# Presentation: 885373

## Partnering with Emergency Medical Services in Arizona

- Nicole Olmstead, MPH
- Cardiovascular Disease Program Manager
- Arizona Department of Health Services

## Today’s Session Will Cover:

- History of Arizona’s CVD program
- How the Arizona CVD Program established the relationship with EMS.
- Successes and Challenges of partnering with EMS.
- Projects that the Arizona CVD program and EMS work on together

## History of the Arizona Department of Health Services CVD Program

- 2004 – Program Manager identified.
- Spring 2005 – State plan completed and published.
- Fall 2005 – First Steering Committee Meeting
- Spring 2006 – Revised objectives completed
- Fall 2006 – First Annual Arizona Cardiovascular Disease Coalition Meeting

## How the Arizona CVD Program established the relationship with EMS. 

- Established Emergency Response as one of the workgroups of the statewide coalition.
- Identified EMS personnel to serve as chairs on this committee
- Met regularly with EMS medical director to identify collaboration opportunities.

**Notes:**
Angina – Chest pain or discomfort that occurs when the heart does not get enough blood.
Heart Attack –happened when a blood clot develops at the site of plaque in a coronary artery and suddenly cutts of most or all blood supply to that part of the heart muscle.  Cells in the heart muscles begin to die and this can cause permanent damage to the heart muscle.

## EMS Objectives from Arizona’s CVD State Plan

- Increase the use of automated external defibrillators.
- Increase the number of sites willing to participate in the Arizona Department of Health Services “Save Hearts in Arizona Registry and Education” Program.
- Increase the number of EMS training programs that include a stroke module in their curriculum.

## Challenges and Successes 

_**Successes**_
- Additional collaboration opportunities.
- Increased contact with EMS organizations.
- Ability to do projects that may not be in line with office agenda.

_**Challenges**_
- Personnel located within another office.
- Each office has own agenda.
- Occasionally tasks get done without knowledge of CVD program staff.

## Projects being done in collaboration with EMS

- Save Hearts in Arizona Registry and Education (SHARE)
- Chest Compression Only CPR
- Stroke Telemedicine with Arizona Rural Residents (STARR)

## Save Hearts in Arizona Registry and Education

- Role:
- To implement a system to collect and analyze out-of-hospital cardiac arrest data to determine baseline.
- Create a culture of precise cardiac arrest event documentation.
- Implement scientifically proven strategies to improve survival.

## Save Hearts in Arizona Registry and Education 

- Apache Junction FD
- Buckeye Valley FD
- Chandler FD
- Daisy Mountain FD
- Drexel Heights FD
- Gilbert FD
- Gila River Indian EMS
- Glendale FD
- Guardian Medical Transport (Flagstaff)
- Lake Havasu FD
- Mayer FD
- Mesa FD
- Northwest FD (Pima County)
- Payson FD
- Peoria FD
- Phoenix FD
- Pinewood FD

- PMT Ambulance
- Puerco Valley FD
- Scottsdale FD
- Sedona FD
- Southwest Ambulance/Rural Metro (Maricopa County)
- Southwest Ambulance/Rural Metro (Pima County)**
- Sun City FD
- Sun City West FD
- Sun Lakes FD
- Tempe FD
- Tolleson FD
- Wilcox FD
- Yuma FD
- Lifestar Ambulance Lifeline Ambulance

## SHARE EMS Participants

**SHARE EMS Participants**
- 2003 Arizona Population Estimate = 5,580,811
- Current SHARE Participants Estimate = 3,500,000
- (63%)

## Major Determinants of Survival From Cardiac Arrest

- Early/Effective CPR
- Early Defibrillation

**Cardiocerebral Resuscitation**

- 200 chest
- compressions

- 200 chest
- compressions

- Single shock
- without pulse
- Check or rhythm
-  analysis

- BVM or Passive
- Insuflation 100% FIO2
- Begin IV

- Analysis

- 200 chest
- compressions

- Single shock if
- Indicated without
- pulse check or
- rhythm analysis

- Analysis

- Single shock if
- Indicated without
- pulse check or
- rhythm analysis

- Resume Standard ACLS
- Consider Endotracheal
- Intubation

- 200 chest
- compressions

- CC
- Only•

- EMS
- arrival

- Administer 1 mg
- IV Epinephrine

- Analysis

-  If adequate bystander chest compressions are provided, EMS providers
- perform immediate rhythm analysis

**Notes:**
This is the Cardiocerebral Resuscitation protocol.

Chest compression alone CPR is advocated and instructed by 9-1-1 dispatchers.

If adequate bystander chest compressions are provided, paramedics go directly to rhythm analysis and shock.

If there is no bystander CPR, Paramedics administer 200 rapid forceful uninterrupted chest compressions at a rate of 100 compressions/minute allowing full chest recoil. 
If a shockable rhythm is present, a single shock is administered followed immediately by another 200 chest compressions prior to pulse or rhythm check. 

The airway is initially managed with either a BVM at a rate of 8 ventilations/minute or 100% FIO2 NRB facemask .  This was left up to the paramedics discretion depending on how many providers were responding to the arrest. 

Paramedics administer one milligram of epinephrine Intravenously as early as possible and again with each cycle of chest compression and rhythm analysis. 

After 3 cycles of chest compressions and rhythm analysis, providers returned to their standard ACLS protocol consisting of endotracheal intubation and ACLS drugs.

## Health Crisis Fund

- 200K appropriated to mass public education in Continuous Chest Compression – CPR
- Tracking those trained
- Tracking bystander response
- Tracking survival rates

## www.heart.arizona.edu

- Chest Compression Only CPR
- can be taught in minutes

## Slide 15

## Stroke Telemedicine for Arizona Rural Residents

- NIH Pilot – lead hub UCSD; primary Arizona hub - Mayo
- System is web-based with high resolution, 2 way audio and video technology
- Immediate access to remote telemedicine site without need for consulting MD to be at a fixed location.
- Pilot sites – Yuma and Kingman – large #’s of acute strokes, no staff stroke neurologist, support from local emergency team.

## Thank you

- Contact Information:
- Nicole Olmstead
- 	Cardiovascular Disease Program Manager
- 	Arizona Department of Health Services
- 	_[olmsten@azdhs.gov](mailto:olmsten@azdhs.gov)_
- 	602-364-0140