health as a HEARTSafe Community and is hopeful

that they will be approved. We know that the signs will bring pride and ongoing inspiration to this community.

CT HEARTSafe Criteria

1. Conduct community CPR and/or CPR/AED

training sessions. The number of heartbeats earned and required depends on community population.

2. Placement of a permanent AED with AED- trained personnel in public or private areas

where many people are likely to congregate or be at higher risk for cardiac arrest.

3. Community has a designated First Responder. 4. All EMS first response-designated vehicles

have been equipped with AEDs and staffed with currently certified CPR/AED personnel. 5. Advanced Life Support personnel will be dispatched to all ALS medical emergencies.

*Optional - Not Required: EMS response with 12-lead ECG capability to calls for chest pain of suspected ischemic origin.

6. An ongoing process to evaluate and improve the ―Chain of Survival‖ in the community.

Other Remarks

A lead agency for improving outcomes, EMD, efforts to

improve citizen CPR, support and monitoring of publically placed defibrillators, rapid response by trained and

equipped officers, integrated care with EMS, an evolving STEMI system of care, data collection and quality improvement…what a great combination.

David Hiltz is with the American Heart Association’s Emergency Cardiovascular Care Programs and has a special interest in systems of care and resuscitation. David has contributed to the development of numerous AHA initiatives and is active on task forces

related to EMS and resuscitation.

Phil Coco is the Director of Emergency Medical Services for the Old Saybrook Police Department and Paramedic for Middlesex Hospital where he has served for 24 years. Phil is an Emergency Medical Services Instructor, Fellow and Instructor with the

National Academy of Emergency Dispatch, Deputy Fire Marshal, Fire Officer and Instructor and an American Heart Association Instructor for BLS, ACLS and PALS and a member of the FEMA EMS national incident management leadership team.

Michael Spera is the Chief of Police and Emergency Management Director in Old Saybrook. Chief Spera is the President of the Connecticut Emergency Management

Association, a Firefighter/Paramedic and Emergency Medical Services Instructor for the State of Connecticut. Additionally, Chief Spera is a Homeland Security Coordinating Council Member, Chairman for the Municipal Safety Committee and a graduate of the

FBI National Academy with a Bachelor of Science in Public Safety Administration.

―I have been so very impressed with the attention and commitment to improving recognition, response, care and outcomes in Old Saybrook. I commend Chief Spera, EMS Director Coco, and all the integrated agencies and supporters of this effort. This

community can serve as an excellent role model for others‖. – David Hiltz, NREMT-P, American Heart Association

About the Old Saybrook Department of Police Services

http://www.oldsaybrookct.org/pages/oldsaybrookct_police/index

About the American Heart Association

http://www.heart.org/HEARTORG/

Old Saybrook cops taking EMT classes en masse (video)

http://www.nhregister.com/articles/2011/02/21/news/shoreline/bb1_mon_ospoliceemts

_art022011.txt

Police Toolkit from the Resuscitation Academy

http://www.resuscitationacademy.org/downloads/PoliceDefibrillationToolkit_1010.pdf

The Shocking Truth about Cops and Defibrillation

http://www.slideshare.net/Hiltz/the-shocking-truth-about-cops-and-defibrillation

Videos

http://www.npssinc.org/html/aed_awareness.html

Related

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CPR facts and statistics as viewed on the American Heart Association website: http://www.americanheart.org/print_presenter.jhtml?identifier=3034352

Department of Emergency Medicine, Medical College of Virginia, Virginia Commonwealth University Health Center (2003). The public access defibrillation (PAD) trial study design and rationale. Resuscitation. 56, (p.135-147).

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