Early Defibrillation
The Secrets of Our Success
- Response time
- Response time
- Response time
This is a bit of a tongue-in-cheek oversimplification but it does emphasize the critical component of effective defibrillation. Without a prompt response there isn't much point in doing this. The Rochester Police Department is determined to do everything that can reasonably be done to assure a prompt response to cardiac arrests. Every minute that the response is delayed reduces the odds of survival by 10%. A delay of six seconds reduces the chances of survival by 1%.
We also have a very aggressive continuous improvement process. Every single defibrillation attempt is critically reviewed by our medical director. If he spots a flaw in our response then we address it promptly. We are always vigilant for possibile improvements in our policies, procedures and training. We are aware that the prime enemy of being great is being good. Sitting back and becoming complacent can be deadly. We don't permit that. We're determined to be great - and to bring others along with us.
So what have we done or are we doing to reduce response times?
- We have emphasized the importance of a timely response to all of our personnel. All of our officers and dispatchers know the value of a single minute as it relates to survival of the patient.
- Strict dispatch protocols reinforce the absolute priority of cardiac arrest calls.
- Dispatchers use special radio alert tones. These tones are distinctive, obnoxious tones that grab the attention of all officers. The use of these tones is restricted to life-threatening emergencies only. When these tones are heard, everyone knows something serious is occurring even if they are unable to hear the details of the voice broadcast due to background noise in the field. While the dispatchers do their best to track the units using a computer aided dispatch system, sometimes the officers know better who can free themselves from other calls. This enables the officers to make decisions to respond which may override the dispatchers original assignment(s) and result in a swifter response to the call.
- The Rochester Police Department does use mobile computers to dispatch calls but all life-threatening calls are also voice dispatched to insure immediate receipt and confirmation of the call by responding officers.
- We have maintained control over the incoming 9-1-1 calls. Our communications are highly centralized. Our dispatchers do not relinquish control of any call until we know what is wrong and where the patient is located.
- We have added the Rochester Fire Department into the standard EMS response. If police officers are too busy or out of position, the Rochester Fire Department will back us up.
- We have installed emergency vehicle traffic signal pre-emption equipment in nearly every traffic signal in the city. This equipment is designed to help emergency vehicle drivers get through traffic by pre-empting the normal traffic signal cycles to favor the emergency vehicles. Some cities have reported response time improvements approaching 25% (Houston, TX and Denver, CO) along with substantial reductions in emergency vehicle-related accidents as well (St. Paul, MN).
- We've installed automatic vehicle location equipment in all marked squad cars and fire rigs. This helps the dispatchers insure that they are assigning the units closest to the emergency.
What have others tried to improve response times?
Motorcycles are used by paramedics in Sydney Australia. Motorcycles can be useful in cutting through heavy, congested traffic. Motorcycles can easily carry defibrillators. Many police departments in temperate climates can make good use of motorcycles. Unfortunately the value of motorcycles in Minnesnowta is somewhat limited.
Public access defibrillation. The HeartSave Program at Chicago O’Hare International Airport is an excellent example of this. Defibrillators are located in kiosks throughout the terminal. They may be used by anyone – they are as accessible as fire extinguishers. Removing an AED from its case will set off an alarm which summons immediate medical backup assistance as well. This program saved six lives within two months of implementation. Airports across the U.S. are now duplicating the HeartSave Program concept.
Numerous public facilities are beginning to implement public access defibrillation programs as well. Public access defibrillation programs may be important to consider in situations that might hamper or delay the arrival of professional emergency medical assistance. Such circumstances might arise in:
- Airlines (most US carriers now have AEDs)
- Amusement parks
- Athletic clubs
- Correctional facilities
- Factories or complex industrial sites
- Golf courses
- High-rise housing – especially those serving seniors
- High-rise office buildings
- Hotels
- Large amusement parks
- Secure facilities where EMS response might be delayed
- Schools
- Shopping Centers
- Stadiums
- Universities
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