HomeMy WebLinkAboutPADD projectMiami -Dade County/City of Miami PADD Project
PUBLIC ACCESS DEFIBRILLATON DEMONSTRATION PROJECTS
Contact Person:
Applicant:
Address:
Phone Number:
E-mail Address:
Allie Grande
Miami -Dade County Fire Rescue
9300 NW 41 Street Miami, Florida 33178
305-331-4653
Grandea cni.miamidade.00v
Receiving a $300,000 award from the U.S. Department of Health and Human
Services will allow Miami -Dade County and City of Miami Fire -Rescue Departments to
implement a new program designed for the general public to lower the response and
shock time know as "Time to Shock" and also deliver cardiopulmonary resuscitation
when a Sudden Cardiac Arrest (SCA) situation is taking place, thus increasing the
possibility of saving human lives. This program will strategically install and maintain 82
Automated External Defibrillators (AED) in the first year throughout Miami -Dade County
and City of Miami, instruct approximately 820 civilians in the first year to recognize
potential SCA situations, and train them in the usage and deployment of CPR/AED
procedures as a response to a possible SCA.
By the end of this program, Miami -Dade County and City of Miami expect to
deploy an AED within the first 5 minutes of a SCA, anticipating a save rate of
approximately 30%. Applying this number to our statistics will result in approximately
1,400 lives being saved during a year.
Just our statistics alone shows the need of a PADD program. This award will
allow Miami -Dade County and City of Miami to significantly increase the survivability of
its residents. This program will allow Fire Rescue personnel to overcome current major
obstacles in saving more lives in our community. The current obstacles are: (1)
overwhelmed highways and significantly congested local traffic, (2) the existence of
many high rise buildings (over 400), and (3) the majority of individuals in our community
having a primary language other than English, facilitates delays and misunderstandings
by 911 operators answering the calls. These obstacles result in reducing the probability
for an AED or an EMS member to conduct AED/CPR procedures within the first 10
minutes of a cardiac arrest. The implementation of the PADD program will address the
above mentioned needs, and facilitate a faster response of the community in a SCA
event.
This program proposes a different alternative to the more traditional methods
implemented by our fire-fighters and emergency response units. It involves the
community by training them to immediately detect a potential SCA and respond to it by
providing AED/CPR procedures thus improving the opportunity for a person to survive a
SCA. This program serves a population of 2.4 million residents in urban and rural areas
distributed in an area of 1,850 square miles.
Miami -Dade County/City of Miami PADD Project
Introduction
Surrounded by water and the Everglades, Miami -Dade County is the most
populated county in the state of Florida, with over 2.3 million residents in a narrow strip
of land covering 1950 square miles. Miami -Dade Fire Rescue responds to an area of
1850 square miles; within the borders of Miami -Dade County is the City of Miami. The
City of Miami is the largest city within Miami -Dade County covering 34 square miles.
The City of Miami and Miami -Dade County's Fire Rescue Departments have
developed a partnership to address the need for a Public Access Defibrillator (PAD)
program within Miami -Dade County. As agencies that support each other with mutual
aid combining efforts to provide a comprehensive program is a necessity to ensure the
survivability of our residents.
Sudden Cardiac Arrest (SCA) is one of the leading causes of death in North
America (over 450,000 annually), killing more persons than breast cancer, lung cancer
and AIDS combined. Studies made by the American Heart Association have shown that
SCA survival rate is greater than 90% when defibrillation, or "Call to Shock", occurs
immediately, and 50-70% if the patient is defibrillated within the first 3 minutes. it
should be noted that "Call to Shock" stands for the amount of time that elapses between
someone recognizing a SCA patient, calling 911 and having the patient defibrillated.
SCA usually results in an irregular heart rhythm called Ventricular Fibrillation (VF). For
every minute the heart remains in VF, the chance for survival decreases by 10%. In
addition, resuscitation must commence in 4 minutes or less from onset of SCA to
prevent brain damage. Lives are needlessly lost because "the clock runs out" before
help arrives. These lost lives almost always result in added suffering of family members
and other loved ones who depend on the patient, not to mention the loss of a productive
citizen to the city. In the August 12, 2004 edition of the New England Medical Journal
researchers confirm that "enhancing a well developed. Monitored, !ay -person -enacted
CPR -response plan by adding AED's and AED training can increase the number of
survivors of out -of -hospital cardiac arrest in public locations".'
An Emergency crew with defibrillator responds when someone within the county
suffers a SCA. Miami -Dade County and the City of Miami do not have a citizen
CPR/AED training program that can create reliance on bystander CPR or AED usage.
Nor does either agency have a Public Access Defibrillation (PAD) Program in place that
trains non-public employees in CPR/AED or that distributes or oversees AEDs outside
of public building or public vehicle settings.
Needs Assessment for County/City PADD Program
The City of Miami Fire -Rescue Department (MFR) has one of the quickest SCA
response time averages in the county at 6.1 minutes. However, Miami -Dade Fire
Miami -Dade County/City of Miami PADD Project
Rescue (MDFR) response time in urban areas is 8.29 minutes; response time in rural
areas is 11.22 minutes to cover an area of 1850 miles.
Response time is measured from receipt of the 911 call for help to the scene
arrival of EMS crews. To assess the "Call to Shock" time, we must add to the
Response Time another 2 minutes of time that it takes the EMS crews to get from the
apparatus to the patient side and apply the defibrillation pads. At this point we have an
average of approximately 8.53 elapsed minutes from "Call to Shock" (average was
obtained by adding 3 above response times and dividing by 3). It has been established
that the SCA patient's chance of survival decreases 10% for every minute they go
without defibrillation. According to our Fire Records Management System in 2003 MFR
responded to 661 cardiac arrest calls and Miami -Dade Fire Rescue responded to an
estimated 3966 cardiac arrest calls for a total of 4,627 cardiac arrest calls. Currently the
City's save rate is 16%. If only based on need a County/City PADD Program is a
necessity.
Miami -Dade County is a narrow passageway of land that suffers from substantial
traffic problems; for our Fire Rescue personnel overwhelmed highways and significant
local traffic create a major obstacle in reaching the public within a survivable timeframe.
Added to this delay are the following:
o Many high rise buildings (over 400) throughout our region that have a
large population of individuals however a very low degree of probability for
an AED or and EMS member to conduct AED/CPR procedures within the
first 10 minutes of Cardiac Arrest.
o Due to a large percentage of individuals in our community having a
primary language other English, the call for help and the 911 operator
assisted call are often delayed and sometimes misunderstood which many
times leads to further Response Time delays of First Responders.
The implementation of a PADD program would significantly increase survivability
of Miami -Dade County residents and visitors due to the fact it would remove the
inherent delays in the 911 system as described above.
According to the most recent report conducted by U.S. Department of Health &
Human Services, persons age 65 and older represent 35 million (12.4%) of the total
U.S. population (about 1 in every 8 Americans). This number is predicted to increase
by 20% in the next 6 years. According to the U.S Census Bureau, more than half of all
persons age 65 and older live in 9 states. Florida, holds the number two spot of the 9
states; of its population of 15.9 million people, 2.8 million (17.6%) are 65 years of age
and older. " Miami -Dade County residents 65 years of age and older comprise 13.3% of
the County's total population. This percentage comprises 9.3% of Florida's total elderly
population. The percentage increases dramatically in November of each year as older
adults known as "snow -birds" migrate down to Florida from colder climates, visiting for
Miami -Dade County/City of Miami PADD Project
several months at a time. The City of Miami has the nation's 7th largest elderly (over
age 65) population. VF affects this age group more than any other; poverty and the lack
of preventative health care that often accompanies it exacerbate the problem as well.
Miami -Dade County is also one of the poorest counties in the nation, according to the
U.S, Department of Commerce. The average household income in Miami Dade County
is 15% below the national average." The City of Miami is the nation's "poorest major
city due to the extreme poverty level neither the county nor the City has the funding
available to purchase and utilize Automatic External Defibrillators (AEDs) or to teach
CPR outside the public employee sector; leaving the hands tied of both MDFR and the
City of Miami Fire from being able to shave precious minutes off the start of defibrillation
and/or CPR on a SCA victim.
Miami -Dade County has implemented the use of a Strategic Business Plan; each
department within the County has a comprehensive plan to address county needs. This
plan focuses on evaluating the needs of the community for placement of services. One
of the goals of the strategic plan is to evaluate AED needs with the assistance of the
American Heart Association; specifically in senior centers and buildings with high
occupancy levels.
Another important factor in the success of the proposed program is public
feedback. Surveys will be conducted of person's within placement sites and will be
used an evaluation tool for future program years.
Methodology
The goal of this project is to establish a County -wide PAD Program aimed at the
general public, more specifically the vast community of elderly in Miami -Dade County.
It is the goal of the program to lower the response and shock time when a Sudden
Cardiac Arrest situation is taking place, thus increasing the possibility of saving human
lives.
If AEDs were readily available throughout the county and deployed within the first
5 minutes of a SCA, we could anticipate that the save rate would be near 30% (this
takes into account un-survivable Dead on Arrival patients). Increasing the save rate to
30% would equal 1,388 additional saved lives per year. This is far better than MFR's
current 16% save rate. Currently Miami -Dade Fire Rescue is working on calculating the
yearly save rate. With the implementation of the County/City PADD Program the two
agencies can expect the impact on the save rate would increase dramatically.
Work Plan
The County/City PADD program will establish a Board of Advisors who will
gather on a quarterly basis to evaluate achievement of program goals, review
Miami -Dade County/City of Miami PADD Project
programmatic statistical outcomes and make recommendations for program change:,.
The Board of Advisors will consist of representatives from the Alliance for Aging, Mercy
Hospital, The American Heart Association, Dade County Health Department, Miami -
Dade Fire Rescue, City of Miami Fire, and PADD volunteers from the community and
Two Medical Directors; one from City of Miami and one from MDFR,
Program Goals include:
Goal 1: Reduce the "Call to Shock" time when a Sudden Cardiac Arrest situation
is taking place from 8.53 minutes down to 5 minutes by end of the proposed
three year grant cycle. This will be accomplished by making the appropriate
placements of AEDs (throughout the public, thus increasing the likelihood of its
usage and decreasing time to 1st shock.
Goal 2: Train and educate 820 civilians by the end of fiscal year 2004-2005, to
immediately respond when a Sudden Cardiac Arrest situation is taking place and
perform CPR/AED procedures on the patient.
We will be partnering with Dade County Health Department (State of Florida
entity that oversees health related issues for entire Miami -Dade County) and with the
American Heart of Association of Miami -Dade County. Working together we will use our
experience, contacts and knowledge to implement a successful PADD Program.
More specifically we will develop and implement the following:
Quarter One
• Miami Dade Fire -Rescue will be responsible to:
o Establish Advisory Board and schedule meetings.
o Establish PAD Office and hire PAD Coordinator to reach out to public.
• Miami Dade Fire -Rescue and City of Miami Fire -Rescue will be responsible to:
o Work with AED manufacturers to partner with them to provide AED's, and
at the same time, have manufacturers contribute to the local PADD
Program so as to allow continued funding of the PADD Program which will
help to maintain AED's in an operational mode for many years to come.
o Seek alternative means of assuring that AED's placed in the public will
remain operational and readily available. This continued funding will help
keep the PADD Program in place, which will ensure ongoing reliability and
a chance to save a life
• PAD Coordinator will:
o Identify target "high risk" areas throughout the county, most in need of
CPR Training and AED placement (this would include large gathering
places, large living facilities, long term care facilities, clinics, elderly care
facilities, home care nurses, schools, transportation vehicles, etc.)
o Team with target areas to educate them on need for CPR/AED's
Miami -Dade County/City of Miami PADD Project
o Work with local high schools to adopt a policy of requiring that students
receive CPR/AED training
o Work with local high schools to encourage community service hours for
CPR/AED training
o Create and educate public (via advertisements, news media, schools,
churches, shopping malls, restaurants, homeowners associations,
business associations, interest groups, security guard firms, etc.) on the
need for CPR/AED's
o Receive and track responses to awareness campaign and capture contact
information
o Set up training schedules
a Deliver education and training in different applicable languages spoken by
the public (we have a large Hispanic, Haitian and English speaking
population)
o Train individuals at the place of work, local parks, local community centers
or at MDFR and MFR buildings in CPR/AED usage using the approved
American Heart Association CPR/AED curriculum
o Begin to purchase AED's and needed accessories. Program these AED's
to give instruction in English, Spanish or French depending on target area
needs.
o Work to develop a street marker (such as a orange colored reflector that
would be glued to the street in front of an AED location) this would alert
passerby's unfamiliar with the AED location as to the availability of an
AED
o Establish Program Management Excel program to keep track of CPR/AED
training, AED units, Pads, Battery expirations. Or establish a maintenance
agreement with the defibrillator vendor who would oversee this task
Quarter Two
• Advisory Board will meet
• PAD Coordinator will:
a Install AEDs at pre -determined locations at target areas
O Install AEDs with cabinets so as to make them more identifiable and
secure
o Install signage at AED location to better display AED
a Install bright signage at front entrance of building that houses AED so as
to better display AED and to prompt passerby AED usage
O Conduct onsite CPR/AED re -enforcement drills at each location
o Establish Team Leaders at each AED Location
o Require quarterly inspections with reports and review quarterly reports on
each AED
o Have PAD Coordinator inspect each AED periodically
o Provide optional re -fresher training and bi-annual re -certification CPRIAEED
training
Miami -Dade County/City of Miami PADD Project
Quarter Three
• Advisory Board will meet
• Miami Dade Fire Rescue and City of Miami Fire -Rescue EMS Staff group will
o Create web based CPR/AED Refresher Course
o Create web based PAD Program Management.
o Implement 24/7 response for any AED usage
o Offer Quality Management of any AED usage (this will include
downloading event into AED software program, reviewing event, meeting
with participants, having participants complete "Event Summary" that will
also record time of Patient Found to time of AED usage, discussing event,
re -enforcing and encouraging participants, service AED unit and placing
unit back into service).
o Educate local EMS agencies on the PAD Program and on the need to
properly treat, document and report AED usage. This will include:
• Add AED location onto 911 Computer Aided Dispatch Screens so
that when a call originates from the AED location the 911 Operator
is alerted to its presence.
• Have 911 call takers inquire as to AED presence on all SCA calls.
• Provide CPR/AED usage protocols at 911 call centers.
• Instruct 911 call takers to guide caller with CPR/AED instructions
when appropriate.
• Educate EMS crews as to AEDs, the PADD Program and the
importance of working with the public to increase their confidence
and usage.
• Insure EMS knows how to properly document and report AED
deployments
• PAD Coordinator will
o Routinely gather resuscitation/defibrillation data from all area EMS
agencies and use Ulstein Reporting Criteria to review events and
• Compare pre-program with current program survival rates
• Give feedback to Advisory Board and EMS agencies/crews
• Make recommendations for improvement
Quarter Four
• Advisory Board will meet and review program outcomes and report outcomes to
the State.
• MDFR and MFR will
o Continue program over site and review feedback, anticipate obstacles and
modify strategies to accomplish goals.
o All of the above will continue to take place
o Develop a review of the program to evaluate the full results and impact
within the community
Miami -Dade County/City of Miami PADD Project
o Develop a plan for dissemination of project results and work with Medical
Directors to have published for National review.
• PAD Coordinator will
o Insure that those AED units already deployed continue to remain fully
operational
n Re -certified those who received CPR/AED training
As per the grant application, Miami -Dade Fire Rescue is required to invite vendors to
bid for contracts. Currently Miami -Dade County uses Medtronic's Physio control units;
which includes all departments within the county to maintain consistency throughout the
County. The county and Miami -Dade Fire Rescue has an existing contract with
Medtronic's Physio to purchase the PADD AED's. This action prevents Miami -Dade
County from incurring costs related to training County first responders to use unfamiliar
equipment. An important component to Miami -Dade County's current contract with
Medtronic's Physio is that they can conduct the Program Management aspect of
tracking CPR/AED training, AED units, Pads, Batteries and expirations, allowing the
PADD Coordinator to focus on training. In addition some condominiums and other
facilities in Miami -Dade County have purchased the same Medtronic's Physio
equipment.
Upon the implementation of the County/City PADD Program, goals will be
realized using Miami -Dade Fire Rescue's Grant Management system. This system will
allow the PADD coordinator to track all program related goals.
This grant will be managed for contract and fiscal compliance by Miami -Dade
Fire Rescue, Financial Resources Division -Office of Grants Management. Monthly
meetings will be conducted between PADD Coordinators from both agencies to
evaluate grant expenditures and address any programmatic challenges that may effect
contract compliance.
In the first year the program expects to train 820 members of the public. Miami -
Dade County will place 38 units and train 10 persons per unit for a total of 380 persons
trained. The City of Miami will place 44 units and train 10 persons per unit for a total of
440 persons trained. In the first year combined the County/City partnership will
generate 820 AED trained members of the public. It is expected that there will be
attrition due to occupants who drop out with will be factored at 12% or 180 persons.
Going forward in year 2 and 3 we can expect the same annual results if the same
funding is available.
Both agencies will compile reports at year end to forward to the State EMS for
integration the State data system. Year end results will also be used to for inclusion in
professional journal articles, as well as a tool of evaluation of the successes of the
program.
Miami -Dade County/City of Miami PADD Project
Our trained public rescuers will use a comprehensive event form that will track
such data as patient found time. The time frame between the patient found time and
the time that the AED machine was used will serve to establish average shock time.
MDFR and MFR both believe that recent history throughout the US has shown
that AEDs are a great tool for saving lives, but a weakness in the issuance of AEDs has
been the lack of ongoing maintenance of the AEDs and the lack of continued re-
certification of those trained in AED/CPR procedures.
MDFR and MFR both acknowledge the success of the PAD Program in San
Diego, California that started 3 years ago with 42 AEDs and they now have 1000 AEDs
in the public setting. The secret to their success is having committed leadership and an
agreement with a sole manufacture to distribute AEDs in their region for a set price and
a continued contribution to the local PADD Program that funds the PAD Coordinator
Position/Office. The San Diego PAD Office also charges for AED/CPR training and
program management. These charges help to fund the program which insures ongoing
training and PAD program management. MDFR and MFR are committed to pursuing a
like agreement which will insure a thriving PAD Program going forward.
Resolution of Challenges
Potential challenges that this program may face include items such as AEID
Trained Citizen attrition. Attrition is expected and a commitment form will be filled out
by each citizen participant to determine challenges. Miami -Dade County has a large
number of citizens in the Miami -Beach area that are Jewish and are not allowed to use
electric on the Sabbath. Taking religious restrictions into consideration, our PADD
Coordinator will address this issue in training and confirm that there will always be
citizens to assist, The creation of the Advisory Board is another means by which our
program will regularly address potential design and implementation problems. Miami -
Dade Fire Rescue's Division of Financial Resources Office of grants management will
review on a monthly basis the program budget and assure contract fiscal compliance.
Evaluation and Technical Support Capacity
Miami -Dade Fire Rescue and City of Miami Fire have successfully partnered in
the Urban Area's Strategic initiative Grant for the past two years. Miami -Dade Fire
Rescue currently manages over 10 million dollars in grant assets, and has been
recognized by FEMA US&R for their comprehensive reimbursement packages which
will be used as the model for fiscal training. Miami -Dade Fire Rescue is the 7tt' largest
fire department in the nation and is fully capable of the shared implementation and
management of the PADD program.
A Board of Advisors will be established to review program design and
implementation will consist of representatives from the Alliance for Aging, Mercy
Miami -Dade County/City of Miami PADD Project
Hospital, The American Heart Association, Dade County Health Department, Miami -
Dade Fire Rescue, City of Miami Fire, and PADD volunteers from the community.
These professionals, experts in their fields, will work to increase the overall quality of
our program.
Within the first three months of the implementation of the County/City PADD
Program, a PADD Coordinator position will be established, final selection of AED
placement sites will be determined and arrangements for provision of training will be
completed. The 2nd and 3rd quarters of the program will focus on the installation of the
AED units, the creation and activation of the AED web -based refresher course, and
training will begin. The final quarter will focus on evaluating final outcomes and
completing training.
Organizational and Consortium Information
Both Miami -Dade Fire Rescue and City of Miami Fire Rescue provide
comprehensive Fire Suppression and Emergency Medical Services for the City and
surrounding municipalities.
Appendix D included an organizational chart that details the relationship between
the lead agency (MDFR) the partner lead agency (MFR), Advisory Board, the PADD
Coordinator, PADD Coordinators supervisor and the AED Trained Citizens and Medical
Directors for visual explanation of work flow.
Miami -Dade County Health Department
8323 NW 12 St. #212, Miami, FI. 33126
Lillian Rivera, RN, MSN at (305)324-2400 Fax (786) 336-1297
City of Miami Fire -Rescue
1151 NW 7 St. 3rd Floor. Miami, FI. 33136
Allen Joyce, Executive Assistant at (305) 416-5430 Fax (305) 400-5029
American Heart Association of Florida
2600 SW 3 Ave. Ste.900, Miami, FI. 33129-2330
Yanet Dopico, Senior Health Initiatives Director
(305) 856-1449 Fax (305)-860-6780
Citations
The New England Journal of Medicine, Public Access Defibrillation and Survival after Out -of -Hospital Cardiac
Arrest, August 12, 2004 Vol. 351 No. 7
www.hhs.gov
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