New AHA Guidelines - They Want OUR Feedback! Come and Comment!

Out of hospital cardiac arrests claim lives! The American Heart Association (AHA) states that there are 350,000 out of hospital cardiac arrest per year. With a dismal 12% successful resuscitation rate, it’s time to think outside the box. Nurses General Nursing Article

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New AHA Guidelines - They Want OUR Feedback! Come and Comment!

AN is pleased to present a press release from AHA which adds another dimension to out of hospital cardiac arrest care - telephonic assisted cardiopulmonary resuscitation via a 911 operator.

The American Heart Association - the world's leading voluntary health organization devoted to fighting cardiovascular disease - published recommendations this month that set standards for timely and high quality delivery of dispatcher-assisted CPR, also known as telephone CPR (T-CPR). The recommendations are accompanied by performance goals to measure successful implementation by first responders.

To generate discussion among professionals engaged in improving survival from cardiac arrest, the program and associated metrics are open for public comment. The AHA will be accepting comments from interested parties through the website until November 16, 2016.

Early access to 911 and early CPR are the first two links in the chain of survival from cardiac arrest. Currently, less than half of those who suffer an OHCA receive bystander CPR.

"The most immediate way to improve survival from cardiac arrest is to improve bystander CPR rates," said Michael C. Kurz, MD, MS, FACEP, FAHA, Associate Professor, Department of Emergency Medicine, University of Alabama at Birmingham and volunteer chair of the T-CPR Taskforce for the American Heart Association. "Providing telephone CPR saves lives by providing just-in- time bystander CPR instructions. When T-CPR instructions are not provided, preventable deaths from out-of- hospital cardiac arrest occur."

The AHA recognized the need for emergency response dispatchers to be trained to provide telephone CPR instructions prior to the arrival of EMS in the 2010 AHA Guidelines for CPR and ECC, and this was reiterated in the Guidelines most recently updated in 2015. As much as 50 percent of bystander CPR in communities that provide T-CPR instructions to 911 callers is directly attributable to those instructions.

AHA's six program recommendations stress ongoing training and continuous quality improvement:

1. Commitment to T-CPR by both the emergency communications center and the dispatch center director

2. Train and provide continuing education in T-CPR for all telecommunicators

3. Conduct ongoing quality improvement for all calls in which a cardiac arrest in confirmed by EMS personnel and in which resuscitation is attempted

4. Communication between the emergency communications center and responding EMS agencies to measure implementation and effectiveness

5. Designated medical director to issue protocols and work closely with the responding EMS agencies

6. Recognition for outstanding performance

"In telephone CPR, the dispatcher and the caller form a team in which the expertise of the telecommunicator, combined with the willingness of the caller to assist, strengthen the first two links in the chain of survival," said Kurz.

The program recommendations are accompanied by a series of five performance metrics:

1. Percentage of OHCA cases correctly identified by the dispatcher

2. Percentage of correctly identified OHCA cases that were deemed recognizable versus those that were not because of complicating factors (e.g., language barriers, caller hang-up, CPR already in progress)

3. Percentage of victims who receive T-CPR

4. Median time between 911 call and recognition by dispatcher of cardiac arrest

5. Median time between 911 call and first T-CPR directed chest compressions

Following the public comment period, the AHA will update the program and performance recommendations. The final document will be published online along with a comprehensive guide to implementing T-CPR at the community level.

So, this is the nursing community's time to comment on action that will have national implications. Voice your opinion, make comments, ask questions. Share your stories of out of hospital cardiac arrests and your commitment to improving care for these very fragile patients.

We (nurses) will be instrumental in these guidelines so lets make our voices heard!

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traumaRUs

About traumaRUs, MSN, APRN

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Alex Egan

Alex Egan, LPN, EMT-B

4 Articles; 857 Posts

Specializes in Home Health (PDN), Camp Nursing.

Most 911 centers already have telecommunicators giving CPR instructions and coaching over the phone. There is already a nation certification for this. Heart has not convinced me that they are

bromgimg anything new to the table here.

traumaRUs
Trauma Columnist

traumaRUs, MSN, APRN

97 Articles; 21,242 Posts

Specializes in Nephrology, Cardiology, ER, ICU.

While this is true - this standardizes the out of hospital care to AHA guidelines. At the present time, it is up to the medical director of each EMS division to determine what if any directions/protocols are followed by 911 operators.

So - this does open up new standards that will provide a national expectation of care across the board.

Loracs72

Loracs72

65 Posts

Specializes in OB/GYN, Home Health, ECF.

What if families filed a lawsuit because of loss of someone who died despite CPR ? Can EMS and 911 Dispatcher be held liable, because the Good Samaritan act would not apply because they are professionals

A new policy would have to be written that an MD can be the only one to stop CPR.

A solution would be to have an MD on board to assess the situation, therefore 911 dispatchers would not be needed to coach CPR via phone. But that would be impractical ! If I am the victim, let me go !

Alex Egan

Alex Egan, LPN, EMT-B

4 Articles; 857 Posts

Specializes in Home Health (PDN), Camp Nursing.

EMD has a question algorithm that determines if CPR is necessary. It mostly rules out obvious mortal injury and decomposing but it already exists.

Also 911 is a governmental organization and is generally following EMD and EFD protocols. Especially if they are federally funded at all. so there is no liability so long as they are following the standards of care that already exist. So liability is not a concern for the dispatcher.

Again in I feel that the AHA is about 20 years late to make a difference or really have strong input in this area. It's already covered in all but the most backwards 911 centers. If they really were interested in improving outcomes they would be airing PSAs about bystander CPR during the Super Bowl, or in the ads before movies.

traumaRUs
Trauma Columnist

traumaRUs, MSN, APRN

97 Articles; 21,242 Posts

Specializes in Nephrology, Cardiology, ER, ICU.

This standardizes out of hospital care. No offense to anyone but the US still has many rural areas and many areas where an all volunteer EMS exists.

And this also exists for bystander CPR.

Finally as as a prehospital provider there are protocols in place which preclude starting CPR or stopping CPR.

Nowadays traumatic full arrests are rarely transported unless the transport time is very very short

I live in a rural community which is entirely dependent on its volunteers.

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