EMS: Courage and Compassion in Action: Protecting the 'Heart' of Our Community

By Shawn Godfrey
10:00AM / Monday, October 08, 2007

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Shawn Godfrey

Cardiovascular events, including sudden cardiac arrest (SCA) and heart attack can happen to anyone, anywhere, and at any time.

According to the American Heart Association, in the U.S. alone, approximately 340,000 people a year die as a result of coronary artery disease without being hospitalized or evaluated in an emergency department. That's about half of all deaths from coronary artery disease – more than 930 Americans each day. Most of these are sudden deaths caused by cardiac arrest or, in other words, unexpected heart stoppage.

Because of these overwhelming statistics, the Massachusetts Department of Public Health, through its Office of Emergency Medical Services, and the American Heart Association have partnered with cities and towns to improve cardiac arrest survivability through an endeavor called the "Heart Safe Community" program.

The recognition program is based on the "Chain of Survival," which is a globally-endorsed emergency response model developed by the Heart Association. This model encompasses four links: Early Access; Early CPR, or cardiopulmonary resuscitation; Early Defibrillation, and Early Advanced Care. Its purpose is to provide further opportunities to enhance community education, resources and services to improve cardiovascular care, and minimize deaths because of cardiovascular-related events, like SCA and heart attack.

For Massachusetts communities to earn the Heart Safe Community designation, they must meet four criteria:

1. Early access to emergency care
   - Bystanders recognize the symptoms of cardiac arrest and call 911 immediately.
   - Emergency medical dispatchers are equipped with instructions for the caller and can get an advanced life support response vehicle to the scene quickly.

2. Early CPR
   - CPR, when properly administered, buys precious minutes until a defibrillator is available.
   - Public knowledge and awareness must be increased so that those trained in CPR will actually use it when it is needed.

3. Early automated external defibrillation (AED)
  - Defibrillation is the delivery of electric shock to restore the heart's normal rhythm.
   - Early defibrillation is considered to be the most critical link in the chain of survival.
   - New AEDs are lightweight, sturdy, and easy to use by anyone who has been trained.
   - AEDs should only be used by individuals certified by defibrillation training programs that have medical oversight and are coordinated with emergency medical services.

4. Early advanced care
   - Advanced care is delivered by an advanced life support response vehicle staffed by paramedics.
  - Medications and oxygen therapy delivered by paramedics can be critical to the survival of cardiac arrest victims.

Those communities earning Heart Safe status proved by their rapid emergency medical service response, the level of CPR training in the community, the placement of AEDs at key public locations (schools, golf courses, churches and other municipal areas) and the creation of new cardiac programs at area hospitals that they were capable of meeting these criterion.

Putting it all Together

Luckily, for an elderly woman, Becket has been a Heart Safe Community since May 15, 2003.

According to Becket's emergency medical service director and EMT-intermediate, James Kupernik, on Sept. 27, a group of senior citizens were sitting down at a Town Hall-sponsored luncheon when one of the guests suddenly collapsed.

Witnesses said the victim, an 88-year-old woman, was apparently having lunch when she suddenly lost consciousness and stopped breathing.

Becket police officers trained in CPR and basic first aid, and fortunately stationed next door, were summoned to the scene. After arriving in less than a minute, the officers confirmed the victim was unresponsive, had no pulse and was not breathing.

Basic life support measures, including CPR, were immediately initiated by the police, while the town administrator and his secretary proceeded upstairs to retrieve the on-site AED.

After quickly returning with the AED, the device was immediately turned over to one of the officers already positioned at the victim's side.

An AED is programmed to tell rescuers exactly what to do using voice, text and character prompts. Rescuers attach adhesive electrode pads to the victim's chest. Through these electrodes, defibrillation delivers electrical energy to the heart to stop a lethal rhythm and allow the heart's normal rhythm to resume. Survivability decreases by 10 percent for every minute that passes without defibrillation. CPR prolongs the time a person can survive until a "shock" is delivered. It is statistically proven that an AED is so easy to use even untrained schoolchildren can operate one quickly and correctly.

After turning on the device and following the prompts, the officer applied the electrode pads to the victim’s torso then pressed the "Analyze" button (the built-in feature enables the device to quickly and precisely determine if a victim’s heart needs defibrillation).

After approximately five seconds, the machine detected a shock was indeed warranted.

Following the defibrillator's voice prompts and waiting for the machine to cycle to the appropriate energy level, the officer prepared to defibrillate the victim.

"Shock is advised. Stand clear," instructed the robotic voice from the AED's built-in speaker.

To avoid rescuer injury, the officer ensured everyone was clear from the victim then pressed the "Shock" button.

The electrical current was rapidly transferred through the electrode pads through the victim's body, causing a brief shudder of her arms and legs.

"Check pulse," commanded the device.

A second officer, positioned near the patient's neck, felt for the presence of a carotid pulse.

"She has a pulse!" shouted the officer.

A single shock from the AED brought the victim's heart back to a more stable rhythm.

By this time, a Becket ambulance staffed with two emergency medical technicians had arrived. The victim was administered oxygen, loaded on the cot and prepared for transportation to an emergency department.

After rendezvousing with an advanced life support ambulance and paramedics while in transit, the patient was subsequently turned over to the emergency department, where she was alert and talking.
The latest medical report indicated the victim is alive and doing well.

As demonstrated in the incident above, following the phases of the Heart Safe model gives anyone stricken by SCA the most optimal chance for survival.

Without timely CPR and early defibrillation, SCA is almost always fatal. The first person on the scene is often in the best position to provide effective life-saving treatment. Because of aggressive community education and training programs using the Heart Safe model, many citizens living in these communities are able to recognize the signs and symptoms of SCA and are prepared to take the necessary steps to help save lives.

Do You Live In a Heart Safe Community?

The following Massachusetts cities and towns have achieved Heart Safe Community Status:

Agawam
Becket
Belchertown
Bernardston
Chicopee
Dalton
Deerfield
East Longmeadow
Florida
Great Barrington
Greenfield
Lee
Lenox
Ludlow
New Marlborough
North Adams
Northfield
Pittsfield
Shelburne
Southwick
Springfield
West Springfield
Westfield
Wilbraham
Williamstown

For information on becoming a Heart Safe Community, please contact your state or regional emergency medical services office.

Sources:

American Heart Association, www.americanheart.org

Western Massachusetts Emergency Medical Services, www.wmems.org

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