• What is Cardio-Pulmonary Arrest?

• What is CPR

• What is Do Not Resuscitate ?

• What is a layperson?

• What does defibrillation and AED mean?

• What is Enhanced 911?

• What are Pre-Arrival Instructions?

• What is the RAP?

• What is a Kelly Day?

What is Cardio-Pulmonary Arrest?

Cardio-Pulmonary Arrest is the sudden stoppage of the heart and or lungs.  This event is commonly referred to as Cardiac Arrest.  Without the life supporting nutrients provided by breathing and flowing blood, the body begins to die in a matter of minutes.  The brain is the most seriously affected organ in the body, it begins to die immediately and is irreparably damaged beyond repair after about 10 minutes.  There have been exceptions where patients have recovered completely hours after cardiac arrest. Most of these cases deal with cold water drowning and as yet medical science cannot reproduce this effect. 

Back to Top

DO NOT RESUSCITATE
In 1999, the State of Ohio enacted statewide protocol for persons wishing to exercise the right to die, referred to as the Comfort Care Program. A person designated as a Do Not Resuscitate - Comfort Care patient, in consultation with a physician or advanced practice nurse who writes the DNR order, may elect implementation of the standard DNR protocol based upon one of two events:

(1) Upon a cardiac arrest or a respiratory arrest, the person receives comfort care only. Until an arrest, responders may provide any and all treatments appropriate for the patient, to include components of CPR. Once an arrest occurs, responders withdraw all resuscitative efforts and provide comfort care; or,

(2) Upon identification of the person as a DNR comfort care patient, comfort care is initiated. Patients with a valid DNR Comfort Care Program form:

Will Receive:
Suction the airway, administer oxygen, position for comfort, splint or immobilize, control bleeding, provide pain medication, provide emotional support, contact other appropriate health care providers such as hospice, home health, attending physician/CNP/CNS

Will Not Receive:
Administer chest compressions, insert artificial airway, administer resuscitative drugs, defibrillate or cardiovert, provide respiratory assistance (other than that listed above), initiate resuscitative IV, initiate cardiac monitoring

Without these forms:
By law if an ambulance arrives on the scene of a patient that recently went into cardiac arrest, (no signs of life), or if a patient dies in front of them, they must initiate CPR, advanced life support, and in most cases transport them to the hospital.

To obtain the forms and get additional information please go to the following web site

http://www.odh.ohio.gov/odhprograms/dspc/dnr/dnr1.aspx

or email Steve Wells at steve.wells@miamitwpoh.gov

Back to Top

What is a Layperson?

A layperson is considered anyone who does not have a duty to react in an emergency.  The distinction between a layperson and a responder is ever changing.  Years ago, police officers and firefighters were considered laypersons.  It is now typical for police and firefighters to routinely respond with EMT's and paramedics to medical problems.  The layperson is generally a family member, or the stranger on the street or anyone else who happens to witness an incident while going about their daily activities. 

Back to Top

What does defibrillation and AED mean?

The medically correct term most often associated with cardio-pulmonary arrest is Ventricular Fibrillation (VF).  VF occurs when the heart stops its rhythmic beating pattern and goes into a chaotic pattern that does not produce a pulse or blood pressure.  Defibrillation is an attempt to deliver an electrical shock to the heart to stop the chaotic pattern and allow the heart's normal electrical activity to resume. 

An AED, or Automated External Defibrillator, is a device that is placed on the patient to analyzes the heart rhythm. The AED then delivers the appropriate energy to accomplish defibrillation.  The AED is programmed to shock only patients in ventricular fibrillation and it will not shock someone with a normal heartbeat.  Even if you can not feel a pulse, but the AED detects normal electrical activity, it will not shock the patient.

Back to Top

What is Enhanced 911?

Enhanced 911 is a special form of the 911 system that provides the call taker with the name and address of the person that pays the phone bill for the phone that is used to call 911.  Most people mistakenly assume that the dispatcher will know your exact location by calling 911. This is true about 95% of the time.  However; such things as, recent moves, phones paid for by someone else, pay phones, cellular phones and corporate phone systems may cause errors in the information provided the dispatcher.  It is for this reason that the dispatcher MUST confirm the callers name, address and location of the emergency. 

Back to Top

What are Pre-arrival Instructions?

Pre-Arrival Instructions are medical instructions provided to the caller while waiting for a public safety unit to arrive. The instructions are given using a national standard set of guidelines.  The dispatcher must ask a series of questions relating to the ill or injured person in order to give the correct instructions.  Some people are annoyed because the dispatcher asking so many questions. It seems, however,  the vast majority of callers appreciate the instructions.

Back to Top

What is the RPAB?

The RPAB is the Regional Physicians Advisory Board.  All pre-hospital emergency medical services in the state of Ohio are mandated by law to have a physician as a medical director.  As well as medical direction, the RPAB has been mandated by law to assist in the improvement of EMS in each of 10 regions in the state.  Each region has its own RPAB that meets not less that twice each calendar year.

Click here to learn more about the State of Ohio RPAB's.

Back to Top

What is a Kelly Day?

Employees who utilize a 24 on / 48 off schedule will encounter one week out of every three weeks where they would work three 24 hour shifts in that week. Instead of the normal 48 hour work week, the employee would have a 72 hour work week. In order to balance out the work weeks, we have negotiated a day off in the long week to keep our work week at 48 hours.  Miami Township Fire & EMS technically calls this day off an HRD or Hourly Reduction Day.  The majority of the fire service calls this day a "Kelly Day".

Back to Top

What is CPR

Emergency Cardiovascular Care (ECC) is the term used by the American Heart Association and other international bodies that describes the process of care and treatment of cardiac related illness.  International ECC standards have been developed to deal with "heart attacks". The most serious result of a heart attack is cardio-pulmonary arrest.  A person suffering cardio-pulmonary arrest requires rapid treatment including CPR and defibrillation.

The AHA Guidelines 2000 state; "The most important link in the ECC system in the community is the layperson.  Successful ECC depends on the laypersons' understanding of the importance of early activation of the EMS system, their willingness and ability to initiate effective CPR promptly, and their training in and safe use of AED's.  Accordingly, providing lifesaving BLS at this level can be considered primarily a public, community responsibility."  AHA Guidelines 2000, pg I-3.

Survival of the patient suffering cardio-pulmonary arrest depends on The Chain of Survival;

• Early Access

• Early CPR

• Early Defibrillation

• Early ACLS

Early Access means that someone has to recognize the warning signs of a heart attack.  Someone must contact the Emergency Medical Service unit. In the United States the  911 system is the most common.  Miami Township utilizes the Clermont County Communications Center which offers enhanced 911 service and Pre-Arrival Instruction.

Early CPR means that effective CPR must be started on the patient within 4 minutes after the patient is unconscious and pulseless.  The patients chances of survival sharply decrease after 4 minutes to near 0% at 10 minutes.  Most EMS systems cannot make a response in under 4 minutes and therefore rely on laypersons to initiate CPR.  This phase is so important that many 911 dispatch centers now offer CPR instructions over the telephone.

Early defibrillation is the application of life saving electrical energy to the patient's heart utilizing a defibrillator.  Defibrillators have long been used in hospitals and ambulances in the United States.  However, with the development of the Automated External Defibrillator (AED) the opportunity exists to make AED's available where they would be the most beneficial; in the public.  Persons trained in AED usage have already saved lives where they have been placed. Most notably in airliners, at O'Hare Airport in Chicago, and other public places.

Early ACLS means Advanced Cardiac Life Support.  ACLS is the application of defibrillation, airway procedures, and medication delivery in an attempt to restore the normal electrical activity of the heart.  Paramedics are trained in ACLS, and they transport the patient to Doctors and Nurses who are trained in the same ACLS techniques. The continuity of care is thereby assured if all caregivers are "playing by the same playbook".

See the community CPR calendar for Miami Township Fire & EMS

To learn more about CPR follow this link to the American Heart Association.

Back to Top