Elk Grove brings Smart 911 Northern California

Recently our local city emergency services partnered with Smart 911 to improve emergency response, becoming the first city in Northern California to implement the system. The system allows citizens to proactively provide important information about yourself and your family to the 911 center before an emergency happens. The system is tied to your phone number so even if you call from a cell phone, if it's registered in the system, they will have your information. You can give them as much or as little information as you are comfortable giving.

From Smart911.com:  Smart911 allows you to proactively provide details on your family and home that 9-1-1 may need in order to send help in the event of an emergency. It is private and secure, and funded by local municipalities and 9-1-1 centers so that it is free to you.  Smart911 is endorsed by citizens, community groups and public safety officials. While not yet deployed everywhere across the U.S., its availability is growing daily. Even if it is not yet in your area, it will work anywhere you travel.

Smart911 also assists in finding callers. According to the Federal Communications Commission, 70 percent of calls to 911 are from mobile devices with limited location information. Smart911 allows residents to associate their family’s mobile phones with home and work addresses, as well as specific family members, which can assist with quickly dispatching the appropriate response team to the right location. 
Smart911 is a free service available to all residents, and officials describe it as “100 percent private and secure.”

Improving CPR Quality

In June 2013, the American Heart Association published a consensus statement about the quality of CPR both inside and outside the hospital.
In this statement, five main components of high-performance CPR have been identified: chest compression fraction (CCF), chest compression rate, chest compression depth, chest recoil (residual leaning), and ventilation. These CPR components were identified because of their contribution to blood flow and outcome.
Minimize Interruptions: CCF >80%
For adequate tissue oxygenation, it is essential that healthcare providers minimize interruptions in chest compressions and therefore maximize the amount of time chest compressions generate blood flow. CCF is the proportion of time that chest compressions are performed during a cardiac arrest. The duration of arrest is defined as the time cardiac arrest is first identified until time of first return of sustained circulation. To
maximize perfusion, the 2010 AHA Guidelines for CPR and ECC recommend minimizing pauses in chest compressions. Expert consensus is that a CCF of 80% is achievable in a variety of settings. Data on out-of-hospital cardiac arrest indicate that lower CCF is associated with decreased ROSC and survival to hospital discharge. One method to increase CCF that has improved survival is through reduction in preshock
pause.
Chest Compression Rate of 100 to 120/min
The 2010 AHA Guidelines for CPR and ECC recommend a chest compression rate of ≥100/min. As chest compression rates fall, a significant drop-off in ROSC occurs, and higher rates may reduce coronary blood flow and decrease the percentage of compressions that achieve target depth. Data from the ROC Epistry provide the best evidence of association between compression rate and survival and suggest an optimum target of between 100 and 120 compressions per minute. Consistent rates above or below that range appear to reduce survival to discharge.
Chest Compression Depth of ≥50 mm in Adults and at Least One Third the Anterior-Posterior Dimension of the Chest in Infants and Children 
Compressions generate critical blood flow and oxygen and energy delivery to the heart and brain. The 2010 AHA Guidelines for CPR and ECC recommend a single minimum depth for compressions of ≥2 inches (50 mm) in adults. Less information is available for children, but it is reasonable to aim for a compression depth of at least one third of the anterior-posterior dimension of the chest in infants and children (≈1½ inches, or 4 cm, in infants and ≈2 inches, or 5 cm, in children).
Although a recent study suggested that a depth of ≥44 mm in adults may be adequate to ensure optimal outcomes, the preponderance of literature suggests that rescuers often do not compress the chest deeply enough despite recommendations. Earlier studies suggested that compressions at a depth >50 mm may improve defibrillation success and ROSC in adults. A recent study examined chest compression depth and survival in out-of-hospital cardiac arrest in adults and concluded that a depth of <38 mm was associated with
a decrease in ROSC and rates of survival. Confusion may result when a range of depths is recommended and training targets differ from operational performance targets. Optimal depth may depend on factors such as patient size, compression rate, and environmental features (such as the presence of a supporting mattress). Outcome studies to date have been limited by the use of mean compression depth of CPR, the impact of the variability of chest compression depth, and the change in chest compliance over time.
Full Chest Recoil: No Residual Leaning
Incomplete chest wall release occurs when the chest compressor does not allow the chest to fully recoil on completion of the compression. This can occur when a rescuer leans over the patient’s chest, impeding full chest expansion. Leaning is known to decrease the blood flow throughout the heart and can decrease venous return and cardiac output. Although data are sparse regarding outcomes related to leaning, animal studies have shown that leaning increases right atrial pressure and decreases cerebral and coronary perfusion pressure, cardiac index, and left ventricular myocardial flow. Human studies show that a majority of rescuers
often lean during CPR and do not allow the chest to recoil fully. Therefore, the expert panel agrees that leaning should be minimized.
Avoid Excessive Ventilation: Rate <12 Breaths per Minute, Minimal Chest Rise
Although oxygen delivery is essential during CPR, the appropriate timeframe for interventions to supplement existing oxygen in the blood is unclear and likely varies with the type of arrest (arrhythmic versus asphyxial). The metabolic demands for oxygen are also substantially reduced in the patient in arrest even during chest compressions. When sudden arrhythmic arrest is present, oxygen content is initially sufficient, and high-quality chest compressions can circulate oxygenated blood throughout the body. Studies in animals and
humans suggest that compressions without ventilations may be adequate early in nonasphyxial arrests. When asphyxia is the cause of the arrest, the combination of assisted ventilation and high-quality chest compressions is critical to ensure sufficient oxygen delivery. Animal and human studies of asphyxial arrests have found improved outcomes when both assisted ventilations and high-quality chest compressions are
delivered.
Providing sufficient oxygen to the blood without impeding perfusion is the goal of assisted ventilation during CPR. Positive-pressure ventilation reduces Coronary Perfusion Pressure (CPP) during CPR, and synchronous ventilation (recommended in the absence of an advanced airway) requires interruptions, which reduces CCF. Excessive ventilation, either by rate or tidal volume, is common in resuscitation environments. Although chest compression−only CPR by bystanders has yielded similar survival outcomes from out-of-hospital arrest as standard CPR, there is presently not enough evidence to define when or if ventilation should be withheld by experienced providers, and more data will be required.

This information has been taken from CPR Quality: Improving Cardiac Resuscitation Outcomes Both Inside and Outside the Hospital: A Consensus Statement From the American Heart Association, published June 25, 2013.
For more information, you can read the journal article here

Beware of CPR class scams

CPR card scams
Be careful of cards that are made to look like American Heart Association cards. They want you to think they are official American Heart Association cards. Look carefully to make sure the card has the actual American Heart Association logo.

This is an older version of an American Heart Association
Healthcare Provider Card

This is not an American Heart Association card.
Notice how they make the card look very similar to an AHA card
The format is the same, same colors, they even make a
similar logo in the upper right corner like the AHA card

This is the current version of the American Heart Assocation BLS for Healthcare Provider card

American Heart Association cards have security features to protect against fraud. For example, the cards have highlighted areas for the name, issue date, and renewal date so the information cannot be altered once the card is printed. Each discipline is designated by a color stripe at the top edge of both sides of the card. BLS and Heartsaver are Blue, ACLS is red, and PALS and PEARS are purple. All cards with a copyright year of 2006 or later use security microprinting for the information lines. For cards produced in 2001 and later, the card name in the top bar is the repeated text. For example, the microprint on the BLS for Healthcare Provider card is "HEALTHCAREPROVIDERHEALTHCAREPROVIDER" (Figure 1).  If the card is copied, the microprint is not visible and the line simply shows up as a line.

Online only classes
Some CPR "Training Centers" want to sell you a CPR card that you can get simply by taking a course online in about an hour. Don't be fooled by these companies, even if they guarantee that their class is accepted everywhere. Check with your regulatory agency to confirm what is required before taking
a class that is only online with no hands-on skills involved. Don't believe a website just because it says they are accepted by everyone. Most regulatory agencies, especially for healthcare providers, require hands-on practice and testing, and an increasing number of medical facilities are specifically requiring American Heart Association certification. In fact, there are agencies such as the California EMS Authority that requires childcare providers to receive 8 hours of pediatric first aid including CPR and AED, and no part of it can be online. The American Heart Association offers all courses, except Heartsaver Pediatric First Aid, in an online format, but students are required to perform the skills for an AHA Instructor to receive their card. Don't get tricked into taking an ACLS or PALS course that is only online. Any agency that requires you to obtain your ACLS or PALS certification will need to to actually perform skills.
Besides, are you really learning how to do CPR or run a cardiac arrest code when you never actually perform the skills? Anyone can read a book or watch a video. You learn the skills a lot more when you actually do them. Don't sell your patients short. Get the right training so you can help them when they need it.

Random guy in the parking lot
Another dangerous way to receive your CPR card is to get it from a guy that just prints one out for you without actually taking a class. Entire groups of hospital personnel have had their cards made invalid and subsequently fired from their jobs because they got their cards from someone printing them in the parking lot for $20 at their lunch break. A proper American Heart Association course involves watching the proper AHA videos, performing the skills, testing the skills, and a written exam (if necessary). This is why every student must sign in to the course roster with their name, address, and phone number. That way each student could be contacted to make sure the class was conducted in the proper manner should questions arise in the future.

Fake American Heart Association classes
Don't be fooled by a website that says "Uses American Heart Association standards" They are not affiliated with the American Heart Association. They just use the same standards and want you to think they are official. Look for the American Heart Association logo to make sure it is an official American Heart Association training center or training site.

Don't waste your money and risk your job. Get the right training the first time. American Heart Association courses are the gold standard in Emergency Cardiovascular Care.

If you've heard of any other CPR scams, please let us know so we can add them and get the information out to everyone.

CPR videos

Here are some funny but informative videos promoting CPR

Ken Jeong promotes Hands-Only CPR

Jennifer Coolidge promotes Hands-Only CPR

Elizabeth Banks promotes Go Red for Women

Here is a great video from the Heart and Stroke Foundation of Canada

From the British Heart Foundation, Vinnie Jones shows how to do Hands-Only CPR

A Lego version of Vinnie Jones CPR video

A music video emphasizing the AHA (American Heart Association)'s 2010 change in CPR sequence from "ABC" to "CAB." Produced by Educational Services, Providence Sacred Heart Medical Center & Children's Hospital, and Providence Holy Family Hospital in Spokane, Eastern Washington.

A spoof of Justin Timberlake's "Sexyback" done by the University of Alberta 2010 Med class. Wenckebach is a type of cardiac arrhythmia.

Call Me Maybe Student Nurses Parody

I'm At a Code

An Usher parody promoting Hands-Only CPR by ZDoggMD

Scene from The Office

Good Samaritan Laws

One of the most ridiculous excuses, in my opinion, for people to not perform CPR to try and save someone's life is, "I don't want to get sued." What some people don't know is there are laws in place that protect people who try to help others. We call these laws Good Samaritan Laws.
In an effort to reduce bystanders' hesitation to help in an emergency for fear of being sued for unintentional injury. Good Samaritan Laws offer legal protection to people who give reasonable assistance to those who are injured, ill, or otherwise incapacitated.

Good Samaritan laws vary from jurisdiction to jurisdiction, as do their interactions with various other legal principles, such as consent, parental rights and the right to refuse treatment. Most such laws do not apply to medical professionals' or career emergency responders' on-the-job conduct, but some extend protection to professional rescuers when they are acting in a volunteer capacity.

 California Civil Code 1714.2 states:

 (a)In order to encourage citizens to participate in emergency medical services training programs and to render emergency medical services to fellow citizens, no person who has completed a basic cardiopulmonary resuscitation course which complies with the standards adopted by the American Heart Association or the American Red Cross for cardiopulmonary resuscitation and emergency cardiac care, and who, in good faith, renders emergency cardiopulmonary resuscitation at the scene of an emergency shall be liable for any civil damages as a result of any acts or omissions by such person rendering the emergency care. 
(b)This section shall not be construed to grant immunity from civil damages to any person whose conduct in rendering such emergency care constitutes gross negligence.

In other words, if you have been trained in CPR to the standards of the American Heart Association or American Red Cross, you cannot be held liable, provided you stay within the scope of your training.

In terms of AED use, California Civil Code 1714.21 states:

(a)For purposes of this section, the following definitions shall apply: 
     (1)"AED" or "defibrillator" means an automated or automatic external defibrillator.
     (2)"CPR" means cardiopulmonary resuscitation.
(b)Any person who, in good faith and not for compensation, renders emergency care or treatment by the use of an AED at the scene of an emergency is not liable for any civil damages resulting from any acts or omissions in rendering the emergency care.
(c)A person or entity who provides CPR and AED training to a person who renders emergency care pursuant to subdivision (b) is not liable for any civil damages resulting from any acts or omissions of the person rendering the emergency care.
(d)A person or entity that acquires an AED for emergency use pursuant to this section is not liable for any civil damages resulting from any acts or omissions in the rendering of the emergency care by use of an AED, if that person or entity has complied with subdivision (b) of Section 1797.196 of the Health and Safety Code.
(e)A physician who is involved with the placement of an AED and any person or entity responsible for the site where an AED is located is not liable for any civil damages resulting from any acts or omissions of a person who renders emergency care pursuant to subdivision (b), if that physician, person, or entity has complied with all of the requirements of Section 1797.196 of the Health and Safety Code that apply to that physician, person, or entity.
(f)The protections specified in this section do not apply in the case of personal injury or wrongful death that results from the gross negligence or willful or wanton misconduct of the person who renders emergency care or treatment by the use of an AED.

In other words, any person who uses an AED in an emergency cannot be held liable. It also says that business that provides an AED for use cannot be held liable, provided they follow the applicable rules. Also, a physician acting as oversight in the use of the AED cannot be held liable.

It would seem, there are no more excuses for helping someone who needs it in an emergency. So get certified in CPR and AED so you can be a Good Samaritan and help save someone's life.

Call 911 from a cell phone?

What is the emergency response number in your area? Most areas use 911, which if you have a landline available, is a great system. When someone calls 911 all their location information is available to the dispatcher. You could, theoretically, put the phone down without saying a word, an help would be able to find you. However, nowadays, with most people having cell phones, more people do not have landlines or are just outside where a landline is not available. Do you know what happens if you call 911 from a cell phone? Did you know the call does not go to a 911 dispatcher as it does when you call from a
landline.

Cell phone technology has not quite reached the point where it can tell exactly where you are and locate the nearest 911 call center. As a result, if you call 911 in California, you will actually be calling a CHP (Highway Patrol) call center, possibly nowhere near your location. It is also not an emergency line so the phone may not get picked up as quickly as a 911 call center. The system still works, but you must be aware that you will need to give details about your location so they can transfer your call to the appropriate call center.

Online AHA courses?

Don't have time to attend a full First Aid or CPR class?

Did you know the American Heart Association has online courses available?

Online versions are available for BLS for Healthcare Providers, Heartsaver First Aid, CPR, and First Aid and CPR.

Go online to onlineAHA.org to take the classroom portion of the course online, at your own pace. Then, see an AHA instructor to test your skills, and you're all done. No need to sit in a classroom for hours, and you will receive the same certification card as if you did!

Due to the regulatory nature of the course for childcare workers, there is no online version of the Heartsaver Pediatric First Aid course. The course must be taken in the classroom.