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Beating Heart for Survival


View a video interview with David Hiltz below this article.

You might say that David Hiltz, NREMT-P, has heart. A lot of heart. In fact, he played a significant role in conceiving, developing and promoting the HEARTSafe Communities program because he cares so much about other people’s hearts.

“I consider myself to be the champion or steward of HEARTSafe Communities,” says Hiltz, public safety account manager for the American Heart Association’s National ECC Programs. “But there are countless HEARTSafe heroes out there.”

The HEARTSafe program is a population and criteria-based incentive program designed to advance systems change along the Chain of Survival, which has four critical steps: early access to emergency care, early CPR, early defibrillation and early advanced care. The primary goal is to increase survival rates from out-of-hospital cardiac arrest. Individual communities are asked to develop and implement lifesaving strategies that focus on coordinating local resources to prevent sudden cardiac arrest from becoming sudden cardiac death.

Starting on a Shoestring to Influence a Nation
“We started with $3,000 in funding, and since that time, more than 50% of communities in Massachusetts are now HEARTSafe designated,” says Hiltz. With Massachusetts holding the distinction of inaugural state, Maryland launched its own HEARTSafe program, followed by Maine, Connecticut, New York, New Hampshire and Rhode Island. “There are programs on the West Coast, as well,” says Hiltz.

Each state is asked to design its own criteria on the basis of its population, system and geographic needs. Cities and towns get points for training certain numbers of residents in CPR. They get credit for having public access to defibrillation programs in schools and municipal buildings, and for having ALS response capability and other enhancements in the community.

“They also get points for having an ongoing plan for improving their chain of survival,” says Hiltz, who’s been in healthcare for more than 25 years.

Meeting the criteria and achieving a HEARTSafe designation signifies that the community has taken a comprehensive approach in ensuring it is HEARTSafe. Meeting the criteria also provides further opportunities to enhance community partnerships, resources and services to improve cardiovascular health and decrease deaths due to sudden cardiac arrest, heart attack and stroke.

The idea of HEARTSafe first came out of a group called the Public Information & Education Resource Committee, a group that works with the Emergency Medical Care Advisory Board in Massachusetts, which was charged with finding better ways for communities to improve response care and outcomes for patients having a heart attack or sudden cardiac event.

“The Commissioner of Public Health at the time asked us to design, develop and launch a program that would encourage citizen CPR and the development of early defibrillation strategies and improve survival in the cities and towns across Massachusetts,” says Hiltz. “The group came up with criteria, designed some traffic grade road signs, put together a rudimentary packet of information and a letter signed by the Commissioner, and mailed it to all of the chief elected officials in 351 cities and towns in Massachusetts.”

Communities around the state picked up the concept. Realtors began using the HEARTSafe designation as a selling point to potential buyers. The program is scaled so communities both large and small will have goals to work toward. “We adjusted the heartbeat points, so if you were in a community of 10,000, you’d have to train more people in CPR to get the required point threshold, in contrast to a community of 1,000,” Hiltz says.

The response to HEARTSafe continues to be enthusiastic.

Connecticut, which launched its program in 2006, has had 64 communities achieve designation, covering a population of more than 1.5 million people. Massachusetts, which got started in 2002, has 183 designated cities and towns, covering 4.4 million people. “Maine has 261 communities, New Hampshire has covered 174,000 people, and Rhode Island has 110,000 people covered,” says Hiltz.

Considering the Options
Those considering developing a HEARTSafe Community should familiarize themselves with existing programs and look to these groups for guidance. The American Heart Association (www.heart.org/cpr) has a wide variety of policy and scientific statements, products and services to support the creation of HEARTSafe Communities. HEARTSafe can also be found on Facebook.

As much as a new community would like to cut and paste from another existing program, Hiltz says, “While there are a lot of commonalities, there are a lot of subtle nuances from state to state.”

Hiltz encourages communities to specifically pinpoint what’s getting in the way of people surviving sudden cardiac arrest and then come up with specific solutions that address those obstacles. “Then use that as your HEARTSafe criteria
to help mobilize your community,” he says.

“Local situations deserve local solutions. So do what’s necessary to develop an optimal response and care strategy for your community.  By sitting down and customizing a program and making it your own, you’ll end up with a much better result.”

Hiltz adds, “Evidence has demonstrated that primary and secondary prevention is incredibly important in helping people stay healthy. At the same time, EMS and the resuscitation community are responsible for building and maintaining the safety net that catches people who fall through the prevention cracks.”

A Personal Quest
More than just an organizational initiative, the HEARTSafe Communities program is a personal mission for Hiltz.

“We get mired in statistics, but however many people we are talking about, whether it’s a million or 200,000, it’s not just a number,” he says. “We’re talking about mothers, fathers, brothers, sisters, our children and valued members of our community.” And he doesn’t want them to die prematurely from something preventable.

“You read these stories about these adolescents who were pre­viously healthy, four-season jocks, who collapse on the practice field in cardiac arrest,” he says. “There are a significant number of people whose hearts are too young to die, and I think that’s where HEARTSafe makes a huge difference. We help avert a preventable death from sudden cardiac arrest.”

Many of these people today fall into two categories, Hiltz says. One is the tragic category of a young person who is unable to be resuscitated. The other category, and one growing in size, is the story of triumph.

“That’s the story of a young person whose heart was too young to die, and a community response was initiated, and everything went right, and that person was able to go back to their pre-event status and live a long and meaningful life,” says Hiltz. This is the ultimate goal that HEARTSafe Communities aim for every time.

“Being in the presence of friends and family who have lost a young son or daughter tears the heart right out of your chest,” he adds. “I’d do anything to help others avoid that tragic circumstance and story.”

Hiltz acknowledges that heart health is a complicated issue with many moving parts. To fully understand its complexity requires education, teamwork, compassion and a continuing understanding of the many changing factors surrounding heart health in general.

“We used to think that heart disease was predominantly a male problem, but that’s not true anymore,” he says. “It’s very much a woman’s health problem, and it’s been ignored.” Hiltz hopes to see things like that change.

Being in the heart business, he’s witnessed a lot of pain he’d like to see others avoid. He believes the HEARTSafe Communities program can offer such an avenue.

“We’d like to afford more people the maximum opportunity to survive such an event, particularly when we know they can survive,” he says. “As grave as cardiac arrest may seem, in many cases, it’s highly treatable, but it’s time sensitive.

“Once you put your arm around somebody who was involved in a story of triumph, it’s extremely rewarding,” he says. “To know that a person who, for all intents and purposes was dead, is now alive and spending time with their families doing worthwhile things is absolutely priceless.”

Please view the interview with David Hiltz that took place at EMS Today.


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