First State, First Shock Early Defibrillation Program

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First State, First Shock!Early Defibrillation
Program
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Objectives

• To reduce mortality and morbidity from sudden
  cardiac arrest.
• Increase the accessibility to AEDs within the
  state
• Increase the number of Delawareans trained in
  CPR/AED.
• Increase public awareness of this initiative and
  the overall risk of heart related disease in
  Delaware.
• Tracking outcome to guide future efforts

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To reduce mortality and morbidity from sudden
cardiac arrest

• EDIN data is showing in increase in the number of
  cardiac arrest patients who experience a return
  of pulses and/or respiration after suffering a
  cardiac arrest.
• OEMS is working with the states hospitals for
  survival to hospital discharge rates.

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Increase the accessibility to AEDs within the
state

• The evaluation measures mentioned have shown that
  the program has been successful.
• Public locations have experienced 36 reported
  usages.
• all but one was utilized by trained 1st
  responders who just happened to be on site at the
  time of the incident.
• Throughout the 5 year funding period
• EDIN data from 2005 showed
• Approx. 362 AED usages by 1st responders.
• Approx. 1 AED usages by non-1st responders
  
  
   
• AED usage by 1st responder (BLS, Fire, Police,
  Safety Teams, and Trained Health Care Providers)
  has increased significantly over the years.

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BLS or First Responder arrival prior to ALS
Actual AED reports, it is estimated that the
number is somewhat higher, there have been some
difficulties with gathering reports Data
gathered from EDIN Prior to start of program
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• Fiscal Year 2001 (July 1, 2000 June 30, 2001)
• First year of funding from the Health Fund
  Advisory Committee (HFAC).
• Fiscal Year 2002 (July 1, 2001 June 30, 2002)
• The states high schools received AEDs
• The OEMS applied for and was awarded 1-year of
  funding through the Rural Access to Emergency
  Devices grant program (federal funding).
• Fiscal Year 2003 (July 1, 2002 June 30, 2003)
• Instructor training courses began.
• The Office of EMS applied for and was awarded a
  3-year non competitive grant through the Rural
  Access to Emergency Devices Program.
• This funding is to provide AEDs and support to
  federally designated rural areas and surrounding
  agencies which provide mutual aid.

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• Fiscal Year 2004 (July 1, 2003 June 30, 2004)
• The train-the-trainer program initiated under the
  2003 Rural Access grant was expanded.
• Additional funds will be utilized to purchased
  batteries and other equipment to assure
  sustainability of the initiative.
• Fiscal Year 2005 (July 1, 2004 June 30, 2005)
• Expanded 1st responder definition
• Any person who has a duty to act or duty to
  respond
• Includes school nurses, safety teams, lifeguards
  etc
• Second tier responders
• Those individuals by nature of there job would
  respond to an incident
• Store/Business manager etc

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• Fiscal Year 2006 (July 1, 2005 June 30, 2006)
• New challenges identified
• Manufacturer slow to produce units
• Changes in AHA guidelines
• New CPR and AED protocols, retraining of
  individuals
• Recommends bi-phasic units, Replace old
  equipment (subject to appropriations)

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Funding
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Increase the number of Delawareans trained in
CPR/AED.

• OEMS has become a certified CPR training site.
• Continuing Education may be computer based, for
  those agencies that do not participate in the
  train-the-trainer program.
• Training classes will be ongoing and will take
  place as needed throughout the funding term.
• CPR/AED classes are generally taught at the
  agencies location, and the time they request.
• OEMS will offer train-the trainer programs in
  CPR/AED
• Agencies/organizations that take part in the
  instructor training and receive training
  materials will be required to offer at least two
  community CPR/AED classes to the general public.
  

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Total trained includes recertification
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Tracking outcome to guide future efforts

• An essential focus of any EMS system is its
  ability to effectively treat cardiac arrest
  patients. As our EMS system matures, we realize
  that more effort and better organization is
  needed to provide optimum EMS care for patients
  with cardiac and cardiovascular related
  complaints.

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Training Agencies

• Vendor 1 - 50 per CPR/AED provider trainee.
  Includes one (1) year certification with a
  no-cost one (1) year recert. Includes a CPR/AED
  training manual and protective barrier device for
  each trainee. AED unit delivered at separate
  time.
• Vendor 2 - 45 per CPR/AED provider trainee and
  150.00 per CPR/AED instructor trainee. Includes
  two (2) year certification, a CPR/AED training
  manual and protective barrier device for each
  trainee. AED unit delivered at separate time.
• Vendor 3 - 40 per CPR/AED provider trainee and
  130.00 per CPR/AED instructor trainee. Includes
  two (2) year certification, a CPR/AED training
  manual and protective barrier device for each
  trainee. AED unit delivered at time of training.
• OEMS training program - 15 per CPR/AED provider
  trainee and 100 per CPR/AED instructor trainee.
  Includes two (2) year certification, a CPR/AED
  training manual and a protective barrier device
  for each trainee. AED unit delivered at time of
  training.

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Training

• Use of funds for instructor training and
  equipment will allow receiving agencies to be
  self sufficient with future training and
  continuing education efforts.
• Agencies/organizations that take part in the
  instructor training and receive training
  materials will be required to offer at least two
  community CPR/AED classes to the general public.
  
• OEMS is currently seeking additional training
  funds through outside grant and funding sources.
• Initial training will remain hands-on.
• Alternative teaching methods.

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Challenges

• One of the barriers OEMS has incurred with the
  sustainability of the program is agencies not
  replacing batteries and electrodes in units and a
  failure to continue training. (Each agency signs
  an agreement stating that they are responsible
  for the ongoing maintenance and training.)
• OEMS sends out a yearly letter to all agencies
  that have received an AED through this program.
• Reminders to check batteries and electrode
  expiration dates
• Reminders that individuals are recommended to
  partake in on-going training efforts
• Yearly submission of forms to include expiration
  dates of equipment, and update of contact
  information.

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Challenges

• Funding
• Personnel
• Program Sustainability

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Where do they occur?
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• Data has shown that in the state, 72 of all
  cardiac arrest occurred in the home in 2005 (a
  number which has remained consistent since 2001)
• By placing more AED units into the 1st responder
  system (law enforcement, fire service, safety
  teams, security agencies, etc..) would have the
  potential to affect more Delawareans.

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Police AEDs

• The EMS Improvement Act tasked the OEMS with
  equipping all law enforcement vehicles with an
  AED by January 1, 2001, subject to legislative
  appropriations.
• To date this goal has not been attained.
• Approximately, 50 of the police vehicles within
  the state are AED equipped.
• By building on a system that is already in place,
  the maximum impact of the funds can be achieved.

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What are the next steps?

• Continue focused contacts with targeted
  facilities
• Follow-up with agencies that already have units
• Assess the feasibility of incorporating the First
  state, First Shock! Program into a more
  comprehensive cardiac arrest/disease treatment
  and prevention initiative.

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National Recognition

• ACEP Research Forum. Washington, DC, September
  2005.
• Location of Cardiac Arrests in the Public Access
  Defibrillation Trial.
• American Heart Association, Scientific Session,
  Nov 2004
• Addition of Police and Public Access
  Defibrillation to a Preexisting First Responder
  AED Program
• National Association of Emergency Medical
  Physicians (NAEMSP), Jan. 2003
• Effect of Adding Police and Public Access
  Defibrillation to a Preexisting First responder
  AED Program
• HRSA/ORP Grantees Meeting 2003

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Questions?