Why EMS must engage the community to "disrupt the odds" and save more lives

Sarah Calams // March 26, 2019

Public safety experts discuss how they were able to identify and implement forward-thinking local approaches to address national problems like cardiac arrest and opioid overdose

It’s often said that the odds are stacked against first responders who respond to time-sensitive events – like cardiac arrest, severe hemorrhage or overdose calls.

Saving lives – particularly those who are bleeding profusely or not breathing – requires community involvement prior to the arrival of first responders in order for a successful outcome. Public access ‘Stop the Bleed’ kits can be a key tool to help bystanders bridge the gap.

During a live webcast from the EMS Today 2019 conference, sponsored by Bound Tree, attendees were offered insight on how to disrupt the odds of death and save the lives of patients with time-sensitive conditions. The panelists said agencies must acknowledge that saving these patients’ lives – particularly those who are not breathing – requires community involvement prior to the arrival of first responders in order for a successful outcome. Presenters included:

  • Dan Ellenberger, director of University Hospitals EMS Training and Disaster Preparedness Institute in Cleveland.
  • Dominic Silvestro, EMS coordinator/educator at University Hospitals EMS Training and Disaster Preparedness Institute.
  • Maureen O’Connor, program manager for the Public Access Defibrillation program for San Diego Project Heart Beat.
  • Billy Wusterhausen, assistant chief with the Round Rock (Texas) Fire Department.
  • Daniel Sledge, lead outreach paramedic for Williamson County (Texas) EMS Mobile Outreach Team.

Ellenberger and Silvestro discussed a University Hospitals EMS Training and Disaster Preparedness Institute program, created after a 2012 high school shooting occurred in Chardon, Ohio, where three students were killed and two injured. The Institute developed a bleeding control kit to provide teachers and students supplies so they can help before first responders arrive.

"It’s our hope that other EMS agencies will duplicate this program in schools," Silvestro said.

They later started a program aimed at training police officers in the use of applying tourniquets and combat gauze around northeast Ohio.

University Hospitals also received approval from the Department of Defense as a training site for the "Stop the Bleed" course. They began to train Ohio-area teachers and staff on how to provide lifesaving measures, such as tourniquet use, wound packing, basic bleeding control and shelter in place strategies, as well as the proper steps to take in the event of an active shooter incident.

"One of our deal-breakers is that we train everybody in the school system – classified and non-classified. We want everyone trained, and we will provide everything for free," Ellenberger said.

Classrooms were provided self-contained kits, or "buckets," for bleeding control, as well as supplies for shelter in place situations. To date, over 4,000 teachers and staff have been trained, and around 3,000 buckets (including supplies like gauze, scissors, gloves, duct tape and a door stop) are in place in Ohio classrooms.

O’Connor explained Project Heart Beat’s mission, which is to help make AEDs as accessible as fire extinguishers and educate the community on recognition and response to cardiac arrest. The program started in 2001, and since then, 9,000 AEDs have been deployed within the communities of San Diego County. To date, 176 lives have been saved as a direct result of the program.

"About 10,000 children every year in our nation die from cardiac arrest, but fortunately, we are saving them, too,” O’Connor said. “Three lives out of those 176 saves were kids – all three at school. They were not involved in athletic activity, but they’re here today because their school had an AED program in place."

Wusterhausen stressed the importance of a community risk reduction program that helps identify a problem and assists residents in finding the proper resources. The Round Rock Fire Department started its community risk reduction program in response to the increase of opioid-related calls and later partnered with the Williamson County EMS Mobile Outreach Team.

Sledge talked about how that team works, the importance of distributing naloxone kits and providing training to patients and their families and offering patient-led discussion about their goals in regard to recovery and treatment.

“When we do outreach, we tell [patients] that we’re not here to shove treatment down their throats,” Sledge said. “We tell them that we’re on their team. We use the principles of motivational interviewing to help with patient-centered goal setting and figure out how we, as a team, can meet those goals.”

Top takeaways on enhancing community preparedness and response

Here are some of the other key takeaways from the presentation:

1. Identify at-risk patients and bridge the gaps.

The first two patients enrolled in the Williamson County EMS Mobile Outreach program, Sledge said, were a result of back-to-back overdose calls.

“It was a gentleman and his girlfriend, and they just kept saying, ‘Thank you for not judging us – you saved our lives,’” Sledge recalled. “They recently celebrated nine months in recovery, and that’s what it’s all about.”

The Mobile Outreach Team identified at-risk patients by running a report on their EMR, but agencies could also recognize patients in need by radio alerts or email referrals from crews. Moreover, Sledge emphasized the importance of initiating gap treatment, medication-assisted treatment and peer recovery coaching.

2. Keep it simple for the student.

O’Connor’s favorite mantra for teaching is to keep it simple for the student. And, when educating the general public, O’Connor reminded attendees that less is always best. For example, she recommends CPR compressions at least 100 beats per minute even though the standard is 100-120 beats per minute.

“If you throw too many numbers out at people, they get confused and scared,” she said. “They’re less apt to put their hands on somebody because they can’t remember which number they’re supposed to remember.”

She also encouraged a “No-No-Go” concept, which she initially learned during a cardiac conference. The concept was originally used to educate dispatchers on how to best identify cardiac arrest during a 911 call.

“No response, no breathing, go,” O’Connor said. “Call 911, get an AED, come back and start pumping hard and fast.”

3. Think outside the box for funding sources.

In a perfect world, money would grow on trees and EMS agencies could spend whatever they need without worrying about funding sources or costs. Unfortunately, that’s not the world we live in.

The University Hospitals outreach program, which is funded by Hospital Community Benefit Funds, costs approximately $300,000, with each bucket/kit costing $70. That’s a significant number, but there are many ways for an agency to receive program funds.

Ellenberger and Silvestro recommended that agencies inquire as to whether or not their hospital systems have money set aside for community benefit donations. Additionally, they suggested reaching out to school district PTAs, civic groups (such as the Kiwanis or Eagle Scouts), local retail and home improvement stores, local fundraisers or other philanthropic organizations or individuals.

“Get into your PTAs and explain to them the importance of bleeding control and how you can’t just wait for EMS agencies to arrive,” Silvestro said. “Your patient is going to bleed to death – you need to be able to put that tourniquet on or pack that wound.”

Learn more about engaging the community and disrupting the odds of survival


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