WHEN SECONDS MATTER

By Audrey Fraizer

If you know anything about the CPR notification application (“app”) developed by the San Ramon Valley Fire Protection District (SRVFPD), you’ve probably heard the story about how it came to be.

If not, here’s a story six months down the road from its release, according to the first-hand knowledge of San Ramon City (Calif.) Mayor Bill Clarkson.

Clarkson was grabbing lunch at a shopping mall at the same time an individual in the parking lot was experiencing a medical emergency. The mayor didn’t know what happened, but once his phone let him know something did, he was on his way to help.

“Got to go,” was all he told his baffled lunch partners.

Although SRVFPD paramedics arrived before he got there, he was nonetheless grateful for the interruption. The same goes for the next day when Mayor Clarkson was enjoying a concert in a city park with 12 other members of the city’s Rotary Club.

“A woman in front of us screamed and we see that the guy next to her had fallen sideways off his lawn chair,” Clarkson said. “He wasn’t breathing. Within two minutes, everyone’s phone lit up at the same time.”

The man gained consciousness in seconds but if he hadn’t, there were 13 people ready and willing to compress his chest to the lifesaving beat of the Bee Gee’s big hit “Staying Alive,” Clarkson said.

“The Rotary Club is all about service and this is a great way to help our community,” he said.

How it works

The CPR notification alert is a software-as-a-service pre-arrival app developed by the SRVFPD and an IT team from Northern Kentucky University under the direction of Chief Information Officer and Associate Provost for Information Technology Tim Ferguson. Where the app is adopted, everyday citizens—and mayors—indicating they are trained in CPR can literally become lifesavers to victims of Sudden Cardiac Arrest (SCA).

When a SCA occurs in a public place, the app notifies users, within covered communities, simultaneous to 9-1-1 dispatch of advanced medical care. Notification isn’t based on where the subscriber purchased the phone. The alert includes both the SCA victim’s location and where to find the nearest Automated External Defibrillator (AED) device.

SRVFPD Fire Chief Richard Price came up with the idea in much the same manner as Mayor Clarkson—over lunch. The chief heard a siren and saw an ambulance drive into the plaza and stop at the store next to the deli where he was eating in response—as he soon learned—to a 9-1-1 call involving an individual who had experienced SCA.

“As fire chief I don’t receive pages for medical calls,” Chief Price said during a EMS 12-Lead Podcast recorded July 12, 2012. “If I had heard, or if someone else close by had been notified, that could have made all the difference in that man’s life.”

When time counts

SCA is survivable, given prompt administration of CPR. According to the American Heart Association (AHA), it occurs when electrical impulses in the heart become rapid or chaotic, which cause the heart to stop beating. A victim of SCA has only about 10 minutes to live, although brain damage begins several minutes before that. With immediate CPR or AED intervention, the victim’s chances increase dramatically. Despite the odds, however, CPR is only performed in about 25% of out-of-hospital cardiac arrest cases. AEDs are retrieved and used only 1% or 2% of the time when available primarily because people don’t know where to find them, Chief Price said.

The Rotarians were among the first to receive CPR training and download the app all in the same day, but they are far from the last. The mobile CPR app, in testing for more than a year prior to its official release on Feb. 13, 2012, has been picked up by Alameda County, Calif., and the San Jose Fire Department service area. So far, there are more than 12,000 using the app.

On the research front, Toronto EMS has partnered with the resuscitation research group Rescu, based at St. Michael’s Hospital at the University of Toronto, Canada, to evaluate the app’s ability to increase bystander CPR rates and AED use for out-of-hospital cardiac arrest victims. Dr. Steven Brooks, a clinician-scientist and emergency physician at Queen’s University in Kingston, Ontario, and an affiliate scientist at Rescu, is the principal investigator for the three-year study funded by the Heart and Stroke Foundation of Ontario.

Dan Cottom, Toronto EMS System Operations superintendent, said a large EMS system and call volume combined with their ability to capture high quality data make Toronto EMS the ideal partner in the pilot project.

“Our service is research-oriented and we do a lot in the line of outcome-based medicine,” he said. “We’ll collect the data and, unless there’s a problem, which I don’t foresee, help introduce it to other parts of Toronto.”

He anticipated the app to be up and running by mid-September.

Chief Price said several other cities and countries have showed an active interest, especially since they created the nonprofit PulsePoint Foundation last year to distribute and support the application.

Load ’er up

To install, users in an area where the app has been implemented simply search PulsePoint in the Apple App Store or in Android Apps on Google Play. Real-time alerts once the app is downloaded—and the phone turned on—are based on the user’s location at that moment in relation to the victim within a specific radius as configured by the covered agency. For security purposes, a call from a private residence does not activate notification.

The app works in conjunction with each level of response, beginning at the call to 9-1-1. If through questioning the dispatcher determines a patient in SCA, the ECHO-level Determinant Code the dispatcher selects activates PulsePoint response. The app does not contradict Pre-Arrival Instructions for bystander CPR or hinder the arrival of emergency vehicles. The process continues as scripted in the Medical Priority Dispatch System (MPDS). Three people arriving on scene are never a crowd since “extras” are then available to assign tasks, rotate turns at CPR, retrieve the closest AED, or clap to the CPR beat.

But CPR is only the beginning, said SRVFPD Communication Center Manager Sean Grayson.

“This applies to a variety of people interested in emergency response,” he said. “It also provides real-time access to emergency activity as it occurs.”

Wondering if a traffic accident in another lane is causing the pile-up on the expressway or where a passing fire engine or ambulance is heading? Users can tap the application to find the incident location or plan an alternate route, according to the PulsePoint Foundation press release. It also acts as a modern-day scanner, allowing users to listen in on live emergency radio traffic.

Chief Price, who serves as president of the nonprofit PulsePoint Foundation, said the response has been positive, with signs of success evident in the momentum it’s gaining. The money the foundation raises is used in development and bringing the application to other areas.

“The app magnifies the good work people are already doing in the chain of survival,” he said. “It gives us another opportunity to deliver people alive to the hospital after suffering a SCA.”

ABOUT THE AUTHOR :
Audrey Fraizer is Managing Editor of the Journal, and is poster child for an editorial personality. She has a focused streak difficult to distract, calls library research a hobby, and believes she fools her co-workers into thinking she’s listening when she’s actually not.

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