Slides from ECCU in San Diego 2015.

1. Death From Cardiac Arrest is a Real Crime!
Can Law Enforcement
Reduce Time to CPR and First Shock?
David B. Hiltz
Consultant-Advocate
Team HEARTSafe

2. No relevant financial relationship(s) exist.
Presenter Disclosure Information

3. Law enforcement can play a pivotal role in
reducing time to CPR and first shock. Let's take a
look at the science, best practices and real world
examples highlighting the lifesaving potential of
law enforcement response in sudden cardiac
arrest.

5. G2000, 2005, 2010, & 2015G2000, 2005, 2010, & 2015
““CPR and AED use by public safety first respondersCPR and AED use by public safety first responders
(traditional and nontraditional) are recommended to(traditional and nontraditional) are recommended to
increase survival rates for SCA (Class I)!increase survival rates for SCA (Class I)!
DOI: 10.1161/CIRCULATIONAHA.105.166554

6. Why LEA-D?Why LEA-D?
• Often more LEA personnel than EMSOften more LEA personnel than EMS
personnel in a given communitypersonnel in a given community
• Patrol units poised to respond rapidlyPatrol units poised to respond rapidly
to emergencies.to emergencies.
• EMS often station-based, fewer inEMS often station-based, fewer in
numbernumber
• LEA personnel often arrive at theLEA personnel often arrive at the
scene before EMS personnelscene before EMS personnel
White RD. Patient outcomes following defibrillation with a low energy biphasic truncated exponential
waveform in out-of-hospital cardiac arrest. Resuscitation. 2001;49:9-14.

7. Why LEA-D?Why LEA-D?
• 81% of police departments respond to81% of police departments respond to
medical emergenciesmedical emergencies
• 50%provide some level of patient care*50%provide some level of patient care*
• Defibrillation capability can greatlyDefibrillation capability can greatly
enhance care renderedenhance care rendered
Cobb LA, Fahrenbruch CE, Walsh TR, et al. Influence of cardiopulmonary resuscitation prior to defibrillation
in patients with out-of-hospital ventricular fibrillation. JAMA. 1999;281:1182-8.

8. Why LEA-D?Why LEA-D?
• Technology has made it possible forTechnology has made it possible for
atypical responders to effectively useatypical responders to effectively use
AEDsAEDs
• LEA personnel trained in CPR-AEDsLEA personnel trained in CPR-AEDs
demonstrate comparable skilldemonstrate comparable skill
competencycompetency
White RD. Technological advances and program initiatives in public access defibrillation using automated
external defibrillators. Curr Opin Crit Care. 2001;7:145-51.
Davis EA, Mosesso VN. Performance of police first responders in utilizing automated external defibrillation
on victims of sudden cardiac arrest. Prehosp Emerg Care. 1998;2:101-7.
Riegel B. Training nontraditional responders to use automated external defibrillators. Am J Crit Care.
1998;7:402-10.

9. High Discharge Survival Rate After Out-of-HospitalHigh Discharge Survival Rate After Out-of-Hospital
VentricularVentricular
Fibrillation With Rapid Defibrillation by Police andFibrillation With Rapid Defibrillation by Police and
ParamedicsParamedics
Annals of Emergency Medicine , Volume 28 , Issue 5 , Pages 480 - 485Annals of Emergency Medicine , Volume 28 , Issue 5 , Pages 480 - 485
R . White , B . Asplin , T . Bugliosi , D . HankinsR . White , B . Asplin , T . Bugliosi , D . Hankins
Conclusion: A high discharge-to-home survival rate was obtained with early
defibrillation by both police and paramedics. When shocks resulted in ROSC,
the overwhelming majority of patients survived (96%). Even brief time
decreases (e.g., 1 minute) in call-to-shock time increase the likelihood of
ROSC from shocks only, with a consequent decrease in the need for ALS
intervention. Short call-to-shock time and ROSC response to shocks only are
major determinants of a high rate of survival after VF.
Seven years' experience with early defibrillation by police andSeven years' experience with early defibrillation by police and
paramedics in an emergency medical services system .paramedics in an emergency medical services system .
Resuscitation , Volume 39 , Issue 3 , Pages 145 - 151Resuscitation , Volume 39 , Issue 3 , Pages 145 - 151
R . WhiteR . White
Conclusion: Both restoration of a functional circulation, without need for
advanced life support interventions, and discharge survival without neurologic
disability are very dependent upon the rapidity with which defibrillation is
accomplished…

10. Law Enforcement Agencies and Out-of-Hospital EmergencyLaw Enforcement Agencies and Out-of-Hospital Emergency
Care . Care .
Annals of Emergency Medicine , Volume 29 , Issue 4 , PagesAnnals of Emergency Medicine , Volume 29 , Issue 4 , Pages
497 - 503497 - 503
H . Alonso-Serra , T . Delbridge , T . Auble , V . Mosesso , E .H . Alonso-Serra , T . Delbridge , T . Auble , V . Mosesso , E .
DavisDavis
Conclusion: Many law enforcement agencies are involved to some extent in
providing out-of-hospital emergency medical care, and most of the agencies
we surveyed would support additional medical training and new or expanded
roles for themselves in EMS systems.
Providing automated external defibrillators to urban police officers inProviding automated external defibrillators to urban police officers in
addition to a fire department rapid defibrillation program is not effectiveaddition to a fire department rapid defibrillation program is not effective
Resuscitation , Volume 66 , Issue 2 , Pages 189 - 196Resuscitation , Volume 66 , Issue 2 , Pages 189 - 196
M . Sayre , J . Evans , L . White , T . BrennanM . Sayre , J . Evans , L . White , T . Brennan
Conclusion: Equipping police cars with AEDs in an urban area where the fire
department-based first response system also carries defibrillators did not
improve the hospital discharge survival rate for victims of OOH-CA.

11. Attitudes of Law Enforcement Officers Regarding AutomatedAttitudes of Law Enforcement Officers Regarding Automated
ExternalExternal
DefibrillatorsDefibrillators
Academic Emergency MedicineAcademic Emergency Medicine ,, Volume 9 Issue 7 Page 751-753, July 2002Volume 9 Issue 7 Page 751-753, July 2002
William J. Groh MD, Miriam R. Lowe MS, Amanda D. OvergaardWilliam J. Groh MD, Miriam R. Lowe MS, Amanda D. Overgaard
BS,BS,
Jeanie M. Neal MS, W. Craig Fishburn BS, Douglas P. Zipes MDJeanie M. Neal MS, W. Craig Fishburn BS, Douglas P. Zipes MDConclusion: Limited knowledge and negative attitudes of law
enforcement officers regarding their involvement in treating OHCA and
using AEDs are commonly present. These factors could result in
barriers that negatively impact law enforcement AED programs.

12. LEA-D concept is endorsed in a jointLEA-D concept is endorsed in a joint
position statement by the Internationalposition statement by the International
Association of Chiefs of Police (IACP)Association of Chiefs of Police (IACP)
and the International Association of Fireand the International Association of Fire
Chiefs (IAFC)Chiefs (IAFC)

14. LAW ENFORCEMENTLAW ENFORCEMENT
AGENCY DEFIBRILLATIONAGENCY DEFIBRILLATION
(LEA-D)(LEA-D)
A review of the published LEA-D studies (Rochester,A review of the published LEA-D studies (Rochester,
Pittsburgh, and Indiana) indicates that significantPittsburgh, and Indiana) indicates that significant
improvements in survival were achieved in studyimprovements in survival were achieved in study
communities with higher population density percommunities with higher population density per
square mile.square mile.
A review of the published LEA-D studies (Rochester,A review of the published LEA-D studies (Rochester,
Pittsburgh, and Indiana) indicates that significantPittsburgh, and Indiana) indicates that significant
improvements in survival were achieved in studyimprovements in survival were achieved in study
communities with higher population density percommunities with higher population density per
square mile.square mile.

15. LAW ENFORCEMENTLAW ENFORCEMENT
AGENCY DEFIBRILLATIONAGENCY DEFIBRILLATION
(LEA-D)(LEA-D)
Police AED Issues Forum panelists agreed thatPolice AED Issues Forum panelists agreed that
Successful LEA-D programs possess certainSuccessful LEA-D programs possess certain
attributes, which are elucidated in the NCED LEA-Dattributes, which are elucidated in the NCED LEA-D
Best Practices ChecklistBest Practices Checklist
Police AED Issues Forum panelists agreed thatPolice AED Issues Forum panelists agreed that
Successful LEA-D programs possess certainSuccessful LEA-D programs possess certain
attributes, which are elucidated in the NCED LEA-Dattributes, which are elucidated in the NCED LEA-D
Best Practices ChecklistBest Practices Checklist

16. ProgressProgress
• Evidence continues toEvidence continues to
support LEA-Dsupport LEA-D
conceptconcept
• More LEA-D programsMore LEA-D programs
have been establishedhave been established
• Lives are being savedLives are being saved

17. Ongoing IssuesOngoing Issues
• What agencies should adopt?What agencies should adopt?
• IntegrationIntegration
• Dispatch policiesDispatch policies
• Medical oversightMedical oversight
• TrainingTraining
• LiabilityLiability
• Program/system coordinationProgram/system coordination
• Quality monitoringQuality monitoring

18. Newman et al. NCED POSITION STATEMENT: LAW ENFORCEMENT AGENCY DEFIBRILLATION
PREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3

20. 1. The ability to respond1. The ability to respond
quicklyquickly and reliably toand reliably to
medicalmedical emergenciesemergencies
The mean LEA response interval (time fromThe mean LEA response interval (time from
9-1-1 call receipt to arrival at the scene) is9-1-1 call receipt to arrival at the scene) is
less than 8 minutes.less than 8 minutes.
The LEA unit arrives at least 2 minutes beforeThe LEA unit arrives at least 2 minutes before
other designated emergency response unitsother designated emergency response units
that provide defibrillation.that provide defibrillation.
The LEA agency continuously strives toThe LEA agency continuously strives to
minimize response intervals.minimize response intervals.
Newman et al. NCED POSITION STATEMENT: LAW ENFORCEMENT AGENCY DEFIBRILLATION
PREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3

21. 2. A supportive medical2. A supportive medical
response culture within theresponse culture within the
law enforcement agencylaw enforcement agency
LEA and local government leadersLEA and local government leaders
support the LEA-D concept and endorsesupport the LEA-D concept and endorse
it in writing.it in writing.
Police officers and their advocates (e.g.,Police officers and their advocates (e.g.,
unions) support the concept.unions) support the concept.
Methods for addressing psychologicalMethods for addressing psychological
issues (e.g., critical incident stressissues (e.g., critical incident stress
debriefing) are established.debriefing) are established.
Success is celebrated (e.g., throughSuccess is celebrated (e.g., through
recognition, awards).recognition, awards).
Newman et al. NCED POSITION STATEMENT: LAW ENFORCEMENT AGENCY DEFIBRILLATION
PREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3

22. 3. Strong champions who3. Strong champions who
serveserve as programas program
advocatesadvocates
Strong champions, such as police officers,Strong champions, such as police officers,
community leaders, and survivors, activelycommunity leaders, and survivors, actively
promote the program.promote the program.
Newman et al. NCED POSITION STATEMENT: LAW ENFORCEMENT AGENCY DEFIBRILLATION
PREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3

23. 4. Integration with the4. Integration with the
emergency medicalemergency medical
servicesservices (EMS) system(EMS) system
Local EMS leaders support the program andLocal EMS leaders support the program and
endorse it in writing.endorse it in writing.
Local EMS collaborates on programLocal EMS collaborates on program
development and training.development and training.
LEA-D protocols are integrated with EMSLEA-D protocols are integrated with EMS
protocols to ensure a seamless transfer ofprotocols to ensure a seamless transfer of
care.care.
Newman et al. NCED POSITION STATEMENT: LAW ENFORCEMENT AGENCY DEFIBRILLATION
PREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3

24. 5. An effective, coordinated5. An effective, coordinated
dispatch systemdispatch system
All 9-1-1 call-takers undergo emergencyAll 9-1-1 call-takers undergo emergency
medical dispatch (EMD) trainingmedical dispatch (EMD) training
Dispatch protocols emphasize the priority ofDispatch protocols emphasize the priority of
cardiac arrest callscardiac arrest calls
Complaints that trigger designation as aComplaints that trigger designation as a
probable cardiac emergency are carefullyprobable cardiac emergency are carefully
evaluated to avoid under- or overtriageevaluated to avoid under- or overtriage
The closest LEA and EMS units are dispatchedThe closest LEA and EMS units are dispatched
simultaneously to cardiac arrest callssimultaneously to cardiac arrest calls
Call processing time is minimized (9-1-1 callCall processing time is minimized (9-1-1 call
receipt to dispatch interval <60 seconds)receipt to dispatch interval <60 seconds)
Newman et al. NCED POSITION STATEMENT: LAW ENFORCEMENT AGENCY DEFIBRILLATION
PREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3

25. 6. A proactive, hands-on6. A proactive, hands-on
medical directormedical director
The medical director is actively involved inThe medical director is actively involved in
program and protocol development, includingprogram and protocol development, including
oversight of trainingoversight of training
The medical director oversees continuousThe medical director oversees continuous
quality improvement (CQI) processes andquality improvement (CQI) processes and
reviews all responses to cardiac arrest and allreviews all responses to cardiac arrest and all
automated external defibrillator (AED)usesautomated external defibrillator (AED)uses
The medical director communicates frequentlyThe medical director communicates frequently
with program personnel, including officers andwith program personnel, including officers and
dispatchers, and provides feedback on specificdispatchers, and provides feedback on specific
casescases
Newman et al. NCED POSITION STATEMENT: LAW ENFORCEMENT AGENCY DEFIBRILLATION
PREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3

26. 7. A designated program7. A designated program
coordinatorcoordinator
A specific individual, the program coordinator,A specific individual, the program coordinator,
is responsible for day-to-day operations andis responsible for day-to-day operations and
program managementprogram management
The program coordinator is authorized to act toThe program coordinator is authorized to act to
ensure program effectivenessensure program effectiveness
Newman et al. NCED POSITION STATEMENT: LAW ENFORCEMENT AGENCY DEFIBRILLATION
PREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3

28. 8. Effective, competency-8. Effective, competency-
basedbased initial and refresherinitial and refresher
trainingtraining
Training is accomplished through use of aTraining is accomplished through use of a
nationally recognized, competency-based,nationally recognized, competency-based,
device-specific training program thatdevice-specific training program that
emphasizes cardiopulmonary resuscitationemphasizes cardiopulmonary resuscitation
(CPR) and AED skills acquisition and retention(CPR) and AED skills acquisition and retention
Refresher training is conducted regularly toRefresher training is conducted regularly to
ensure continued competencyensure continued competency
Newman et al. NCED POSITION STATEMENT: LAW ENFORCEMENT AGENCY DEFIBRILLATION
PREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3

30. CQI processes are established to ensureCQI processes are established to ensure
excellenceexcellence
A data collection tracking process isA data collection tracking process is
established to monitor response and outcomeestablished to monitor response and outcome
information and survival trendsinformation and survival trends
9. An effective CQI program9. An effective CQI program
that includes writtenthat includes written
policies, data collectionpolicies, data collection
andand analysisanalysis
Newman et al. NCED POSITION STATEMENT: LAW ENFORCEMENT AGENCY DEFIBRILLATION
PREHOSPITAL EMERGENCY CARE JULY / SEPTEMBER 2002 VOLUME 6 / NUMBER 3

31. Have officers used theirHave officers used their
AED?AED?
AEDs UsedAEDs Used ## %%
YesYes 8686 75.43975.439
NoNo 2323 20.17520.175
UnknownUnknown 55 4.3864.386
(Total n=114)
Source: Massachusetts LEA Survey 2006

32. Why do you want to haveWhy do you want to have
AED capabilities to yourAED capabilities to your
department?department?
• Their proven valueTheir proven value
• To better serve the residentsTo better serve the residents
• To save livesTo save lives
• To save lives, including our ownTo save lives, including our own
Source: Massachusetts LEA Survey 2006

34. What barriers are impedingWhat barriers are impeding
your agency getting AEDyour agency getting AED
capability?capability?
• Training CostsTraining Costs
• Need for policy changesNeed for policy changes
• High equipment costHigh equipment cost
• Union / CollectiveUnion / Collective
bargaining issuesbargaining issues
Source: Massachusetts LEA Survey 2006

35. What solutions have youWhat solutions have you
found to overcome thesefound to overcome these
barriers?barriers?
• Training compensatedTraining compensated
by contractby contract
• Training is done as partTraining is done as part
of in-service training atof in-service training at
the police academythe police academy
• TBDTBD
Source: Massachusetts LEA Survey 2006

36. OTHEROTHER
CONSIDERATIONS?CONSIDERATIONS?

37. Recently, the Old Saybrook Department of Police
Services, in cooperation with the Old Saybrook
Ambulance Association and Middlesex Hospital has
decided to move forward with several strategies to
improve response, care and outcomes and are
addressing community education, responder
education, emergency system access and dispatch
and research/quality improvement.
"We thoroughly understand that the fastest way to provide emergency cardiac
care is for police officers who are already mobile and deployed throughout our
community to be trained and to respond immediately with AEDs and other
lifesaving skills and equipment. To enhance that the department is working with
the AHA to enhance public and professional education, expand our public access
AED program and assure the highest quality pre-arrival instructions given by our
9-1-1 dispatchers prior to the arrival of our police officer first responders".
- Chief Michael Spera
Best Practice?Best Practice?

38. The Old Saybrook Department of Police Services provides
all first responder services in the town of Old Saybrook.
Recently, the department’s police officers / first
responders have all completed 90 hours of training and
have upgraded their credentials from Emergency Medical
Responder to Emergency Medical Technician. Some of
the unintended consequences include improved lines of
communication between the first responders and
paramedics. Additionally, there has been appreciable
improvement in feedback about cases and an iterative
process where the first responders are learning to better
work with the paramedics and improve quality and
timeliness of care.
"Our patrol division members were so passionate about upgrading their training
that they voluntarily gave up their overtime and rearranged their vacation
schedules to take the required 90 hours of training to earn their EMT
certifications in order to provide a higher level of medical care to their patients.
This has already resulted in improved cardiac care”.
- Phil Coco, EMS Director/Instructor

39. Arresting V-Fib with Early Defibrillation
All police cruisers are equipped with AEDs and
rapid dispatch is supported by departmental
policies and procedures. Additionally, there are
19 publically accessible AEDs in the community.
Information regarding the type and location of
these devices is integrated into the computer
assisted dispatch system in Old Saybrook, and
the readiness of the devices is monitored by the
Department of Police Services.
“I have been so very impressed with the attention and commitment to improving recognition, response,
care and outcomes in Old Saybrook. I commend Chief Spera, EMS Director Coco, and all the
integrated agencies and supporters of this effort. This community can serve as an excellent role
model for others”. – David Hiltz,
NREMT-P, American Heart Association

42. SummarySummary
We need to influence more agenciesWe need to influence more agencies
and individual officers not only toand individual officers not only to
adopt but to establish the system in aadopt but to establish the system in a
manner that brings about the greatestmanner that brings about the greatest
degree of efficiency and effectivenessdegree of efficiency and effectiveness

45. http://www.heartsafe-community.org/