1. 2016 In-Service Training This information will be tested during your skills evaluation.

2. 2016 In-Service Training Focused Performance Cardiac Arrest Where does it occur? 60-80% in the home 40-60% witnessed 20-30% bystander CPR 40-80% initial rhythm VF 5% overall survival to hospital discharge

3. 2016 In-Service Training Focused Performance Cardiac Arrest 1.1998: CFD Began first responder AED program 2.2002: Emphasis on compressions ROSC improved (28-40%) (Return of Spontaneous Circulation) 3.2007: STEMI Protocol 4.2009: Induced Hypothermia Protocol 5.2009: Cardiac CARES (Cardiac Arrest Registry to Enhance) Historical

4. 2016 In-Service Training Focused Performance Cardiac Arrest Improve outcome from cardiac arrest comes from Utstein Template for cardiac arrest reporting VF / VT arrest records Witnessed Arrest Bystander CPR

5. 2016 In-Service Training Focused Performance Cardiac Arrest 1.Improve outcome from cardiac arrest ROSC (Return of Spontaneous Circulation) National statistics: 4-5% Seattle, WA: 33% Charlotte, NC: 7/1/06 - 6/30/07 28.32% 7/1/07 - 6/30/08 28.30% 9/11/09 -1/31/11 68% (VF-VT arrest) 2010 - 40.9% 2011 - 40% 2012 -51.5% 2013 - 45.5% 2014-52%

6. 2016 In-Service Training Focused CPR Project Update Do not apply the AED if you do not intend to fully work the cardiac arrest on the patient. You must do a minimum of two (2) minutes of CPR on a cardiac arrest patient prior to applying the AED You must never base your decision on whether to work a patient based on what rhythm the AED shows The AED is to be only applied to patients who are pulseless and apneic.

7. 2016 In-Service Training Focused CPR Project Update The AED is not to be used in patients in cardiac arrest as a direct result of a traumatic incident. You may consider using the AED if the patient appears to have suffered a cardiac arrest from a pre-existing medical condition that leads to a traumatic incident. An example would be a cardiac arrest patient in a low speed / impact crash with minimal vehicle damage or a fall from medium heights with no obvious signs of potentially fatal trauma.

8. 2016 In-Service Training Focused CPR Project Update As of 15, 2011, The King ltd Airway could be utilized in trauma patients who are pulseless and not breathing. Do not extend or flex the patients neck in order to assist it’s insertion. Remember with the King Airway, the purpose of the suction catheter is to eliminate gastric distention by primarily removing air from the stomach. It is not necessary to suction stomach contents

9. 2016 In-Service Training Focused CPR Project Update Ensure two minutes of CPR on the unwitnessed cardiac arrest victim, the EMT performing compressions will count out loud and administer 200 compressions prior to the AED being turned on.

10. 2016 In-Service Training Focused Performance Cardiac Arrest Model 1.Each team member / first responder has a specific and defined role 2.The roles assigned should remain consistent 3.All roles serve to achieve common goal of ROSC

11. 2016 In-Service Training Focused Performance Cardiac Arrest Protocol 1.FR arrival on-scene prior to Medic 2.Medic arrival on-scene prior to FR

12. 2016 In-Service Training Focused Performance Cardiac Arrest Protocol –FR On-Scene First General Responsibilities 1. 1 st arriving FR: Patient care compressions 2. 2 nd arriving FR: Patient care airway 3. 3 rd arriving FR/co/officer: Scene management and documentation 4. 4 th arriving FR: Stand by Assist Medic on arrival 5. Additional FR: Patient care and other assistance.

13. 2016 In-Service Training Focused Performance Cardiac Arrest Protocol -FR On-Scene First 1stArrival Responsibilities Compressions 1. Immediate compressions a. Direct to patient b. Establish pulse \ no pulses c. Begin compressions (quick down stroke & upstroke) remember coronary perfusion happens on upstroke

14. 2016 In-Service Training Focused CPR Project Update The Company Officer Or lead EMT will oversee a switch of EMT’s providing compressions every 200 strokes. (Approximately every two minutes) This is to be accomplished with no interruptions in the delivery of compressions. Count out loud

15. 2016 In-Service Training Focused CPR Project Update When the AED is interpreting the initial rhythm, you will not do compressions. You will immediately return to compressions after the shock. Count out loud

16. 2016 In-Service Training Keys for successful resuscitation NOBODY DIES in VF/VT Change in Culture from top/down 2 minute CPR intervals Count out loud 90% time on chest (CPR performed) All CPR pauses < 10 seconds Timely defibrillations Control respiratory rate

17. 2016 In-Service Training AED analyzing At 180 compressions Lead EMT readies AED for analyzing At 200 compressions Lead EMT presses analyze button, CPR rotation is made and compressor hovers over chest When analyzing complete if shock advised then defibrillate ASAP If no shock advised 200 compressions ASAP

18. 2016 In-Service Training Responsibilities Lead EMT now owns the shocks and ensures defibrillations with AED are timely Paramedics own the shock with the MRX and will pre charge at the 180 th compression Paramedics/ Lead EMT will palpate the femoral pulse while compressions are being performed Person doing compressions counts 1 then every 20 th compression (allows for AED review of compressions) Breaths are delivered on every 20 th compression count Rotation is done after every 200 th compression

19. 2016 In-Service Training Supervisors Role Provide on-scene oversight on all aspects of resuscitation Rotation is performed Compressions and ventilations adequate Time off chest < 10 seconds Timely Defibrillations MRX properly deployed ETCO2, QCPR, SPO2

20. 2016 In-Service Training FF I FF II Lead EMT FFIII Compressions Stand By Airway Place AED and provide shock if indicated CPR begins with FFI doing compressions FFII doing the airway Lead EMT Placing AED and pressing shock button when needed. FFIII in standby position. 1 st 200 hundred compressions

21. 2016 In-Service Training FF I FF II Lead EMT FFIII Compressions Stand By Airway Place AED and provide shock if indicated CPR begins with FFI doing compressions FFII doing the airway Lead EMT Placing AED and pressing shock button when needed. FFIII in standby position. 2 nd 200 hundred compressions

22. 2016 In-Service Training FF I FF II Lead EMT FFIII Compressions Stand By Airway Place AED and provide shock if indicated FFI goes to stand by. FFII doing the airway Lead EMT Placing AED and pressing shock button when needed. FFIII compressions. 3 rd 200 hundred compressions

23. 2016 In-Service Training Make moves quickly Make changes in compressions without a pause When AED says analyze, come off chest If no shock advised, immediately resume CPR Lead EMT will advise clear and push orange button Immediately after shock, resume compressions. Never more than 10 sec. delay less is better Infants in Arrest should never be carried to meet Medic

24. 2016 In-Service Training FF I FF II Lead EMT ENG Compressions Stand By Airway Place AED and provide shock if indicated FFI goes to stand by. FFII doing the airway Lead EMT Placing AED and pressing shock button when needed. FFIII compressions. 200 hundred compressions Medic Arrives Medi c 2 Medic 1 ALS

25. 2016 In-Service Training Arrival of Medic Crew Chief will start ALS 2 nd Medic set up 4 lead and end-tidal Co2 2 nd Medic falls into rotation

26. 2016 In-Service Training Philips HeartStart FR3 Pad quality Adult Vs. Infant Key QCPR Puck Data download Equipment operations

27. 2016 In-Service Training Philips HeartStart FR3 Pad quality –Peel and place SMART Pads III. There’s no foil pouch when the pads are preconnected Cradled

28. 2016 In-Service Training Philips HeartStart FR3 Adult Vs. Infant Key –Infant/Child Key automatically decreases the defibrillation therapy and implements the configured infant/child CPR protocols which allows the Infant/Child Key use of SMART Pads III for adults and children Key is for use on patients under 8 years old or under 55 lbs.

29. 2016 In-Service Training Philips HeartStart FR3 QCPR Puck Provides visual targets where you want it--on the patient’s chest compression depth compression release compression rate compression Inactivity Discrete corrective feedback when targets are missed Compression counter Detects and alerts when hyperventilation occurs Note: Q-CPR is for use on patients at least 8 years old or 55 lbs (25 kg)

30. 2016 In-Service Training Philips HeartStart FR3 Compression Targets and Counter Compress Deeper Release Between Compressions Compress Slower Depth target 5 cm not to exceed 6 cm Rate range 100 – 110 CPM

31. 2016 In-Service Training Philips HeartStart FR3 Data download Via, S/D Card reader EMS Training and Medic (automatically)

32. 2016 In-Service Training Philips HeartStart FR3 Make sure you are the only one logged in. Make sure Philips HeartStart Data Messenger is running Plug S/D card in card reader

33. 2016 In-Service Training Philips HeartStart FR3 Data should send on its own. To verify you can check the sent folder of your Outlook Mail.

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52. 2016 In-Service Training Up Date 1/28/2014

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