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HomeMy WebLinkAboutMINUTES - 08012006 - D.65 I L Contra TO: BOARD OF SUPERVISORS .' "� Costa FROM: Family and Human Services Committee "` `wo County Emergency Medical Care Committee A Cobs DATE: August 1, 2006 SUBJECT: Community CPR Training SPECIFIC REQUEST(S) OR RECOMMENDATIONS(S) & BACKGROUND AND JUSTIFICATION RECOMMENDATION ACCEPT report from the Health Services Department, Emergency Medial Services Agency, as recommended by the Family and Human Services Committee and the Emergency Medical Care Committee. DIRECT the County Administrator's Office to work with the Health Services Department to make information available through the County web site and Contra Costa Television (CCTV) on the availability of CPR training opportunities in the County. FISCAL IMPACT None. BACKGROUND/REASONS FOR RECOMMENDATION On May 19, 2006 the Board of Supervisors directed the Family and Human Services Committee and the Emergency Medical Care Committee to convene a joint meeting, with participation from specific agencies, to discuss possible methods for implementing a program for increasing the number of individuals in the community who are trained in cardio pulmonary resuscitation (CPR). CONTINUED ON ATTACHMENT: X YES SIGNAT RE: _RECOMMENDATION OF COUNTY ADMINISTRATOR X RECOMMENDA I N F BOARD COMMITTEE X APPROVE OTHER SIGNATURE(S): Supervisor Mark DeSaulnier Supervisor Feder I Glover ACTION OF BOARD ON © o l APPROVED AS RECOMMENDED OTHER, VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A �C UNANIMOUS (ABSENT ) TRUE AND CORRECT COPY OF AN AYES: NOEge ACTION TAKEN AND ENTERED ON THE ABSENT: ABSTAIN: MINUTES OF THE BOARD OF SUPERVISORS ON THE DATE SHOWN. Contact: Dorothy Sansoe 5-1009 ATTESTED Orig. Dept.: County Administrator JOHN CULL N, CLERK OF cc: County Administrator THE BOARD OF SUPERVISORS HSD— Emergency Medical Services AND COUNTY ADMINISTRATOR BY DEPUTY Page 2 On July 24, 2006 the Family and Human Services Committee and representatives of the Emergency Medical Care Committee met and reviewed the attached report. This report provides detailed information on the emergency medical response to sudden cardiac arrest and public participation in CPR training and defibrillation. Discussion took place on what was currently being offered in the community, the free classes being provided by American Medical Response under their ambulance service contract with the County, what other cities in the nation were doing, and what Contra Costa County could do to enhance CPR training and increase the number of trained individuals. During the discussion it was suggested that information could be posted on the County web site and run on CCN. Contra Costa Health Services Emergency Medical Services Agency July 17, 2006 Sudden Cardiac Arrest—EMS Response and Public Participation A Background Paper Prepared for the Board of Supervisors Family,and Human Services Committee I. EMS Response to Sudden Cardiac Arrest In a series of articles appearing in USA Today in May 2005 ("Six Minutes to Live or Die"),results of an 18-month survey of EMS response to sudden cardiac arrest in the 50 largest American cities were presented. Only 12 of the 50 cities were found to use precise measures of cardiac arrest survival. Among these 12, actual survival rates, measured by patients discharged from the hospital without serious deficit, ranged from a low of 3%to a high of 45%. The major conclusion of the series was that few EMS systems are effective in saving cardiac arrest victims and that most systems are unable to measure key factors related to successful cardiac arrest saves. Success, according to the series, has been achieved in cities like Seattle(45%)and Boston(40%) through strong community leadership resulting in widespread public CPR training and rapid defibrillation. While recognizing that cardiac arrests comprise only a small portion of EMS patients, the series theorizes that EMS systems that respond well to cardiac arrest are likely to respond well to other emergencies as well. Cardiac arrest occurs when the heart's pumping action ceases. Cardiac arrest can occur from different causes. Traumatic injury, electrocution, drowning, and drug overdose, for example, can bring about cardiac arrest. Among adults, the major cause of out-of-hospital sudden cardiae arrest is coronary heart disease. Among children,trauma, Sudden Infant Death Syndrome, and respiratory failure are the most common causes of cardiac arrest. The terms "cardiac arrest" and"heart attack"are often confused by the public and in the media. While a heart attack may lead to cardiac arrest,many persons experience heart attacks without going into cardiac arrest, and many cardiac arrests are not a result of heart attack. As there are different underlying causes of cardiac arrest,there are also different conditions of the heart that can result in cardiac arrest. "Asystole," also called"flat-line," is the cessation of all electrical activity in the heart. A person whose heart is in asystole can seldom be resuscitated. But between the extremes of asystole and the heart's normal sinus rhythm are a wide array iof abnormal heart rhythms, or arrhythmias, some more dangerous than others. Several arrhythmias can be associated with sudden cardiac arrest, but the most common is ventricular fibrillation(V-fib). It is the rhythmic contraction of the heart's ventricle chambers that pumps blood to the brain and other parts of the body. Ventricular fibrillation can be described as a condition where the heart's ventricular muscles go into a quivering state no longer capable of pumping blood. In a related condition known as pulseless ventricular tachycardia, the contractions of the ventricles are so rapid that pumping is ineffective. Ventricular fibrillation and pulseless ventricular tachycardia if untreated are deadly, but most victims stand a good chance of survival without serious deficit if defibrillation Contra Costa Emergency Medical Services Agency 7113/1006 Sudden Cardiac Arrest—EMS Response and Public Participation occurs immediately following I nset. After 5 or 6 minutes, brain death begins to set in, and very few victims are saved if not shocked within 10 minutes. Defibrillation is the only treatment known to revive a patient in ventricular fibrillation or pulseless ventricular tachycardia. It was the need for rapid defibrillation that led to the development of mobile coronary care units that could bring defibrillation to the scene of a cardiac arrest. The fust mobile coronary care units in the 1960's were staffed by physicians. The first paramedic programs were developed in 1969 in Miami, Florida and Seattle, Washington. Physicians in these cities trained firefighters to use portable defibrillators to treat cardiac arrest victims. Defibrillators used by paramedics are manually operated devices requiring assessment of the patient's heart rhythm before delivering a shock. The development of automated external defibrillators (AED's), first introduced in 1979, enabled persons with very little training to administer defibrillation. The AED has a computer which, when the AED is properly attached to the patient, determines if the patient should be shocked andldelivers the appropriate shock. An AED will only deliver a shock to a person in ventric Ilar fibrillation or ventricular tachycardia. With the availability of funding for EMS enhancements following the passage of Measure H in 1988, Contra Costa County became one of the early California counties to implement a countywide first responder defibrillation program. All firefighters were trained in first responder defibrillation and all engines equipped with AED's. Currently all ambulances and all fire engines in Contra Costa County are equipped with defibrillators—either manual defibrillators used by paramedics or AED's used by non- paramedic responders.' Several police departments are also equipping squad cars with defibrillators. AED's are currently being carried or are planned for police units in Antioch, Brentwood, Hercules, Kensington, Lafayette,Moraga, Orinda,Pittsburg, San Ramon, Alamo, and Blackhawk. But even with widespread first responder defibrillation,many cardiac arrest victims cannot be reached by EMS in time to be helped. Response times for rescue crews coming from the nearest fire station average 5 to 7 minutes in most systems. Response times are usually measured from the time the call is received at the fire dispatch center until the engine arrives at the scene. Added allowance must be made for the time it takes to place and process the 9-1-1I call and for the crew to get from their vehicle to the patient, assess the patient, and apply the shock. These steps add at least 3 to 5 minutes, sometimes much longer. If the patient is located in a large building or complex, it may take several minutes once on scene for the EMS crew to actually locate the patient. As the need for faster access to defibrillation was recognized and as confidence grew in the use of automated defibrillators, laws were passed allowing for the development of public access defibrillation programs (PAD'S). California law establishes minimum requirements for public access defibrillation programs and provides Manual defibrillators enable a paramedic to view,the heart rhythm on a monitor and deliver an appropriate shock based on interpretation of the rhythm. Manual defibrillators provide the paramedic greater flexibility than is available with an AED,which is limited to defibrillation of computer-confirmed ventricular fibrillation and pulseless tachycardia. -2- Contra Costa Emergency Medical Services Agency 7/13/2006 Sudden Cardiac Arrest—EMS Response and Public Participation liability protection to lay persons who use an AED. No specific training is required for lay use of an AED. In Contra Costa County, the EMS Agency estimates that there are approximately 350 public use defibrillators located in office buildings, commercial facilities, and community facilities. While most of these were privately acquired, the EMS Agency working with thel Board of Supervisors provided some 40 AED's to community facilities at no charge. Under the County's emergency ambulance service contract, American Medical Response has agreed to provide 25 AED's to community facilities at no charge during each year of the contract beginning July 1, 2005. What role does cardiopllmonary resuscitation(CPR)play in treatment of cardiac arrest victims? In cases of respiratory arrest due to near drowning or drug overdose where the patient may be in respiratory arrest but not cardiac arrest,the process of CPR including clearing the airway and administering rescue breaths, may stimulate the return of spontaneous breathing. But for a cardiac arrest victim in ventricular fibrillation, only defibrillation can bring about a return of spontaneous circulation. CPR, in the case of cardiac arrest, has traditionally been viewed as a mechanism to supply some oxygenation to the brain and heart extending the time that a patient might be successfully defibrillated. Some experts believe that CPR performed correctly and started immediately following arrest can double the time available for successful defibrillation—in effect extending a 5- 6 minute window to a 10-12 minute window for defibrillation. The American Heart Association promotes the concept of"Chain of Survival." This chain of survival consists of four links that must be undertaken immediately to save a victim of sudden cardiac arrest: I (1) The first link is early access to emergency care by calling 9-1-1. (2) The second link is i arly CPR to be started and maintained until EMS arrives. (3) The third link is early defibrillation, the only response that can re-start the heart function of a person in V-fib. (4) The fourth link is el rly advanced care administered as needed by EMS. In Contra Costa County, approximately 60% of patients with witnessed sudden cardiac arrests are reported to have received bystander CPR prior to the arrival of EMS. Only one of the 50 cities in the USA Today survey, Albuquerque, reported a higher bystander CPR rate than Contra Costa County. Contributing to the high bystander CPR rate in Contra Costa County is1 the County's Emergency Medical Dispatch program in which dispatchers at the three fire/medical dispatch centers (Contra Costa Fire, San Ramon Valley Fire, and Richmond Police) are trained to give"pre-arrival" instructions to 9-1-1 callers to provide emergency assistance while EMS responders are en route. These instructions include CPR. Many people who are reluctant to start CPR for fear of making mistakes will perform CPR when prompted and instructed by a trained emergency dispatcher. Based upon seven months(November 2005 —May 2006) of patient data American Medical Response responds to about 513 cardiac arrests annually? (See i 'AMR's service area includes all of Contra Costa County except the San Ramon Valley and Moraga- Orinda Fire District and includes about 89%of the county's population. -3- Contra Costa Emergency Medical Services Agency 7/13/2006 Sudden Cardiac Arrest—EMS Response and Public Participation Attachment A.) Of these, about 147 (28.7%) per year are witnessed cardiac arrests. Of all witnessed cardiac arrests, about 43 (29.3%) experience a return of spontaneous circulation(ROSC). Of the estimated 147 witnessed cardiac arrests annually, about 31 (21.1%) are reported to have an initial rhythm of ventricular fibrillation(26) or ventricular tachycardia(5). Of the 31 witnessed arrests with ventricular fibrillation or ventricular tachycardia, about 21 (66.7%)receive bystander CPR and about 12 (38.9%) have a return of spontaneous circulation. Data are not currently available on the number of patients surviving to hospital admission or discharge. Also, existing data does not fully distinguish between cardiac arrests of cardiac and non-cardiac etiology. While rapid CPR and rapid defibrillation have traditionally been associated with successful resuscitation of cardiac arrest victims, there has been a frustrating lack of correlation between these variables and survival rates when comparing outcomes for different communities. There is little or no correlation, for example, in the USA Today data between cardiac arrest survival rates and either bystander CPR or time to shock. In fact, one of the lowest survival rates was reported by a city(Colorado Springs)with one of the highest bystander CPR rates and one of the shortest time-to-shock rates. The lack of expected relationships between cardiac arrest survival and factors commonly thought to contribute to survival such as short response times and bystander CPR in the USA Today survey is consistent with the findings of a recent study published in the American Journal of Emergency Medicine. Combining data from 14 published studies of cardiac arrest in which data was reported based on the Utstein template, the authors concluded that there is tremendous variability in outcome not explained by the traditional risk factors for low survival.3 Specifically, this analysis did not find a relationship between bystander CPR and cardiac arrest survival. Conclusions with respect to the effectiveness or ineffectiveness of traditional CPR,however,may be moot. Based on the 2005 International Consensus Conference on Cardiopulmonary Resuscitation,the American Heart Association has issued revised standards making significant changes in the way CPR is performed and in the use of CPR in conjunction with defibrillation. The major change in CPR is an emphasis on compressions rather than breaths. Rescuers are to be taught to "push hard,push fast" (at a rate of 100 compressions per minute) allowing complete chest recoil and minimizing interruptions in chest compressions. EMS personnel are instructed to provide CPR between defibrillation cycles and, on unwitnessed arrests,prior to defibrillation. It is thought that these changes,just now being introduced into CPR instruction, may significantly improve CPR results. The authors of the American Journal of Emergency Medicine article did not speculate on what other factors might be at play in affecting the widely ranging cardiac arrest survival rates reported in different systems. Some differences are no doubt due to health status variations among different populations and variations in the levels of hospital treatment of cardiac arrest victims. It seems clear,however, that, even in i a Fredriksson,Martin,J.Herlitz,MD,and G.Nichol,MD,"Variation in Outcome in Studies of Out-of- Hospital Cardiac Arrest:A Review of Studies Conforming to the Utstein Guidelines,"American Journal of Emergency Medicine,Vol.21,No.4,July 2005. 4- Contra Costa Emergency Medical Sel Wces Agency 7/1312006 Sudden Cardiac Arrest—EMS Respno Ise and Public Participation systems making good faith efforts to adhere to the Utstein4 template,there is room for extensive variation in data measurement and data quality. Much of the reported variation in survival rates is no doubt due to inconsistencies in measurement. An important conclusion of the USA Today series was that most EMS systems are unable to accurately measure response times and patient outcomes. This has been the case in Contra Costa County as well. The measurement of ambulance response time starts when the fire/medical dispatch center requests the ambulance and ends with the arrival of the ambulance at the nearest public road access point. While this is an appropriate measure of contract compliance, it does not accurately assess the time from the placement of the 9-1-1 call until arrival of EMS at the patient site. There may be delays between the placement of the 9-1-1 call and the time the request is relayed to the ambulance provider. There may be delays between the arrival of the ambulance vehicle at the scene and the arrival of the crew at the patient site. First responder response times, although available on a case-by-case basis,have not been linked with ambulance dispatches in a manner enabling the EMS Agency to analyze overall EMS response times. Under the first responder defibrillation program, first responders were able to upload data, including time stamps, EKG's, and a voice recording of the incident, from AED's on all defibrillation attempts directly to EMS providing a good data source for monitoring, evaluation, and quality improvement. Unfortunately, a side effect of the movement to first responders paramedics using manual defibrillators was the loss of the data source that had been available from uploaded information on each first responder AED usage. The EMS Agency together with the EMS providers has been working on a number of improvements in data collection and EMS access to data. Ambulance dispatch data has long served as the basic data system available to the EMS Agency. Ambulance patient care reports are available to the EMS Agency,but not in a format conducive to statistical reporting: First responder dispatch data and patient care reports have been available on a case-by-case basis, but not in a form suitable for statistical reporting. Two new products will enhance EMS data capability. FirstWatch has been put in place at the San Ramon Valley and at Contra Costa County Fire dispatch centers to capture EMS incident data related to first responder and ambulance dispatch. FirstWatch now gives the EMS Agency the ability to track response time from when the 9-1-1 call is answered at the fire/medical dispatch center through hospital transport. Plans are in place to expand FirstWatch to include the Richmond dispatch center and American Medical Response. (AMR responses to Contra Costa County Fire incidents are already captured by FirstWatch.) The second new product is the Zoll patient data system recently obtained for use by all first responder agencies. This will enable each first responder agency to monitor its own patient care data and will enable the EMS Agency to monitor all first 4 The internationally recognized Utstein standards for uniform reporting of data from out-of-hospital cardiac arrests were developed in 1991 to provide a template for consistent measurement of survival rates in different systems. The standardslprovide definitions of terms and a template for data analysis. The so- called Utstein"gold standard"looks only at witnessed cardiac arrests with cardiac etiology and an initial rhythm of either ventricular fibrillation or pulseless ventricular tachycardia. The percent of this group who survive to hospital discharge gives the"gold standard"survival rate. 5- Contra Costa Emergency Medical Services Agency 7113/2006 Sudden Cardiac Arrest—EMS Response and Public Participation responder patient care data. UlI-mately, it is planned that FirstWatch will facilitate the linkage of both dispatch and patient care records for both fust responder and ambulance. Using the new data analysis tools now or soon to be available, the EMS Agency has undertaken a rigorous perusal and analysis of data on sudden cardiac arrests using the Utstein template. Data will include measurement of the time interval from telephone pickup at the fire/medical dispatch center to EMS arrival on the scene to delivery of shock, identification of witnessed arrests, identification of initial heart rhythm and probable etiology(cardiac or non-cardiac), and, if possible, emergency department disposition and final hospital disposition. -6- Contra Costa Emergency Medical Services Agency 7/13/1006 Sudden Cardiac Arrest—EMS Response and Public Participation H. Public Participation—CPR Training and Defibrillation Most CPR training in the United States is conducted under the auspices of either the American Heart Association or the American Red Cross. While both organizations provide CPR training, the Red Cross focus is on emergency and disaster preparedness for individuals, families, and communities, while the Heart Association's focus is on reducing death and disability due to cardiovascular disease and stroke. CPR courses given by Red Cross and Heart Association certified instructors adhere to CPR standards established by the Heart Association. Heart Association approved CPR training includes a variety of courses aimed at both professional rescuers and the public. Courses vary in length depending on content and whether a certifying examination is given. A "Friends and Family" course including adult, child, and infant CPR but no examination or certification is taught in 4.5 hours. Shorter courses are available covering just adult or just infant and child CPR. Courses including a final examination and certification and those aimed at health professionals run longer. Charges for CPR classes typically run between$35 and$75 depending on the length and whether a certification card is issued. The American Heart Association has recently introduced a 30-minute self-taught Friends and Family CPR Anytime course for adult CPR. Using an inexpensive kit (available from the Heart Association for$30)that includes a manual, video, and practice manikin,the American Heart Association has found that CPR for adults can be taught in as little as 20 minutes plus an additional 5 minutes each for choking and AED. In some communities,kits can be checked out from public libraries or local fire stations. California regulations require a minimum of 4 hours of training for first responder rescue personnel approved to use AED's. However,there is no specific requirement for lay personnel to have training in order to use an AED. AED's intended for lay use are fully automatic and very easy to use. Easy-to-follow instructions and voice prompts guide the user through the process. An onboard computer analyzes the heart rhythm and assures that a shock is delivered only when appropriate. Most CPR classes now include instruction on use of AED's. Public Access Defibrillation The EMS Agency has been working collaboratively since 2002 with the American Heart Association in support of the AHA's Operation Heartbeat to promote public access defibrillation. In 2004, with Board of Supervisors approval, the EMS Agency was able to acquire 42 AED's used in the county by first responders as a part of a vendor-sponsored testing program for distribution to community agencies for public access defibrillation. This program is being continued in concert with American Medical Response under its community AED donations. EMS and AMR staff have been working with community agencies in each supervisorial district to establish programs and train staff in each participating agency. Most AED's obtainedlfor public access defibrillation are purchased by businesses for employee use. AED vendors are required by statute to notify the local EMS agency when AED's are placed. Information on AED location can then be entered into a database used by emergency medical dispatchers so the dispatcher will know when an emergency call is received that an AED is registered on the premises and suggest its use -7- Contra Costa Emergency Medical Se ices Agency 7113/2006 Sudden Cardiac Arrest—EMS Response and Public Participation if appropriate. Altogether, soml 350 public use AED's have been registered with the Contra Costa EMS Agency. Information of public access defibrillation including a program implementation guide, state regulations, and a vendor list is available on the EMS Agency website at www.ciccems.org. EMCC Proposal/AMR CPRI Classes In 2004 Rod Talavera(District 5 Alternate)proposed to the Emergency Medical Care Committee that a program be developed to provide no-cost CPR training to large numbers of the public. A subcommittee was appointed to further explore the proposal. Following meetings with representatives of various organizations including the American Heart Association,the American Red Cross, Contra Costa County Fire Protection District, and American Medical Response, a concept plan was presented to and endorsed by the EMCC at its meeting oflDecember 8, 2004. The plan as presented would entail a massive campaign enlisting the support of community leadership, the media, and community and labor organizations with a goal of training 50,000 persons annually in CPR, AED use, and first aid. Recognizing the importance of citizen CPR training and public access defibrillation,American Medical Response offered to provide CPR training to the public and to donate a number of AED's for use by community organization. Specifically, AMR agreed as a part of its emergency ambulance service contract with the County to provide 25 free CPR classes to the public, annually, in addition to its commitment mentioned above to donate AED's for community agency use. AMR's CPR classes have been averaging about 15 attenaee each. CPR Classes Available to the Public in Contra Costa County In order to promote the availability of CPR, the EMS agency maintains a phone number— 1-800-GIVE CPR 1 to provide information to the public on where CPR training can be obtained. Attachment A is a list of CPR training resources available to the public in Contra Costa County and known to the EMS Agency. Since any individual with CPR instructor certification can give CPR instruction, there may be other resources not included on this list. A View of Three Selected Cities I A number of communities have taken on CPR training as major communitywide goals. Most notable of the large-scale community CPR training initiatives is probably the Medic 11 program in Seattle, Washington. This section describes the cardiac care and CPR initiatives of three communities—Seattle/Kings County, Boston, and Tucson. These community programs were selected for description here for different reasons. Seattle is widely recognized as one of the first communities to make a major communitywide commitmentI to improving cardiac arrest survival. Boston has been cited as a major city that has been successful in turning a low-performing EMS system into a high-performing system. Tucson accepted academic direction in changing its approach to cardiac arrest care. A common element in the three initiatives undertaken in these three cities was a strong belief by community leadership that deaths from sudden cardiac arrest could be significantly improved by changes in response to cardiac arrest by both the public and EMS. -8- Contra Costa Emergency Medical Se, ices Agency 711312006 Sudden Cardiac Arrest—EMS Response and Public Participation Seattle/King County I II and Student CPR Training Programs. Seattle began its Medic II mass citizen CPR training 1972 as an adjunct to its Medic I paramedic program. Seattle's Medic 1, spearheaded by the University of Washington Medical School and the Seattle Fire Department, was one of the nation's first paramedic program. Recognizing that paramedics would be unable to arrive on the scene quickly enough to save many cardiac arrest victims unless bystander CPR could be initiated immediately following the incident, Seattle's Medic I leadership initiated the Medic II program to train as many residents as possible in' CPR. Medic II received extensive community support. Initial funding was provided through local businesses. The Seattle Rotary Club, for example, donated some $100,000 between 1972 and 1978 to the Medic II program. During its first two years,the program trained some 200,000 persons in CPR. Some 650,000 persons have been trained since Medic II's inception, and the program continues to train about 18,000 persons annually. Training is conducted by Seattle and surrounding King County firefighters and is free to the public. Private donations from the United Way and other sources now sustain the instructional budget. Fire departments provide needed equipment and absorb the administrative costs of scheduling classes and running the program. Seattle Fire Department's Medic II program has long been recognized internationally as one of the most successful models for community CPR training and claims to have doubled the save rate for witnessed out-of-hospital sudden cardiac arrests. In addition to the community unity CPR training classes provided by Seattle and other King County fire departments,)the King County Emergency Medical Services Division offers a major CPR training initiative focusing on the public schools. Seventeen King County school districts participate in the Student CPR Training Program,which provides CPR training to students in grades six through twelve. Funds are provided through EMS to school districts to hire substitute teachers while regular teachers participate in a two- day CPR instructor certification program or a one-day recertification program required every two years. About 200 schoolteachers in King County actively participate in the program providing CPR instruction to students in their respective schools. According to EMS, some 18,000 students receive CPR training annually through this program, about the same number as trained through the Medic II program. Boston Defibrillator and Cardiovascular Program. In 1992, Boston's Mayor Thomas Menino spearheaded an effort to upgrade that city's EMS system. Mayor Menino,who had a practice of riding along on a city ambulance to observe first hand how the EMS system worked,took on resolving the historical turf war between fire and ambulance service crews,hired a medical director to oversee the city's EMS program and a number of physicians to review EMS cases, and enlisted public response to help improve cardiac arrest survival. Eight years later, the City of Boston announced an increase in cardiac arrest survival from 14.0% in 1993 to 32.5%in 1999. This was attributed by Boston EMS to placement of AED's on all of the city's EMS response units and on strategic police units, enlistment of over 50 public and private partners including some of Boston's major employers in a public access defibrillation program,promotion of early access to 9-1-1, and citizen CPR. Boston EMS offers various CPR classes to the public at a fee. -9- Contra Costa Emergency Medical Services Agency 7/1312006 Sudden Cardiac Arrest—EMS Response and Public Participation University of Arizona Tucson Sarver Heart Center `Be a Lifesaver" Program. The University of Arizona Sarver Heart Center has advocated a form of CPR known as "continuous chest compression"CPR(CCC-CPR) or cardiocerebral resuscitation(CCR). This approach,not endorsed by the American Heart Association, provides compressions only at a rate of 100 compressions per minute to adult cardiac arrest victims. CCC-CPR was adopted by the Tucson Fire Department in 2002 and has since spread to other communities in Arizona and to some areas outside Arizona. Through its`Be a Lifesaver"program,the University of Arizona Sarver Heart Center has instituted a program of public education teaching CCC-CPR in Tucson and other Arizona communities. Sarver Heart Center researchers believe that survival rates for witnessed cardiac arrests with bystander CPR can be significantly improved through the use of CCC-CPR for a couple of reasons. CCC-CPR, according to the Sarver Heart Center, is more effective than standard CPR as performed by most persons, and more persons are willing to perform bystander CPR using chest compressions only than with mouth-to- mouth resuscitation. The Sarver Heart Center claims high success with CCC-CPR and the increased emphasis in chest compressions has, in fact,been incorporated into the 2005 American Heart Association standards. - 10- Contra Costa Emergency Medical Services Agency Attachment A Sudden Cardiac Arrest—EMS Response and Public Participation AMR Utstein Data Nov 2005- Annual May 2006 Po ulation served 901,000 Confirmed cardiac arrests considered fort resuscitation 299 513 56.9 per I 100,000 P02. Resuscitation not attempted 18 31 Resuscitation attempted I 281 482 53.5 per ° 100 000 pop. 100.0/o No return of spontaneous circulation 228 391 81.1% Return of spontaneous circulation 53 91 Non-cardiac etiology I Unknown Cardiac etiology Unknown Not witnessed 195 334 Witnessed 86 147 100.0% Nobystander CPRS 34 58 39.5% 100.0% No return of s b ontaneous circulation 28 48 82.4% Return of s ontaneous circulation 6 10 17.6% B stander CPR 1 52 89 60.5% 100.0% No return of s 6 ontaneous circulation 33 57 63.5% Return of spontaneous circulation 19 33 36.5% As stole 1 31 53 100.0% Nobystander CPR 10 17 32.3% B stander CPR 1 21 36 67.7% No return of s ontaneous circulation 17 29 54,8% Return of spontaneous circulation 4 7 12.9% Died en route or in ED Unknown Admitted1to hospital Unknown Diedlin hospital Unknown Disc$ar ed alive I Unknown Other rhythm 1 37 63 100.0% Nobystander CPR 18 31 48.6% Bystander CPR 19 33 51.4% No return of spontaneous circulation 11 19 29.7% Return of s ontaneous circulation 8 14 21.6% Died en route or in ED Unknown Admitted to hospital Unknown Died in hospital Unknown Dischar ed alive Unknown V-FibN-Tach 18 31 100.0% No bystander CPR 6 10 33.3% B stander CPR 1 12 21 66.7% No return of'spontaneous circulation 5 9 27.8% Return of spontaneous circulation 7 12 38.9% Died en route or in ED Unknown Admitted to hospital Unknown Died in hospit Unknown Dischar ed alive Unknown Source: Contra Costa Emergency Medical Services Agency. A-1 CPR/First Aid Resources .x �� ., •a:,, A G`*s' w 3�, ` r" f.� � � e- '� sg � as': " y' 9 s Cartl xi. +tame of Oran�zat,c�n, "Glass Lpcatwn�: � Phor►e � � ,Cos#� � f `�) ]� � ��Y1fe6site w' F > _ '�%, �ax e_�"` ��Uxy8RVWl "w; � a � .+ ..� "3, -�.aEd., .. . Adams Safety Training San Ramon (925)454-0895 $45 Yes www.adamssafet .com Various American Heart Association throughout 1-800-242-8721 Yes www.americanheart.org county Various American Medical Response throughout No charge No county American Red Cross Countywide (510) 307-4400 $45 to$65 Yes www.ba area- l-800-520-5433 redcross.org Concord, City of(Dept of Concord (925) 671-3480 www•ci.concord.ca.us/ Parks & Recreation (925) 671-3404 EI Cerrito Fire Department EI Cerrito $20 Fast Response Berkeley (510) 849-4009 Varies Yes www.fastresponse.orq/ Walnut Creek (925) 946-6666 Danville (or given to groups I (925)858-9789 Fontaine Fire, Inc. throughout- (925)831-9263 Varies Yes www.fontainefire.com County I Hercules Community Swim $58 Res www.ci.hercules.ca.us/ Center Hercules (510) 799-8291 $63 Non Yes New/ Res John Muir Health & Fitness Concord (925) 798-9401 $55 Yes www.iohnmuirhealth.co Institute m John Muir Women's Health Walnut Creek (925) 941-7900 $55 Yes www.iohnmuirhealth.co Center i m $60 Kaiser http://members.kaiser p Kaiser Clinic Antioch (925) 779-5147 Member Yes ermanente.org/kpweb/c $70 Non- lasses/list.do Member Lafayette, City of(Parks & Lafayette (925)284-2232 $37 Yes www.lafmor- Rec Dept) recreation.orq Los Medanos College Pittsburg (925)439-2181 X $26 www.losmedanos.edu/ 3347 NameuOrgan�zatonscatNons �h � �Y,esino) Website tib Ax&4s Martinez Adult Education Martinez (925) 228-3276 $35 Yes www.martinez-ed.org Mt. Diablo Adult Education Concord (925)685-7340 $55 Yes www.mdusd.kl2.ca.us/ X 2732 adulted Moraga-Orinda Fire $50 Various National Safety Council throughout 1-800-848-5588 Varies Yes www.nsc.or county I Orinda, City of Orinda (925)254-2445 $35 to$45 Yes www.ci.orinda.ca.us Rodeo-Hercules Fire No charge $28 Residents $35 Non San Ramon, City of(Parks& San Ramon (925) 973-3200 Residents www.ci.san- Community Services) $23 ramon.ca.us/ Residents $29 Non Residents San Ramon Valley Fire Minimal charge Walnut Creek, City of Heather Farms (925) 943-5858 $42 Yes www.walnutcreekrec.or Park $72 .9 $70 YMCA, Delta Family Oakley (925)625-9333 Member Yes www.mdrymca.org $88 Non- Member $63 YMCA, Irvin Deutscher Member Family Pleasant I ill (925)687-8900 $79 Non- Yes www.mdrymca.org Member $30 YMCA, West Contra Costa Richmond (510)412-5647 $25 Yes www.vmcaeastbay.org $50 6/2006