Strive to Revive! Translating Science to Survival The HEARTSafe Community Concept
A Lifesaving InnovationDavid B. Hiltz
Consultant-AdvocateTeam HEARTSafe
No relevant financial relationship(s) exist.
Presenter Disclosure Information
Often it "takes a village" and indeed the entire community to make a significant difference! Hear how the HEARTSafe Community concept is designed to promote survival from sudden out-of-hospital cardiac arrest by recognizing and
stimulating efforts by individual communities to improve their cardiac arrest system of care.
Community Based Strategy
WHERE YOU LIVE SHOULD NOT DETERMINE IF YOU LIVE!
Who Could Disagree?
The System is (fill in the blank)!
A “Wicked” Problem!
Gizmos and Technology Will Save Us?
Pharmaceutical Agents?
Or a Coordinated and Community Based Strategy?
HEARTSafe is a public health initiative intended to help more people survive after sudden out-of-hospital cardiac arrest. When someone’s heart suddenly
stops, they will generally not survive unless a number of interventions take place immediately, including CPR and defibrillation. In order to facilitate this process, a strong system must be established to ensure the rapid execution of each step.
The HEARTSafe Community concept works by creating criteria that support this “cardiac chain of survival” and encouraging communities to work toward them.
HEARTSafe
Common Elements
In the basic HEARTSafe model, a region (generally a US state, but county-based and international programs
also exist) establishes a set of minimum criteria its communities must meet in order to achieve
HEARTSafe status.
The Premise…
Analogy?
These should be goals that support the chain of survival, such as widespread CPR instruction, public access defibrillators, and aggressive resuscitation protocols for first responders and area hospitals. Individual communities in each region which meet the
established criteria—such as cities, towns, counties, even neighborhoods or campuses—can apply to their home office and become designated as a HEARTSafe Community.
Street signs proclaiming this status are usually posted at the edge of town. If a community does not meet minimum criteria, it can take steps to work toward compliance
and eventually earn accreditation.
HEARTSafe Goals
Survival Envy vs. Sign Envy…
Each state or regional program is managed independently, designates its own criteria, and answers to no external arbiter. For assistance and advice, there is a strong community of peer support provided by existing program directors and advocates, but there is no central authority that certifies or
coordinates all HEARTSafe communities; in any given area, the certifying authority is merely whichever regional agency that has been chosen to
administer the program.
Who is in Charge?
sus-tain-a-ble adjective
1. capable of being supported or upheld, as by having its weight borne from below.
2. pertaining to a system that maintains its own viability by using techniques that allow for continual reuse: "sustainable agriculture. Aquaculture is a sustainable alternative to overfishing."
3. able to be maintained or kept going, as an action or process: "a sustainable negotiation between the two countries."
4. able to be confirmed or upheld:"a sustainable decision."
5. able to be supported as with the basic necessities or sufficient funds: "a sustainable life."
EMSFIRE
HEALTH DEPT
POLICE DEPT
EMA DIR
HOSPITAL(S)
CHAMPIONS CITIZENS
WHO ELSE?
Improving systems for cardiac arrest care requires widespread change, and this isn’t possible without
many parties committing to the cause.
Building Support
Two overlapping groups will need to be courted: individuals in positions of power, and the general public. Although it may be possible to make
progress with buy-in from only one of these parties, movers and shakers are more likely to listen when there’s a groundswell of support behind you, and likewise the public can only accomplish so much without the
implementation of top-down initiatives.
Building Support
In some cases, it may be effective to approach the decision-makers early, establish the HEARTSafe criteria and accreditation process, and then seek
out local support once you can point to a concrete incentive. But more often, SCA system improvement begins at the grass-roots level, with at least partial
community buy-in—when one community or a portion of a community has made good progress, and local champions want to expand this progress
across the map.
Building Support
Public support can be effected through media campaigns, and many areas have had success using low-budget guerilla methods, such as social media (Facebook groups,
Twitter accounts, and so forth). Local newspapers and television stations are often interested in reporting on large-scale CPR classes (for instance, 20-minute CPR Anytime
courses for entire gymnasiums or stadiums full of people at a time), or human interest stories about recent cardiac arrest “saves”; this type of coverage can serve as free
publicity and help spread your message. As budget allows, paid public service announcements can also be run in local TV, newspapers, billboards, or other venues.
Building Support
Under whose auspices will your new HEARTSafe program be administered? Most commonly in the US, this is organized at the state level (through the Department of Public Health or similar bureau with the appropriate authority). County-based programs also exist, and a few national
programs have been instituted in Ireland, New Zealand, and Taiwan.In general, it’s wise to aim as large as you think you can succeed with. If a county program is the
best that seems feasible, then create a county program, but if you can found a new statewide program, go big! It’ll mean the system is available to more people in more areas.
Aiming at the Target
Most regional governments have the stated goal of improving public health among their constituents, and have an infrastructure in place for facilitating this. Programs like HEARTSafe probably already exist—just not for sudden cardiac arrest. You merely need to convince the powers-that-be that SCA is a real concern (statistics can support you
here) which is worth their time and money to address.
Aiming at the Target
Fortunately, establishing a HEARTSafe template and accreditation system typically requires almost no money spent by the central office, just a bit of time to write down the rules and determine which existing
staff will manage the process. Any financial outlay generally comes from the community itself, such as the businesses who need to purchase AEDs or host CPR classes.
Aiming at the Target
Every community is different, and the obstacles to a strong chain of survival are unique everywhere. Consider the common
elements of a program, then look at your existing community. What are you currently working with, and what needs to be
changed or added to strengthen your system?
Analyze Your Situation
What is the availability of EMS around your community? Are there areas in which response
times are frequently prolonged?
Analyze Your Situation-Consider Factors…
How many hospitals do you have available to you, and how distant are they? Can they provide therapeutic
hypothermia and emergency PCI?
Analyze Your Situation-Consider Factors…
Do you want your program to include support for supplemental stand-alone public health measures
such as stroke and STEMI care, or to exclusively focus on cardiac arrest?
Analyze Your Situation-Consider Factors…
If your community collects statistics on sudden cardiac arrest, perusing them can help you to understand where you’re coming from. Is your survival rate already fairly good, and you’re simply trying to polish it a bit and fill a few gaps? Is it quite poor, in which case many elements of your chain of survival may need substantial overhaul? Can you pin down specific neighborhoods or
areas that experience unusually high numbers of arrests, or whose proportional survival from arrest is particularly poor? How often is bystander CPR or defibrillation performed? What are typical
response times for EMS? (Depending on the quality of your statistics, you may be able to answer all or none of these questions, and that will reinforce the importance of gathering this type of data in
the future!)
Critical Question!
One of the key pieces of any HEARTSafe program is to collect data and track progress. This is typically done with cooperation from the local EMS agency and their destination hospitals. When an effective system for gathering statistics is in place, it allows you to track the results of your changes. You can determine what’s working, what isn’t, where you need to focus further efforts—and when it all goes well, it provides motivation by revealing the improving numbers resulting from your hard work. Nearly every existing HEARTSafe system includes a requirement that communities establish a system of
data-collection, feedback, and mechanisms for ongoing change.
Tracking Changes
No studies have specifically attempted to demonstrate improved survival after instituting an explicit HEARTSafe program in a community.
However, when considering criteria for a new program, we do recommend that requirements should be based on scientifically-supported measures, such as increased bystander CPR,
early access to defibrillators, and post-ROSC care. In addition, the general model of community-level efforts to strengthen the chain of survival
has been successful (e.g. in Arizona and Wake County, NC) and is supported by expert recommendations.
Where is the EVIDENCE?
WHERE DO WE GO WHERE DO WE GO FROM HERE?FROM HERE?
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