A city that’s residents love baseball has watched its high-profile CPR and AED program bat 1,000 during one week in July as citizens, lifeguards and EMS and fire crews teamed up to accomplish four AED saves out of four AED deployments in one week.
San Diego Project Heart Beat (SDPHB), the public-access defibrillation program of San Diego EMS, is seeing the results of what can happen when the community embraces this lifesaving technology.
The program, and its affiliated fire and EMS agencies throughout San Diego County, has helped place more than 6,000 AEDs throughout the county since its inception. SDPHB trained citizens in CPR and prominently announced and displayed each AED. Also, a staff member is sent to each AED deployment to immediately collect patient data and transfer it to the hospital.
On July 14, a 77-year-old male patient at San Diego International Airport collapsed in his vehicle parked curbside at the terminal. San Diego Harbor Police Department (SDHPD) officers were on patrol nearby and carefully removed the patient from his vehicle, initiated CPR and applied an AED. The AED administered one shock to the patient, who’s ironically a physician, and he had a return of spontaneous circulation (ROSC). San Diego airport has 22 AEDs strategically positioned throughout its terminals, and all SDHPD officers carry AEDs on their vehicles (and boats). SDHPD officers have been credited with saving multiple lives at the airport and the surrounding marina district.
On July 16, a 63-year-old male was found unresponsive and apneic on the sand after a day of surfing at Mission Beach, a popular San Diego waterfront recreation area. San Diego City Lifeguards, a division of San Diego Fire Rescue, immediately initiated CPR and applied an AED. One shock was administered, and the patient regained consciousness. He was initially combative post ROSC. He soon became conscious and alert and was able to converse with the EMS response crews on their arrival.
On July 19, a 65-year-old male was playing tennis at an outdoor court at the Rancho Bernardo Swim and Tennis Club and collapsed without warning. The tennis pro and the patient’s tennis partner immediately initiated CPR and applied an AED, which was retrieved from a nearby location. After the AED administered one shock, the patient regained consciousness and was alert and able to converse when EMS arrived on scene. This was the second life saved by an AED at this facility.
Then, on July 19, a 51-year-old male was playing basketball with his league and his sons at a City of San Diego Parks and Recreation center when he collapsed on the court. Two center employees immediately initiated CPR and applied a nearby AED. The AED delivered one shock prior to arrival of EMS. The patient was treated on scene and transferred to the emergency department (ED) with pulses and spontaneous respirations.
SDPHB staff members share call-back responsibilities on each of the San Diego Fire Rescue schedule shifts and are notified by the city’s dispatch center whenever an AED is deployed. They’re able to arrive on scene shortly after the patient is transported to the hospital. The SDPHB staff member then downloads the ECG information from the AED device, prints it out and delivers it to ED nurses and physicians. The ED staff finds this rapid receipt of patient’s initial rhythm and care extremely beneficial to the continuum of care.
SDPHB credits 87 lives as being saved through its program since its inception 10 years ago. For more on San Diego Project Heart Beat, go to www.sdprojectheartbeat.com.—Criss Brainard, EMT-P
Rehab Saves Lives & Reduces Liability
If you’ve ever belonged to a service for which firefighter rehabilitation wasn’t the norm, you’ve probably heard moans and groans from the firefighters who were forced to go to on-scene rehab. Many firefighters don’t like having their temperatures checked and vitals taken, or being asked, “How are you feeling?” at the scene of the big fire. However, as Bob Dylan once sang, “The times they are a changin’.”
In 2008, the National Fire Protection Association (NFPA) introduced the second edition of the NFPA 1584 Standard on the Rehabilitation Process for Members During Emergency Operations and Training Exercises. Overnight, firefighter rehabilitation went from being merely a “recommended” practice to a standard. The minor change in terminology from recommended practices to “standard” vastly changed the importance of complying with NFPA 1584.
Rehab, as it’s commonly called, provides rest, fluids and medical evaluation for firefighters who have worked for extended periods of time. The goal of rehab operations and NFPA 1584 is to reduce the number of deaths and injuries of firefighters at emergency scenes and training sessions. Chapter 1 of NFPA 1584 explains, “When emergency responders become fatigued, their ability to operate safely is impaired. As a result, their reaction time is reduced, and their ability to make critical decisions diminishes. Rehabilitation is an essential element on the incident scene to prevent more serious conditions, such as heat exhaustion or heat stroke, from occurring.”
“Standards” demonstrate the industry’s general custom and basic practice. Normally, standards aren’t laws, but the NFPA standards have been widely used in civil litigation. They’re built from a nationwide consensus of a practice. Therefore, the NFPA rehab standard could help describe to a jury what reasonable firefighters or practitioners would have done in similar circumstances. And if standards aren’t followed, a court may find that the fire department wasn’t acting reasonably and could be found negligent (and, consequently, award damages to the person suing the fire department). Clearly, the NFPA standard “raises the bar” for all fire rescue organizations to ensure they have a rehab program in place.
Some states have adopted the NFPA standard into their statewide EMS or firefighter protocols. Some states will impose fines and take other actions against an organization if they don’t follow proper rehab protocols. It’s important to determine whether your state has specific rehab requirements.
A key to effective rehab is giving authority to rehab personnel to remove a person from active duty if they feel it’s medically necessary. This is similar to the role of the safety officer, who shuts down an operation that’s unsafe. Clearly, this may cause issues in some organizations. However, the liability that can ensue from knowingly allowing a firefighter in poor physical condition to re-enter active duty isn’t a risk worth taking.
Beyond the legal reasons to follow the standard, rehab saves lives. Countless studies tell us overstressing firefighters leads to on-duty casualties. If providing adequate rehab for firefighters can help mitigate the risk of cardiac events, strokes, heat exposure and other ailments, then don’t we have the ethical duty to do so? At this point, we may also have a legal duty to do so. JEMS
Pro Bono is written by attorneys Doug Wolfberg and Steve Wirth of Page, Wolfberg & Wirth LLC, a national EMS-industry law firm. Visit the firm’s Web site at www.pwwemslaw.com for more EMS law information.
Australia, New Zealand and Canada are developing extended-care paramedics (ECP) programs. New South Wales, Australia, has been using ECPs for three years, and during that time, they’ve averted 10,000 visits to hospital emergency departments. After six months of trials, South Australian Ambulance Service is now using ECPs.
In South Australia, emergency calls are screened for possible ECP response. When appropriate, EMS responds in a quick-response vehicle, rather than an ambulance. Typical cases in which an ECP would cover are wound care, pain management, palliative care, chest infections, dehydration, confirmed migraine, confusion, dizziness and lethargy.
Victoria, Australia, also wants to start an ECP program. Ambulance Employees Association Victoria General Secretary Steve McGhie says, “We would like to see either an extension of scope of practice for paramedics in total or have specialized paramedics doing it. I don’t think it would cost much to train a group of paramedics to trial this, but the stumbling block will be both government and the ambulance service will not wish to pay additional wages to the people providing this service.”
What started out as a simple gesture of caring—handing out bottled water to people working outside in the summer heat of Kanawha County, W.Va.—became Operation Hydration a couple of years ago. Mike Jarrett, EMT-B, public information officer and chaplain at the Kanawha County Ambulance Authority, credits County Commission President Kent Carper with the name.
“Kent is a former EMT, so he understands us,” says Jarrett. “Medics love to support their community.”
County ambulances are stocked with bottled water to pass out to construction workers and other community members whose jobs are outdoors. They also make sure the volunteer departments in the county have water supplies. When the county ambulance crews work special events, such as the Special Olympics, they “go through the crowd handing out sunscreen and water,” says Jarrett. “We provide preventive EMS.”
The area was hard hit by the heat wave much of the country suffered through this summer. When Jarrett was asked how much water they had handed out, he started counting bottles in a case and the number of cases on a pallet but gave up trying to figure it out. Suffice it to say, Kanawha County Ambulance Authority quenched a lot of thirst.
This article originally appeared in September 2011 JEMS as “Four Saves, One Week: San Diego Project Heart Beat program sees results.”
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