To get the word out about hands-only CPR, EMS providers and CPR advocates have gotten creative—think flash mobs in shopping malls. The latest technique? Bringing hands-only CPR training to large public gatherings—the sort of places where cardiac arrests can, and do, occur.
In April, Boston Marathon runners and spectators could take advantage of a quick lesson in hands-only CPR in the Runners Expo at the Hynes Convention Center, a pre-race gathering that drew 75,000 people over three days. The CPR training, offered four times daily on Saturday and Sunday, was offered by the Boston Athletic Association, Massachusetts General Hospital, the American Heart Association and the American Red Cross.
A similar idea occurred to people involved in Save Lives Sonoma, a multi-agency effort involving EMS, fire and hospitals to improve survival rates by teaching hands-only CPR in Sonoma County, Calif. At the Sonoma County Fair in the summer of 2011, paramedics and EMTs from American Medical Response–Sonoma taught hands-only CPR in their first-aid booth to fair-goers throughout the 17-day event. “We became carnival barkers, recruiting people off the street,” says Dean Anderson, AMR general manager. “We saw about 2,000 people during the course of the fair.”
Since then, AMR–Sonoma and Save Lives Sonoma have offered hands-only CPR training at other major events, including a charity bike ride known as the GranFondo that draws 7,500 riders, and in the registration hall and exhibit area before the Santa Rosa Marathon.
“If you have athletes who are trained and somebody goes down on the course, instead of having to wait for a paramedic or an EMT to get there, they can start compressions immediately,” Anderson says. “We haven’t run into a case yet where somebody started bystander CPR and has said, ‘I learned it at the fair or at a bike ride,’ but I’m sure it’s just a matter of time.”
Drug Shortages Easing
America’s drug shortage crisis appears to be easing, with the U.S. Food and Drug Administration reporting that new reports of drug shortages have fallen and EMS agencies saying the situation isn’t as dire as it was last spring. “Drug shortages seem to be letting up somewhat, and key drugs are not as impacted,” says Ed Racht, M.D., medical director for American Medical Response.
The drug shortage crisis emerged in 2010, when 178 commonly used drugs ran short, according to the FDA. The problem got worse in 2011, when 232 were on shortage, and 2012 was on pace to be as bad. Reasons for the shortages included manufacturers discontinuing generic—and less profitable—medications, according to the FDA, while some drug makers have said they’ve had difficulty getting raw materials and components from suppliers. More than 80 percent of the drugs in short supply are generic injectables.
The federal government tackled the issue on Oct. 31, 2011, when President Obama issued an executive order requiring that drug-
makers notify the FDA six months in advance of pending supply problems. The FDA says the new rule enabled the agency to intervene to avoid 100 shortages through August 2012. That includes working with manufacturers and, in a few cases, importing drugs from other countries.
The FDA logged about 100 drug shortages from January through September 2012, down from about 180 at the same time in 2011, Capt. Valerie Jensen, R.Ph., associate director of the drug shortage program in the FDA’s Center for Drug Evaluation and Research, told MedPage Today in September.
EMS agencies also took steps to deal with the issue, such as changing protocols to authorize the use of alternative medications, permitting the use of drugs past their expiration dates, and turning to compounding pharmacies, Racht says.
All of that has helped, says Rory Chetelet, EMS manager for the Southern Nevada Health District, which took such steps to deal with the shortages. And yet there are still challenges ahead. For example, they’ve been able to substitute fentanyl or hydromorphone for morphine on shortage, and Inapsine for Zofran, also on shortage, says John Hammond, EMS field representative in Southern Nevada Health District’s Office of EMS and Trauma System.
Yet they are still having trouble getting sodium bicarbonate, Hammond notes. (According to the American Society of Health-System Pharmacists, which tracks drug shortages, two manufacturers have eliminated certain formulations of the drug, while three others have recently said the drug is on backorder due to manufacturing delays or increased demand.) “It’s a moving target,” Chetelet says. “It still seems like it’s a different drug on shortage every week, and we are still in crisis on certain drugs.”
For the latest on drug shortages, visit the American Society of Health-System Pharmacists here.
IAFC Position Statement Warns About On-the-Job Drug Use
Firefighters taking over-the-counter or prescription drugs—not to mention illicit drugs—have a responsibility to consult with a health expert to ensure that the medications don’t have side effects that may interfere with their ability to safely do their job, according to a new alcohol and drug policy statement from the International Association of Fire Chiefs (IAFC). “The use of illegal drugs and the improper use of prescription and over-the-counter drugs have an enormous impact on not just firefighter safety, but the safety of all members of the community,” said Matt Tobia, chair of the IAFC Safety, Health and Survival Section, in a statement. “We must be proactive and assertive in tackling such tough issues head-on in a responsible, compassionate but resolute way.”
The previous IAFC alcohol statement, “Zero-Tolerance for Alcohol & Drinking in the Fire & Emergency Service,” was issued in 2003 and calls on firefighters who had consumed alcohol during the previous eight hours to “voluntarily remove themselves” from emergency responses or training, and encouraged fire departments to prohibit alcohol on the premises anywhere in the station. The new statement, issued Sept. 14, expands on that to also address illegal, prescription and OTC drugs, and encourages department support of assistance programs that can help responders avoid or address substance abuse.
Read the Drug and Alcohol-Free Awareness position statement here.
