Transcript Document
VSA 2004 Ottawa Ottawa Cardiac Arrests 2002 2003 2004 Cardiac cause 441 452 412 Average age 69 68 66 Gender – female other 35% 65% 34% 66% 31% 69% Ottawa Base Hospital Dr. J. Maloney VSA 2004 Ottawa Cardiac Arrests 2004 (03) Ottawa Locations Residence 65% (68%) Citizen CPR 25% (7.1%) Public 22% (13%) Defibrillator EMS Fire 77% (68%) 18% (23%) PAD 5% (7%) 2000 2001 2002 2003 2004 5.4% 3.3% 5.9% 6.6% 6.1% 13% 12.9% 7.1% 25% Ottawa Base Hospital 8.7% Dr. J. Maloney VSA 2004 Ottawa Ottawa Cardiac Arrests 2004 Ventricular Fibrillation # V Fib cases 133 If Citizen CPR (44) First to apply defibrillator First to apply defibrillator EMS 76% EMS 68% Fire 17% Fire 24% PAD 7% PAD 8% Survived 12% Survived 11% Ottawa Base Hospital Dr. J. Maloney VSA 2004 Ottawa Cardiac Arrests Ottawa The Big Picture Cardiac arrest 60’s year old men At home Often witnessed (2/3) (3/4) (1/2) If witnessed in a residence, in Ottawa, witness starts CPR … 1 3 Ottawa Base Hospital Dr. J. Maloney VSA 2004 Ottawa Ottawa Cardiac Arrests 2004 Increase survival … what to do?? • Targeted increase fire tiered response • Maximize police response • PAD locations ?? • Private PAD placement public places • Home defibrillation • Education re: AED application time • Strategic Targeted CPR Ottawa Base Hospital Dr. J. Maloney VSA 2004 Ottawa Strategic Targeted CPR Strategic • Use local stats in courses • Video • Web-based • Scenario based teaching Targeted • Families of cardiac patients • Seniors • Church CPR (Cardio Pulpit Resuscitation) • Nursing Homes Chronic care Ottawa Base Hospital Dr. J. Maloney VSA 2004 Ottawa Strategic Targeted CPR It is not enough to teach CPR You have to provide the key that “unlocks” them Something that will make them act Training • Answer questions • Use scenarios … when it really happens it should not be the first time they see it … help them see it ! Ottawa Base Hospital Dr. J. Maloney VSA 2004 Ottawa Your CPR Course Strategic Targeted CPR What’s the “GO” (Goals & Objectives) Teaching someone to • To recognize that chest pain may be cardiac • To recognize a stroke • To act … Call 911 will save more lives than “Thump and Blow” … and don’t forget teaching risk factors that is important too ! ! Ottawa Base Hospital Dr. J. Maloney VSA 2004 Ottawa Ottawa STEMI Base Hospital Paramedic Training • Fall 2000 - Intro ACP, ACS, ECG recognition • Spring 2001 - ACP ACLS • Spring 2002 - ECG recognition re-inforced • Fall 2002 - Intro Lytics • Spring 2003 - Lytics study • Fall 2003 - PCP ECG acqure, recognition • 2004 - heavy with STEMI • 2005 - heavy with STEMI Ottawa Base Hospital Dr. J. Maloney VSA 2004 Ottawa Ottawa STEMI Cardiac chest pain > 30 min, < 12 hours 12 Lead ECG ST elevation borderline or not clearly positive OR Evidence LBBB OR Pt is pre/post VSA ST elevation clearly > 1 mm in 2 contiguous limb leads OR ST elevation clearly > 2 mm in 2 contiguous precordial leads Ottawa Base Hospital Nearest ED Notify Heart Institute “Positve STEMI, ETA” Patient transported there directly Dr. J. Maloney VSA 2004 Ottawa Ottawa Stroke Bypass Within 2 hours of onset In Ottawa Has … a. GCS>12 b. Stable Airway (i.e. not requiring airway support) c. Vitals Signs BP>90, Heart Rate >60 and < 120 d. Blood Sugar reading ≥ 4.0 mmol/L e. Age ≥ 45 yrs. Does not have: a. Terminal illness (i.e. palliative care) b. Valid DNR c. History of seizures Ottawa Base Hospital Dr. J. Maloney VSA 2004 Ottawa Ottawa Stroke Bypass Has … • Difficulty speaking • Unilateral arm weakness • Facial Droop. Go directly to Ottawa Hospital General / Civic Ottawa Base Hospital Dr. J. Maloney