Heart Safe Community ECCU 2006
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Translating Science into Action: Using Population and Criteria-based Incentive Programs to Advance Systems Change and Chain of Survival Priorities
David B. Hiltz, NREMT-PAmerican Heart Association
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Conflict of Interest Disclosure
• Commercial/industry– Full-time employment by the American Heart
Association
• Potential intellectual conflicts– Full-time employment by the American Heart
Association
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Objectives
• Discuss the rationale for addressing acute event and SCA
• Visit current recommendations regarding acute event and SCA
• Review the history of HEARTSafe
• Discuss adapting HEARTSafe to address system change and COS priorities
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BIG Issues
• CVD-SCA is number one killer
• 220,000 to 335,00 OOH SCA each year
• 70-80% occur in/around home
• 95% death rate
• Not a reportable cause of death:
National Center for Vital Statistics
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Other Issues
• VERY few get bystander CPR
• Fewer get good CPR
• Less than one-third of kids get CPR before EMS
• Large numbers of
people will die this
year from SCA
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Recommendations
• “Community Coronary Care Units”• Organized response to emergencies• EMD• Citizen CPR• Early defibrillation• Effective BLS and ACLS • Early detection of ACS• Early definitive intervention
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Lay responder defibrillation significantly increases
survival after cardiac arrest if the program is able to
defibrillate prior to EMS arrival and the PAD
emergency response plan is effectively
implemented and sustained.
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Translating Science Into Action
• We have evidence based guidelines
• We have excellent training programs
• We have top notch instructors
• “Top down” strategies DO NOT WORK
• Local situations
require local solutions
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Changing Behavior
• Commercial marketing expensive and often ineffective
• Social marketing experience is good
• Incentive change methods offer a less expensive option
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Disclaimer
• This presentation will discuss incentivizing and guiding implementation of strategies to save lives.
• The intent HEARTSafe is to permit the evolution of funding sources at the community level.
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Emergency Medical Care Advisory Board –EMCAB-
• The board advises the DPH/OEMS on the development of EMS policy
• Established by statute• Appointed by Commissioner• Key stakeholders
GENERAL LAWS OF MASSACHUSETTSChapter 111C: Section 13 EMS system advisory board; membership;duties; advisory committees
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HEARTSafe History
Howard Koh, MD,MPh Former Public Health CommissionerNow Director , Division of Public Health PracticeHarvard University
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Charge by Koh to PIER Committee of EMCAB
“Develop a program to increase awareness regarding CPR and early defibrillation and improve survival in all communities”
No problem!
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Oh…and no, there isn’t any funding
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~Jerry Garcia of the Grateful Dead
“Somebody has to do something, and it’s
just incredibly pathetic that it has
to be us.”
Mike and David
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Mike and David
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HEARTSafe Community
A population and criteria based incentive program designed to advance systems change and chain of survival priorities.
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HEARTSafe Community
Get credit or earn points in the form of Heartbeats for specific activities relating to the designed criteria.
The number of Heartbeats required is specific to both the activity and the population base.
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Population Based
• Up to 5,000 population: 40 heartbeats
• 5,001 – 30,000 population: 50 heartbeats
• 30,001 – 50,000 population: 60 heartbeats
• 50,001 – 100,000 population: 70 heartbeats
• 100,001 – 150,000 population:80 heartbeats
• 150,001 population or more: 90 heartbeats
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Criteria Based
• Conduct community CPR training sessions.• All EMS first response-designated vehicles*
have been equipped with AEDs • Placement of a permanent AED with AED-
trained personnel in public or private areas • Advanced Cardiac Life Support (paramedics) * • An ongoing process to evaluate and improve the
“Chain of Survival”in the community.
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HEARTSafe Community
Is NOT limited to promoting AEDS!
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“Heartbeats”
Core to HEARTSafe
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HEARTSafe Incentives
Bragging rights!
HEARTSafe Community
Massachusetts Department of Public HealthOffice of Emergency Medical Services
Presented this _______day of _______in the year_______
In recognition of the community efforts to improve survival from sudden cardiac arrest and for meeting the criteria to be
designated aHEARTSafe Community.
Commissioner, Department of Public Health
HEARTSafe Community
Massachusetts Department of Public HealthOffice of Emergency Medical Services
Presented this _______day of _______in the year_______
In recognition of the community efforts to improve survival from sudden cardiac arrest and for meeting the criteria to be
designated aHEARTSafe Community.
Commissioner, Department of Public Health
HEART Safe
Community®
Mass. Dept of Public Health
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Initial Funding
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Promotion
• Announced at Statewide EMS Summit
• Strategic alliances
• Roadside signs
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Program Operations- Launch
• Letter and worksheet
• Direct mail campaign to municipal leaders
• Media Advisory
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Process
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Process
Self tabulation-requires communication
across lines
• Inventory current achievements
• Launch strategies to meet criteria
• Submit to DPH OEMS and Regional EMS
• Schedule designation
• Notify AHA
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HEARTSafe Designation Events
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The Partnership for a Heart Healthy and Stroke Free Massachusetts
• A coalition of more than 100 organizations and agencies (est. 2001)
• Funding from the U.S. Centers for Disease Control and Prevention
• Devise strategies to reduce illness and death related to heart disease and stroke among Massachusetts residents
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±0 10 20 30 405Miles
HeartSafe Communities
Towns
Coast
County Boundaries
State Boundary
Region Boundary
One Hundred and Forty-Four Massachusetts HEARTSafe Communities
Region 3
SUFFOLK
PLYMOUTH
DUKES
as of May 19th, 2006
Region 4
Region 2Region 1
BERKSHIRE
WORCESTER
FRANKLIN
HAMPSHIRE
HAMPDEN
NORFOLK
MIDDLESEX
ESSEX
BRISTOL
by Emergency Medical Service Regions and Counties
Region 5
BARNSTABLE
NANTUCKET
HEARTSafe Community Designation requires that a Community VIGOROUSLY support community training inCPR and strategic public placement of AEDs for trained users
Source: Massachusetts Office of Emergency Medical Services, May 19, 2006
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Unique Designations
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Unique Designations
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Pending Designations
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Unique Request
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Promotion at ECCU
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Outside of MA
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Connecticut
“We looked at the program and saw it as an excellent way to promote awareness of the signs and symptoms of heart attacks and to improve the systems response to incidents.”
Gary St. Amand Health Program Associate
State of Connecticut Dept. of Public HealthHeart Disease and Stroke Prevention Program
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Connecticut
“Strategic placement of AEDs and larger numbers of people trained in CPR increases the survival rate for cardiac arrest patients.”
“We would like to see all 169 of Connecticut’s municipalities strive to adopt the HEARTSafe Community designation.”
J. Robert Galvin, M.D., M.P.H. DPH Commissioner
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HEARTSafe RI
Increase:• number of lay bystanders trained in CPR • number of First Responders who are
equipped with AEDs• ensure appropriate pre-arrival instructions• improve the performance of our prehospital care
system
and make a lifesaving difference.
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HEARTSafe RI Lifesaving Potential
Location Estimated SCA Frequency Lives Saved at Current Survival Rate – 5%
Goal – Lives Saved at 20% Survival Rate
Rhode Island 1000 50 200
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RI Recommendations
• Systems reviewed
• Discussion
• Revisions
• Consensus
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RI Recommendations
• Organization
• EMD
• CPR
• AED
• LEA-D
• 12 Lead ECG
• ACLS
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HEARTSafe RI PSA
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Inside RI
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Proposed Support from the AHA
Project implementation staff, volunteers and support.
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Proposed Support from RI DOH
• Endorsement of program
• Use of the RI DOH stylized name and logo
• DOH staff and resources for program implementation <0.05 FTE?
• Funding for HeartSafe signs in the amount of $1,200$15.50 to $16.00/sign (delivery and initial art charges included).
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HEARTSafe Review Process
Completed HeartSafe applications are sent to the RI DOH
Applications are reviewed for completeness by RI DOH
Applications are reviewed for content by RI DOH using a special panel appointed by the Director (Division of EMS staff member, ASAB members [2], AHA ECC staff member, and AHA ECC Committee member)
Determine Disposition No recommendation for Designation
Notification and guidance
for applicant
Recommendation for Designation
Community notified of successful designation by RI DOH
Designation event scheduled
AHA prepares paper plaque
Community orders signs if desired
AHA prepares media advisory and distributes to media contacts asneeded. (Additional communications activities as needed)
Designation
Data entry into RIDOH system
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Benefits
• Low cost mechanism for the advancement of efforts to reduce disability and death from SCA and other cardiovascular emergencies.
• Improved dialog with community leaders and stakeholders.
• Visibility for the DOH/DPH at the community level across State.
• Use a previously and proven program.• Platform for other DOH/DPH efforts and
programs.
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Where is the DATA?
• We are certain that this is changing behavior
• NEMSIS data set implementation will provide additional insight and validation
• Until then, we believe that the absence of hard data should not stand in the way of a perfectly good idea!
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So David, How Can We Do This?
• Identify what the issues are, or more appropriately design the collective vision for YOUR ultimate community based coronary care unit.
• Use existing resources to package.
• Form alliance with your State or local board of health.
• JUST DO IT!
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Not Always So Easy!
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HeartSafe Materials
http://www.mari-ecc.org/
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Where Can We Go From Here?