Opioids to cardiac arrest: Training citizens for emergencies
A panel of experts share their community outreach best practices in educating citizens how to respond to cardiac arrest and overdose emergencies
By Nicole M. Volpi, PhDc, NREMTB
NASHVILLE — Community outreach organizations are instrumental in identifying a specific need in the community and providing support to educate its citizens.
Moderatored by Rob Lawrence, MCMI, Paramedics Plus chief operating officer, four experts at the EMS World Expo 2018 shared their stories and best practices in educating citizens in the hopes of saving more lives.
Top Quotes on educating citizens to respond to emergencies
Here are some memorable quotes from the panel on educating citizens in overdose and cardiac arrest response.
“We need to consider the change in landscape when it comes to the opioid crisis.”
— Scott Goldberg, MD, MPH, FACEP, FAEMS
“Let’s speak in one voice to save lives.”
— Jennifer Chap
“My chances of survival was one in a million. No one should have those odds.”
— Mike Papale
“Your rate of survival should not depend on the zip code in which you live.”
— Teri Campbell, RN, BSN, CEN, CFRN
Increasing public access to naloxone
The opioid overdose crisis remains a hot topic in communities across the nation and its effects are felt across demographics.
Scott Goldberg, MD, MPH, FACEP, FAEMS, Brigham & Women's Hospital instructor of Emergency Medicine, led a discussion on the major impact opioids and fentanyl overdoses are having in our communities.
Historically, the medical community, majority hospitals and pre-hospital care, have been able to save lives in these situations by administering naloxone. Goldberg poses the question, “Is it possible to push the bounds a step further and put naloxone in a public space? I think the answer is yes.”
To date, public access to automated external defibrillators and tourniquets have been proven to save more lives when placed in public spaces, however, there is a unique set of challenges when taking a similar approach with naloxone. Goldberg related some of the challenges encountered when implementing Public Access Reversal Kits (containing gloves, masks and medication) into the community and how to overcome them:
- Public access and simple to use. For these boxes to be effective, they have to be accessible in the public space for either the user or the bystander to simply obtain the medication quickly. Research still needs to be done to identify the best location (e.g., businesses, public bathrooms).
- Securing the medication. To ensure the medication would be available when needed, boxes were installed with keypad locks, but remote locks may be used in the future.
- Protection from the elements. Naloxone is sensitive to extreme cold/heat temperatures, therefore, each box is equipped with cold/heating elements.
- Integration with the current EMS system. These kits are not meant to replace EMS, but to augment care until they arrive. “Every patient should have a medical touch.” Meaning, a medical professional should assess the user when naloxone is administered.
Once everything is set up, here’s how users or bystanders can administer the Naloxone:
- Bystander calls 911.
- 911 dispatches ambulance.
- Dispatcher guides bystander to nearest box and provides the code.
- Dispatcher guides the bystander through the administration of the medication.
In an initial study, Goldberg and his team were able to develop a simulation using a prototype kit to test its effectiveness in an area with a high amount of overdoses. It was found that all but one participate was able to administer the drug quickly and effectively, decreasing the administration time. Overall, the participants in the study were willing to help, however, public buy-in is still needed when trying to implement wide distribution in cities.
Empowering public action for sudden cardiac arrest
Rick and Jennifer Chap, BuddyCPR and StrataVerve cofounders, are passionately determined to save lives from sudden cardiac arrest (SCA) through community action. After Rick’s sudden cardiac arrest, the Chaps created BuddyCPR to strengthen the “chain of survival” by adding links to include the bystander and dispatcher roles.
In her session, Chap explained her vision to raise awareness of SCA, provide education and training opportunities to the public on the use of AEDs and CPR, and pioneer research to better understand citizens’ actions when witnessing an arrest.
Here are some top takeaways:
- “Confusion creates that unintentional apathy with deadly consequences,” Chap said. Before someone can act to help in an SCA event, they must have an awareness, understanding and belief. These attributes are essential to the pre-chain of survival for lay rescuers.
- A baseline study conducted by Chap and her organization, in partnership with the Sudden Cardiac Arrest Foundation, found “a frightening lack of awareness when it comes to recognizing an SCA and how/when to start CPR or use an AED.” In a most recent study, Chap was able to show a significant increase in the amount of people deciding to start CPR and an even higher increase in using an AED just by receiving a better understanding of the definition of an SCA.
- Bystander actions are instrumental in the survival rates of sudden cardiac arrest through a better understanding of an SCA, how to use an AED and perform CPR.
BuddyCPR has recently become co-partners in a national movement, the Call-Push-Shock Campaign, to continue to raise awareness, educate the public and empower immediate action in an effort to save more lives.
Community outreach programs for understanding sudden cardiac arrest
At a young age, Mike Papale, In A Heartbeat president and founder, and his family experienced life-altering events when he suddenly collapsed at a basketball camp one morning without warning. At the time, bystanders were unaware of what to do and there was no AED on sight. It just so happened there was a Wallingford volunteer firefighter and EMT, Bob Huebner, who was close by and received the page to respond. Upon arrival and after assessing the situation, Huebner, initiated CPR that was instrumental in preserving Papale’s life until advanced medical help could arrive. Later, Papale and his family would find out he was born with an often silent cardiac disease called Hypertrophic Cardiomyopathy (HCM). Since then, he has made it his mission “to prevent death from sudden cardiac arrest and hypertrophic cardiomyopathy."
Here are some of Paple’s key takeaways:
- Sudden Cardiac Arrest takes more lives each year than Alzheimer’s firearms, breast cancer, cervical cancer, colorectal cancer, diabetes, HIV, house fires, motor vehicle accidents, prostate cancer, and suicides COMBINED.
- Hypertrophic Cardiomyopathy (HCM), a hereditary condition that causes thickening or enlargement of the heart muscle, is the leading cause of death amongst athletes.
- In 2015, In a Heartbeat, was created to carry out a mission of saving more lives from a seemingly hidden disease through the following community outreach programs:
- AED Donation program. Through the power of generous donors, grants are available for the purchase of AEDs and donated to qualified businesses, schools, organizations, and families. To date, this program has donated approximately 60 AEDs in various states, including the help of initial set-up, education and training, and development of action plans. If anyone is interested, a grant form is located on the organization's website.
- Hypertrophic Cardiomyopathy Research Funding Program. Future research is still needed to understand sudden cardiac arrest in relation to HCM. This program raises money through various community fundraising initiatives. So far, $35,000 have been raised to further this research.
- Support program for survivors and their families. Emotional support and the ability to relate to others in similar situations is a powerful tool to the road to recovery. This program is willing to offer an emotional support system to any cardiac arrest survivors, heart disease patients, and anyone living with an implanted device, and their families. Support can be requested on the website or by joining the new In A Heartbeat Support Group on Facebook.
- Heart screening. Since HCM is known to go undetected new initiatives are being created for early detection. Next year, this organization will host a heart screening event in an effort for early detection. For more information on this screening, please reach out to this organization.
- AED and CPR awareness amongst college teammates. At the time of his sudden cardiac arrest, Papale was a rising basketball player making plans to finish his high school senior year and was already receiving letters to play in college. Due to HCM, Papale was not able to continue on this path, however, he did become a college basketball coach. As a coach, he noticed a lot of players were training on their own or just hanging out with friends playing pick-up games. Since coaches and trainers are usually not around during these time, would the players know what to do if one of their teammates went into cardiac arrest? Through the Get the Assist – Save a Teammate’s Life campaign, Papale has created an instructional video that teaches athletes what to do in these situations. This can be done in three steps: 1) Call 9-1-1, 2) Get the AED, and 3) Start CPR.
Ensuring quality of care for sudden cardiac arrest victims
Teri Campbell, RN, BSN, CEN, CFRN, flight nurse, University of Illinois at Chicago, University of Chicago, director, Illinois Heart Rescue, has set out to ensure every out-of-hospital cardiac arrest victim gets the same quality of care. EMS and hospitals cannot do this alone so “we need to empower our communities” to help. In her session, Campbell explains how her rescue program is dedicated to educating and empowering citizens to take action when needed.
Here are the three phases used to get this accomplished:
- Identified their hot-spot neighborhoods. 9-1-1 data was analyzed to identify where the most cardiac arrest events were happening and was there use of bystander CPR. The results revealed most of these events were happening in low-income neighborhoods with a high percentage of cardiac arrest and a low instance of bystander CPR.
- Training, education, and community outreach. Based on the findings above, culturally targeted information was created to inform citizens in these neighborhoods about the benefits of performing bystander CPR to increase the likelihood of saving more lives.
- Evaluation of success. Through trial and error, Campbell was able to adjust their community outreach measures based on past experiences to sustain future efforts. Here is what she found to work well:
- Keep it simple, fast, and cheap for the layperson.
- Take it to the streets. Go where people were already congregating, i.e. sporting events, schools, faith-based organizations, hospitals, etc.
- Empowered students by training them in Bystander CPR with an incentive for a “no homework pass” by teaching five other people what they learned.
- Relieved the educational and financial burden incurred through donations by providing materials, teaching CPR high school classes, and creating “plug-n-play” Youtube videos for teachers to use.
- Implementation of telephone-assisted CPR by 9-1-1 Dispatchers.