1. VSA 2004 Ottawa Ottawa Base HospitalDr. J. Maloney Cardiac cause 441 452412 Average age 69 6866 Gender – female 35% 34%31% other 65% 66%69% 20022003 2004 Cardiac Arrests Ottawa Cardiac Arrests

2. VSA 2004 Ottawa Ottawa Base HospitalDr. J. Maloney LocationsResidencePublic 65% (68%)22% (13%) Cardiac Arrests Ottawa Cardiac Arrests 2004 (03) Citizen CPR 25% (7.1%) Defibrillator EMS Fire PAD 77% (68%) 18% (23%) 5% (7%) Survival 5.4% Citizen CPR 13% 200020012002 3.3% 8.7% 5.9% 12.9% 2003 6.6% 7.1% 2004 6.1% 25%

3. VSA 2004 Ottawa Ottawa Base HospitalDr. J. Maloney Ventricular Fibrillation # V Fib cases 133 First to apply defibrillator EMS76% Fire17% PAD7% Survived12% Cardiac Arrests Ottawa Cardiac Arrests2004 If Citizen CPR (44) First to apply defibrillator EMS68% Fire24% PAD8% Survived11%

4. VSA 2004 Ottawa Ottawa Base HospitalDr. J. Maloney Ottawa Cardiac Arrests Cardiac arrest 60’s year old men (2/3) At home(3/4) Often witnessed (1/2) The Big Picture If witnessed in a residence, in Ottawa, witness starts CPR … 1 3

5. VSA 2004 Ottawa Ottawa Base HospitalDr. J. Maloney Ottawa Cardiac Arrests 2004 Targeted increase fire tiered response Maximize police response PAD locations ?? Private PAD placement public places Home defibrillation Education re: AED application time Strategic Targeted CPR Increase survival … what to do??

6. VSA 2004 Ottawa Ottawa Base HospitalDr. J. Maloney Strategic Targeted CPR Targeted Families of cardiac patients Seniors Church CPR (Cardio Pulpit Resuscitation) Nursing Homes Chronic care Strategic Use local stats in courses Video Web-based Scenario based teaching

7. VSA 2004 Ottawa Ottawa Base HospitalDr. J. Maloney Strategic Targeted CPR Training Answer questions It is not enough to teach CPR You have to provide the key that “unlocks” them Something that will make them act Use scenarios … when it really happens it should not be the first time they see it … help them see it !

8. VSA 2004 Ottawa Ottawa Base HospitalDr. J. Maloney Your CPR Course Strategic Targeted CPR What’s the “GO” (Goals & Objectives) Teaching someone to To recognize that chest pain may be cardiac To recognize a stroke To act … Call 911 will save more lives than “Thump and Blow” … and don’t forget teaching risk factors that is important too ! !

9. VSA 2004 Ottawa Ottawa Base HospitalDr. J. Maloney Base Hospital Paramedic Training Fall 2000 - Intro ACP, ACS, ECG recognition Spring 2001- ACP ACLS Spring 2002 - ECG recognition re-inforced Fall 2002- Intro Lytics Spring 2003- Lytics study Fall 2003- PCP ECG acqure, recognition 2004- heavy with STEMI 2005- heavy with STEMI Ottawa STEMI

10. VSA 2004 Ottawa Ottawa Base HospitalDr. J. Maloney Cardiac chest pain > 30 min, < 12 hours 12 Lead ECG Nearest ED ST elevation borderline or not clearly positive OR Evidence LBBB OR Pt is pre/post VSA ST elevation clearly > 1 mm in 2 contiguous limb leads OR ST elevation clearly > 2 mm in 2 contiguous precordial leads Notify Heart Institute “Positve STEMI, ETA” Patient transported there directly Ottawa STEMI

11. VSA 2004 Ottawa Ottawa Base HospitalDr. J. Maloney Within 2 hours of onset In Ottawa Has … a. GCS>12 b. Stable Airway (i.e. not requiring airway support) c. Vitals Signs BP>90, Heart Rate >60 and < 120 d. Blood Sugar reading ≥ 4.0 mmol/L e. Age ≥ 45 yrs. Does not have: a.Terminal illness (i.e. palliative care) b.Valid DNR c.History of seizures Ottawa Stroke Bypass

12. VSA 2004 Ottawa Ottawa Base HospitalDr. J. Maloney Has … Difficulty speaking Unilateral arm weakness Facial Droop. Ottawa Stroke Bypass Go directly to Ottawa Hospital General / Civic