1. HeartSafe Community is an international initiative that began in 2002 on the east coast and has spread throughout the U.S., New Zealand, and Taiwan. To make a community HeartSafe, more people need to recognize the signs and symptoms of cardiac arrest, know when to call 911, be trained in hands-only (bystander) CPR and the use of AEDs (Automated external defibrillators). The purpose of a HeartSafe is to teach the community about recognizing these signs and symptoms of a heart attack and what they can to do to potentially save a life through collaboration of EMS (Emergency Medical Services), Fire Departments, Health Systems, and various other community partners.

2. Objectives
Discuss cause of a heart attack and how to reduce your risk of heart disease
Examine heart attack warning signs
Review the importance of rapid treatment for a heart attack
Demonstrate Hands-Only CPR

3. Heart Disease: Major Problem in the United States
Heart disease #1 killer of adults
Coronary heart disease
Affects 17.6 million Americans
Heart Attack
1.2 million affected each year
4,100 per day
800,000 deaths per year
Half occur before reaching the ER

4. What is a Heart Attack?
Blood flow through one of the coronary arteries becomes blocked.
Heart disease, which can lead to a heart attack, develops over time as fatty deposits narrow the coronary arteries, restricting blood flow to the heart.
The basic definition of a heart attack- happens when the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked and the heart can't get oxygen. If blood flow isn't restored quickly, the section of heart muscle begins to die. Heart attacks most often occur as a result of coronary heart disease (or coronary artery disease).

5. These pictures are of a retired firefighter with KCKFD
These pictures are of a retired firefighter with KCKFD. The picture on the left, notice the dark line above the arrow and the absence of the dark line below the arrow. This shows where the artery is blocked. The blood flow to that portion of the heart is severely compromised. The picture on the right is the after picture. Notice that you can now see how the blood flow improved after receiving treatment at the hospital.

6. Controllable Risk Factors
Cigarette smoking
Diabetes
High blood cholesterol
High blood pressure
Overweight/obesity
Physical inactivity
What can you do to “control” your risk of having heart disease or a heart attack. The things listed on this slide are considered controllable risk factors and therefore things that you as an individual have the ability to limit your risk of heart disease.

7. Non-Controllable Risk Factors
Age
Gender
Race/heredity
Family history of early heart disease
Previous heart attack or other signs of heart disease
The things listed on this slide are considered to be non-controllable risk factors, i.e. outside of our control to limit our risk for heart disease. We cannot change our age (although most of us would like to), gender, our race, our family, or whether we’ve had a previous heart attack.

8. What is a Heart Attack Really Like?
Heart attacks often begin with vague symptoms that slowly intensify.
Pain or discomfort can be relatively mild.
Symptoms may come and go for hours and/or days.
People think a heart attack is like what they see in the movies or on TV. Someone clutches their chest and falls on the floor, where they immediately start writhing around. This is not the case. Sometimes it may be like what you see on TV, but most of the time it is not.

9. Ask the audience to shout out what they are some heart attack warning signs.

10. Heart Attack Warning Signs
Chest pain (ache, burning, pressure, tightness)
Shortness of breath
Left arm pain
Jaw pain
Neck/back pain
Nausea/vomiting
Feeling weak, lightheaded, or faint
Reiterate the warning signs. Many people are thrown off when you ask them about their chest pain. They may say they don’t have pain and will describe it as an ache, pressure, burning, or just a tightness or squeezing sensation. Remember, some symptoms may come and go so may not have all these symptoms at the same time. Sometimes will have had chest pain yesterday, but not today and could still be having a heart attack.

11. Heart Attack in Women Women are as vulnerable as men.
Tend to delay longer than men in seeking help.
Likely to experience:
Shortness of breath
Fatigue
Nausea/vomiting
Back or jaw pain
Women can present differently. Fatigue is the #1 symptom. This is not “I have to take a nap” fatigue. This is the “I’m walking through wet cement and I can’t take another step kind of fatigue. Survivor story: 52 y.o. female; full-time employee, full-time college student, and full-time mom. She came home from work to study for a test that she had the following evening. She began to feel exhausted…like she never had before. Her son, a police officer, had just come home from work. She told him she was going to go upstairs and lie down. He heard a thud upstairs, and ran up to find his mother on the floor pulseless and non-breathing. He called 911, and began doing hands-only CPR (He had just learned it that week). He continued until the ambulance arrived. She was taken to the hospital, where she walked out 2 weeks later.

12. Reaction to a Heart Attack
May not be sure it is a heart attack
May confuse with symptoms of other diseases or conditions, such as heartburn or indigestion
May ignore symptoms or take a wait-and-see approach
People attribute their symptoms to other illnesses that they have. “I have some left arm pain, but it may be my arthritis”. Or “I’m nauseous, sweaty, and weak…I think it’s just the flu”. “It’s just heartburn.” Those that take the wait-and-see approach just take a couple Tylenol and are going to see how they feel in the morning. They may not see morning.

13. Delay Can Be Deadly Early recognition is key
85% of heart damage occurs within the first 2 hours of blockage
Within 6 hours of blockage, there is usually total damage
Recognizing the symptoms early and seeking treatment is key to save the heart muscle. The longer someone waits, the more detrimental the circumstances. Within the first 2 hours of a heart attack, 85% of the damage to the heart has already occurred. Within 6 hours, there is usually total damage to the heart muscle..

14. Importance of Rapid Treatment for Heart Attack
Quick action and medical treatment restores blood flow and saves heart muscle
Treatments should begin within 1 hour after symptoms start
Dead heart muscle cannot be restored
A person experiencing signs and symptoms of a heart attack should call 911 within 5 minutes of their symptoms starting. We want them at the hospital within 60 minutes after the start of the symptoms. Dead heart muscle cannot be restored

15. Do you know what the typical response time for EMS to get to your house is for your community? 3 minutes, 5 minutes, 10 minutes, 15 minutes??? Getting EMS activated is crucial to getting Paramedics to your side quickly so that treatment can begin.
Do Not Wait to Call 9-1-1

16. Importance of Activating Emergency Medical Services
Medical treatment is started by EMTs and Paramedics
Able to obtain EKG, administer medications and oxygen
Communicate with hospital nurses and physicians
Activate Cardiac Specialists from the ambulance
Care for patients that are having a heart attack starts as soon as the fire truck or ambulance gets there. Vital signs are taken, oxygen is given, a heart monitor is placed. They can perform a 12 lead EKG. Aspirin is given, along with Nitro. An I.V. is started and pain meds are given. If you are having a heart attack, before the ambulance even pulls away from the residence, the hospital is notified and are making the appropriate preparations. In many hospitals, you can bypass the ED and be taken straight to the cardiac catheterization lab where the Cardiologist and their team that is trained in the procedure to open the blocked artery will be waiting.

17. Why People Do Not Call 9-1-1
Think symptoms are not bad enough
Think transporting self is faster
Concern about embarrassment
Don’t want to cause a scene
Don’t want to bother the EMTs
Too expensive
Unaware of benefits of using 9-1-1
“What will the neighbors think with all the lights and sirens?” Story: 55 y.o. male was out working on his acreage in the rural metro area. He began feeling some chest discomfort and shortness of breath. He came inside for lunch and told his wife he felt “funny”. Instead of going to the hospital, he went back out and continued to work on his land. About 3:00 p.m., he came inside and told his wife that he thought he should get checked out. He got into his car and drove himself to a hospital, which was not the closest hospital. He parked the car, and walked into the ER. He went to admitting, and gave them his info. He then went to triage where he finally said the magic words “chest pain”. He was immediately given a room and the staff began the work-up. 15 minutes later he was dead. If he had called 911, the care could have begun immediately, and he would have been transported to the closest appropriate facility. His chances of survival would have been significantly better.

18. Sudden Cardiac Arrest
Heartbeat stops abruptly and unexpectedly which stops flow of blood to the body
Loss of consciousness, unresponsive
Loss of normal breathing
Loss of pulse
95% of deaths from sudden cardiac arrest occur before arriving at the hospital and are often witnessed by family, friends, or co-workers
CPR and access to an AED can double the chance of survival
When the heart stops beating normally, blood stops flowing to the brain, the heart, and the rest of the body, and the person collapses. Without quick treatment, the person will remain dead. If bystanders can quickly begin CPR and use an AED to defibrillate the heart (to help reestablish normal heart rhythm), the chance of survival increases. Every minute of delay in defibrillation decreases the chance of survival by 7-10%.

19. What do you do if someone collapses in front of you?
So, what do you do if a stranger or a loved one collapses in front of you?
Check- Call- Compress
These 3 steps can help you save a life.

20. Step 1: Check for Response
Tap or gently shake victim
Ask the victim loudly-“Are you OK?”
Step 1- check for a response by gently tapping or shaking the victim and asking them if they are ok.

21. Step 2: Call Have someone call 911, or call 911 yourself
Ask someone to find the closest AED
Step 2- If you do not get a response from the victim, call This can be done by someone else if you are not alone. You also need to ask someone to find the closest AED and bring it to you. Remember, early defibrillation with an AED helps to increase the chance of survival.

22. Step 3: Compress Initiate hands-only CPR Push hard and fast
100 times a minute!
Step 3- Begin compressions (CPR). Place the heel of one hand in the center of the chest along the breast bone. Next, place your other hand on top and lace your fingers together. Position your shoulders directly over your hands, keep your arms straight and your fingers up off the chest. Push down hard on the chest and let the chest come back up. Continue to push the on the chest hard and fast, 100 compressions per minute.
Hand Placement

24. Early Defibrillation with AED
Early defibrillation is considered to be the most critical link in survival. Nowadays, AEDs can be found in many public buildings, schools, sports stadiums, shopping malls, restaurants, airports, etc. You may recall having seen a sign or box such as the top 2 pictures this slide. The picture on the bottom is a picture of what the AED may look like. There are different brands of AED, so they may vary. Notice the one in the box on the top left is yellow while the one pictured on the bottom is blue. The functionality for all AEDs are similar.

25. AED Operation Call 9-1-1 (Have bystander start CPR) Turn AED power on
Remove top/shirt
Place AED pads directly on chest (not abdomen)
Follow AED prompts
Push shock if indicated
Resume CPR
AEDs will have instructions for use on the machine. There should be patches with the AED. These patches are placed on the chest- the patches will have a picture of what part of the chest the patch should be placed. The AED will prompt you as to what to do. If the AED tells you that a shock is indicated, make sure no one is touching the victim before you push the button. After the shock has occurred, resume compressions on the chest. Push hard and fast, 100 compressions per minute. After 2 minutes of compressions, stop to let the AED analyze for whether another shock is needed. Continue until EMS arrives.

26. For information on how to make your agency or group part of the
Heart of America
HeartSafe Community go to:

27. References
American Heart Association. (2010). Emergency Response: Hands-Only CPR. Retrieved March 16, 2014, from
American Heart Association. (2014). Hands Only CPR: Learn More. Retrieved March 16, 2014, from
Beltina.org. (n.d.). Atherosclerosis - what is, definition, symptoms and treatment. Retrieved March 16, 2014, from
Bloomberg News. (2012, February 22). Women: Beware of Stealth Heart Attacks. Retrieved March 16, 2014, from Newsmax Health:
Deputy Heart Attack. ( ). The EHAC Course. Retrieved March 16, 2014, from

28. References
Hawk, T. (n.d.). If I Only had a Heart. Retrieved March 16, 2014, from flickr:
Maine Cardiovascular Health Council; Maine Emergency Medical Services, Department of Public Safety. (2013). Maine HeartSafe Communities. Retrieved March 16, 2014, from
National Institute of Health. (2002, February 21). NHLBI Issues Resources To Help Americans "Act In Time To Heart Attack Signs". NIH News Release. Retrieved March 16, 2014, from
New Hampshire Department of Safety Division of Fire Standards and Training and Emergency Medical Services; New Hampshire Department of Health and Human Services, Division of Public Health. (n.d.). New Hampshire HeartSafe. Retrieved March 16, 2014, from

29. References
Schulke, J. (2012, June 7). How to perform CPR: Chest compressions. Retrieved March 16, 2014, from examiner.com:
Stanton, M. (2012, June). You Can Save a Life. Retrieved March 16, 2014, from AARP:
Tate, N. (2013, February 15). Many Women Underestimate Heart Risks. Retrieved March 16, 2014, from Newsmax Health:
The Heart Foundation. (2014). What is Heart Disease? Retrieved March 16, 2014, from