CPR and PAD

Cardiopulmonary Resuscitation (CPR)

The Pinewood Fire Department in conjunction with UPFF local 1505 provides CPR training once a month from June through Sept.

Heart attack, drowning, electric shock, and other problems may cause a person’s heart to stop pumping blood. Studies show that effective CPR right away improves survival from cardiac arrest. You never know when you might need to use these skills you learn from this course on one of your loved ones. You can make a difference!

 Sadly 70 percent of Americans feel helpless to act during a cardiac emergency because they either do not know how to administer CPR or their training has significantly lapsed. As much as 88 percent of cardiac arrests are witnessed by family members. The Pinewood Fire Department will help teach you what you need to know to help save a loved one’s life.

The Pinewood Fire Department teaches “Hands-only CPR” which consists only of compressions. Hands-only CPR gives patients the best chance of survival, by keeping the blood moving until professional help arrives. Anyone can learn CPR and everyone should! We teach all ages so don’t hesitate to sign up.

To learn more about Hands-Only CPR visit azshare.gov/info4public

The Heart saver course will provide the general public with the hands on training and confidence you’re looking for in a CPR class. All classes are taught by certified CPR instructors that are full time Pinewood Fire Department firefighters

This is a free course offered to all members of the community and lasts about 2 to 3 hours. If you would like a healthcare provider card the cost is $5.00

 The Pinewood Fire Department has implemented a program in the community called the PAD (Public Access Defibrillation). The goal of this PAD system is delivering an early electrical counter shock to primary ventricular fibrillation victims, training is key and response of personnel is imperative.

 Through review and evaluation of our community we have asked all the businesses throughout the community to buy and place an AED inside their business that is easily accessible to the community.  Through the extension of modern technology, training, and immediate service delivery, our community has the unique opportunity to impact citizen mortality due to sudden cardiac death.

A community P.A.D. equipment program, coupled with the massive effort to train the largest number of citizens possible in CPR and defibrillation intervention, will provide that needed first responder capability, insuring that a higher percentage of victims of this deadly disease will walk out of the hospital to resume their lives as fully productive citizens in our community.

Public Access Defibrillation Program (P.A.D.)

Overview

As the 1990’s arrived, the medical community came to the realization that early defibrillation was the primary saver of lives during sudden cardiac death.  This was due to primary ventricular fibrillation as being the most common cause of this life threatening disorder.  As most of the EMS community was equipped with defibrillation devices, and had been since the early 70s, it was assumed that early defibrillation from responding EMS personnel was only effective part of the time (even with early and/or citizen CPR) due to delays occurring from response times.  At the same time, early in-hospital defibrillation (within 1 to 2 minutes) was effective almost 98% of the time.

Following this reasoning, several EMS product manufacturers began developing Semi-Automatic External Defibrillators (SAED) to allow earlier field access to defibrillation.  The rationale was, initially, to provide a device that required less training thereby enabling EMT level responders to deliver and use a defibrillator earlier.  As an extension of this concept, even earlier defibrillation was looked to as a better adjunct.

Enter the Public Access Defibrillation (PAD) program.  The Public Access Defibrillation program enables ordinary citizens without formal medical training the opportunity to provide the earliest defibrillation possible.  By placing SAED equipment in public places, defibrillators are almost immediately available to effectively treat the life threatening arrhythmia of ventricular fibrillation that is the most common cause of sudden cardiac death.

While each manufacturer has certain features that may be different from one another, the defibrillators all have the same basic operating system.  However, in keeping with the American Heart Association’s Advanced Cardiac Life Support (ACLS) algorhythms, a biphasic type of defibrillation has generally been recommended.  Another consideration in the search for the appropriate P.A.D. is the compatibility of equipment between the AED and the primary responding agency’s equipment.

Early defibrillation, while effective, can only provide the first step in the survival of a patient.  Unlike the movies and television, a patient almost never walks away from a sudden death event, and requires an extraordinary effort by EMS and hospital personnel to insure the successful release of a live, sentient human being.  In order for this transfer of patient care (and continuing increase in level of care); some compatibility between equipment is necessary.  The Pinewood Fire Department will be utilizing the Zoll M series 12 lead monitors to provide that higher level of care, and the counterpart to this piece of equipment is the Zoll AED Plus.  It is highly recommended that any AED purchases follow this compatibility to insure the best possible outcome for patient survival.

Defibrillator Access

In order to promote early access to the P.A.D. system, locations providing the easiest access to the largest number of potential defibrillation candidates is a must.  For this reason, simple demographic studies are imperative to determine defibrillator placement.  In most communities, at risk populations are diverse and widespread, and so the overall well being of the greatest number of citizens must be considered.  Even after initial placement options have been chosen, and devices have been placed, a continuous evaluation for need and use must be undertaken.

Large metropolitan areas generally place these devices in fixed locations where the greatest numbers of people congregate.  Airports, sports stadiums, and arenas tend to draw the largest number of people, and therefore from a demographic standpoint, the largest percentages of potential candidates for PAD use.  However, a case must be made for access to PAD systems through a mobile interface such as volunteers, public works personnel  and other civil servants that may be within 1 to 2 minutes of an event, and therefore able to deliver the needed rapid countershock early.

Pinewood is rather unique in both of these categories.  From the standpoint of large concentrations of people (as in stadiums, etc.), the only occupancy within our geographic area that would qualify would be the Munds Park RV Park.  This park is in private hands, has an onsite staff and with EMS training, automatic external defibrillators (AED) could be placed onsite.  While these defibrillators might not available for public access, they can be placed for early access through an extension of their workforce (EMS trained) and would be available in the 1 to 2 minute time frame established as necessary for a PAD environment to be successful.

Community placement of PAD units would have to provide access to the largest number of potential arrest victims, and would therefore have to be placed in high population areas.  The Country Club, local restaurants, gas stations, and the fire station are all potential candidates for placement of PAD devices.  Through the use of alarmed cabinets, these units could be retrieved and placed into service by the general public and employees of these facilities within 30 to 60 seconds of an event, potentially decreasing the mortality of our citizens and visitors considerably.  Since the highest level of saved sudden cardiac death patients occurs with early access to defibrillation, a “full-court press” should be initiated to insure that as many merchants and businesses in our town participate in purchasing their own AEDs as possible.  A media blitz and citizen-training program will have to be undertaken by the Pinewood Fire Department to mainstream the basics of P.A.D. and citizen CPR, thereby making these subjects a part of our everyday life.  This same program will raise the level of awareness concerning Heart Association risk factors and therefore decrease the overall incidence of heart disease and the related risk of sudden death.

There are times, however, that our community’s population swells to more than the norm and a PAD system would have to be flexible in its placement.  Special events held during the year draw visitors from outside our area, and placement of defibrillation equipment at strategic locations would enhance and expand the current EMS delivery system.  By placing PAD equipment at key locations that have been identified to trained personnel, and identified visually to knowledgeable bystanders, PAD equipment could be delivered and used within 30 to 60 seconds of a sudden death event.  It is for this reason that permanent locations would have to be augmented by the placement of temporary locations to accommodate special events needs.

To further enhance this special event delivery, the placement of AED in various service vehicles such as sanitary district, DPS, and Sheriff’s Office vehicles, would allow mobile and rapid deployment to the scene of a sudden cardiac death event.  These devices would normally be placed in service with trained employees on a routine to meet the needs of mobility in this program.  With the nature of their work, police officers or service oriented people are, many times, first onscene at medical events.  Because of their unique positioning (almost always in their vehicle and on the road), the moment the EMS system is activated for a probable cardiac arrest, they could be dispatched to initiate primary care faster than the in-place EMS delivery system.

PAD System Maintenance Requirements

The AED of choice for this PAD program would likely be the Zoll Medical Corporation AED Plus.  This AED utilizes a long life battery system (non-proprietary camera batteries) that does not require charging apparatus and provides up to 4 years of use prior to replacement.  Its size and weight (notebook sized and under four pounds) make it ideal for placement in an alarmed cabinet, placed into a car trunk, or easily assigned to be carried by events personnel.  Maintenance consists of regular automatic self-function checks, replacement of electrodes as they reach the end of their shelf life (every 4 years), and cleaning of the outside cases, all of which could be accomplished by personnel at regular intervals throughout the year.

PAD System Training

In order to accomplish the primary goal of the PAD system, that of delivering an early electrical countershock to primary ventricular fibrillation victims, training of key response and use personnel is imperative.  While the AED of choice requires almost no training to operate, to be most effective, training is still a necessity.  Permanent location employees, police officers and service personnel assigned to carry the device, and special event personnel would require initial familiarization and training, as well as continuing education.  In order to make the best use of these devices (earlier identification of need and more rapid delivery of countershock due to familiarity of equipment); training of regularly assigned employees is imperative.

Further extension of this program would include the training and certification of as many members of our community as possible.  Through an active citizen CPR program, the

Pinewood Fire Department and its various volunteer groups, would provide training in the use of the AED to ordinary citizens that may be thrust into action during a cardiac crisis.  This would increase our “depth on the bench” to include almost every interested citizen in the community, thereby allowing a large percent of our population to come on board with expanded life saving capabilities.

PAD System Review

Review and evaluation are critical in the extension of this form of service, particularly where members of the public may be asked to participate in a program involving this technical level of skill.  Through the use of the existing Pinewood Fire Department EMS delivery system, follow-up and review of the efficacy of our P.A.D. program can be tracked.  This tracking must include a performance review of the device, the morbidity and mortality figures associated with placement and use, and the level of training of the persons most frequently utilizing these devices.

Through this tracking and review, the PAD program can be evaluated concerning expansion, alternate placement of existing devices, and future training/purchase needs.  The Pinewood Fire Department will use our base medical director at Flagstaff MedicalCenter as our director for medical control in this project.  The participation of a third party hospital system will allow our department and community the flexibility of applying outside (non-political) review of a system that will require constant monitoring.

PAD Planning and Development

While this is a community-based program, the overall thrust of the PAD system follows the in-place EMS delivery system.  For this reason, the program, its planning, and development must be rooted within the Pinewood Fire Department and our affiliation with Flagstaff Medical Center.  Any program of this magnitude must have a sound management plan and direction, and through past experience, the use of well meaning but uninformed citizen committees tend to be counter-productive.  It is with this thought in mind that all management and coordination of this program must be conducted through the specialized emergency response system currently in place.

All placement issues, training (citizen, law enforcement and special needs groups), efficacy review and maintenance will be decided through the Pinewood Department.  As individual issues arise, they will be reviewed and dealt with through the EMS Section of the Pinewood Fire Department.

Equipment evaluation, maintenance, and care will be undertaken by the Pinewood Fire Department, and all training programs and training records will be maintained at the Pinewood Fire Department District office.  These records and demographics, as well as any documentation concerning AED use and the following patient care will be forwarded to our Medical Director at Flagstaff Medical Center for review.

Synopsis

Through the extension of modern technology, training, and immediate service delivery, our community has the unique opportunity to impact citizen mortality due to sudden cardiac death.  The infrastructure is already in place in our EMS delivery system to extend an expanded care role from our professional responders.  However, the first onscene citizen responders must have the training and equipment needed to impact this disease in a quick and timely fashion.  A community P.A.D. equipment program, coupled with a massive effort to train the largest number of citizens possible in CPR and defibrillation intervention, will provide that needed first responder capability, insuring that a higher percentage of victims of this deadly disease will walk out of the hospital to resume their lives as full and productive citizens in our community.