Sudden Cardiac Arrest Risks

Recent studies have shed light on many risk factors related to Sudden Cardiac Arrest (SCA); often a quick and silent killer.

Up to ninety percent of those who die from SCA have evidence of plaque (fat and cholesterol) in two or more major arteries. Plaque buildup leads to one common underlying cause: coronary artery disease.

Sudden Cardiac Arrest Risks

The Mayo Clinic (a medical research group) reports that because the link between coronary artery disease and SCA is so strong, the same factors that put you at risk of coronary artery disease also may put you at risk of SCA.

These include:

• Family history of coronary artery disease
• Smoking
• Hypertension
• High blood cholesterol
• Obesity
• Diabetes
• Sedentary lifestyle
• Alcohol (more than one to two drinks per day)
• Age (after 45 for men and 55 for women)
• Being male (2-3 times the risk)

Sudden Cardiac Arrest Risks

The American Heart Association reports that Sudden Cardiac Arrest Risks can be caused by almost any known heart condition, they list the following specific factors that further increase the odds:

Scarring or enlargement of the heart from a previous heart attack or other causes can make someone more prone to developing life-threatening ventricular arrhythmias.

Cardiomyopathy is a deterioration of the heart muscle; typically a root cause of SCA in athletes.

Heart medications, under certain conditions, can set the stage for arrhythmias that cause SCA. Antiarrhythmic drugs sometimes can produce lethal ventricular arrhythmias, even at normal doses.

Electrical abnormalities, such as Wolff-Parkinson-White syndrome (a condition with an extra electrical pathway in the heart) and long QT syndrome (a disorder of the heart’s electrical activity) may cause SCA in children and young people.

Blood vessel abnormalities, particularly in the coronary arteries and aorta, may be present in young SCD victims. Adrenaline released during intense physical or athletic activity often acts as a trigger for SCA when these abnormalities are present.

Recreational drug use, even in people without organic heart disease, is a cause of SCA.

There are numerous risk factors related to SCA, but there are also ways to reduce the risk. Next week we will highlight some SCA prevention methods that you can incorporate into your everyday life. Don’t forget to check back!

Defibrillator Liability: Do You Have All the Facts?

Introduction

Sudden cardiac arrest (SCA) strikes over 45,000 Canadians per year. The only proven treatment for SCA victims is early defibrillation. If no defibrillation is administered within ten minutes of the attack, the chances for survival approach zero.

The latest guidelines from the Heart & Stroke Foundation call for lay responders trained in the use of Automated External Defibrillators (AED’s) as well as CPR.

Organizations that implement early defibrillation programs demonstrate a commitment to the advancement of public health and the welfare of their staff and co-workers.

Defibrillator Liability

Defibrillator Liability

As medical technologies go, public access to defibrillation is relatively new and it is not uncommon for people worrying that novel plans may lead to unexpected problems: problems that can land them in court.

The truth is that legal liability risks associated with early defibrillation programs are remote. Liability concerns should not deter those considering the purchase and use of an AED.

Relevant trial court verdicts suggest that organizations that adopt AED programs face a lower liability risk than those that do not. This includes the US states of Florida and California, which have the highest medical litigation rates in North America.

Many provinces also have laws that limit the types and scope of negligence lawsuits permissible against individuals who render emergency medical care including tort limitation, Good Samaritan laws and a variety of immunity laws.

Defibrillator Liability and the Law

Only two US cases on record directly address the issue of early defibrillation by non-healthcare professionals¹, and both complaints alleged negligence for not having an AED available. Because they were both dismissed on technical grounds, neither case offers much guidance on how future appellate courts might address issues surrounding public access defibrillation.

Future trial court cases will likely revolve around society’s view of reasonableness when businesses are faced with ill or injured patrons.

Courts examining notions of reasonableness in other medical contexts have historically resisted requiring businesses faced with ill or injured patrons to do anything more than summon an ambulance. However, the AED legal and regulatory landscape is evolving.

Action (or inaction) that the courts view as reasonable today may be viewed as unreasonable tomorrow.

Advances in AED technology, their relatively low cost and the now proven ability of these devices to save lives may persuade trial and appellate courts to sanction businesses that do not adopt AED programs.²

A Word on Causation

Defibrillator Liability

A successful negligence lawsuit involving defibrillator liability requires proof that the alleged misconduct caused legally recognized damages such as death or injury. That means any case will allege harm through one of three possible causation theories:

  • Failure to purchase and make available an AED
  • Failure to use an available AED
  • Improper use of an available AED

Businesses that do not deploy AEDs at the scene of an SCA are at the greatest risk in terms of proof of causation.

Next in order of risk are those situations in which an AED is available but not used or improperly used. Modern AEDs are both easy to use and difficult to misuse. These systems have been extensively tested in thousands of cases without a single recorded case of accidental shock. Companies that purchase and train their staff to properly use AEDs assume the lowest causation risk.

Left untreated, a sudden cardiac arrest will always kill the victim. A properly used AED can only help. Therefore, proving medical causation of harm in any early defibrillation case would be extremely difficult.

The most likely causation question to be considered is whether death could have been prevented with –not caused by– the availability and use of an AED.

Minimizing Legal Defibrillator Liability

There are a variety of ways to manage the lawsuit liability risks associated with early defibrillation programs:

1. Design a careful program

The development of a detailed plan for having a trained rescuer quickly arrive at the side of an injured or sick person will reduce the stress burden of any responder, and lead to improvements in administering care.

General rules governing negligence cases suggest organizations that implement a plan for their early defibrillation programs face lower legal liability risks than those that do not.

2. Promote Good Samaritan laws

Most provinces have Good Samaritan laws³ that protect individuals from legal liability flowing from the provision of emergency medical care.

A growing number of laws specifically protect responders to medical emergencies from legal liability under certain circumstances. A review of local laws will help determine whether, and to what degree, liability immunity protection exists.

Summary

Certain types of businesses can actually reduce their exposure to claims of negligence by adopting an AED program.

The notion held by many companies that buying and deploying AEDs increases risk is not borne out in the courts. No one in North America who had used an AED to render aid has ever been sued for that deployment. Moreover, liability risks impacting businesses that implement AED programs can be further reduced by Good Samaritan laws.

Having an early defibrillation program is the right thing for business and the lower risk option to not having one.

Iridia can provide any organization with the components for a comprehensive AED Program including acquisition of the AED and its accessories; physician-led training and certification, response planning and oversight; and liaison with health care agencies.

Our experience as pioneers of occupational AED programs, and our passion for universal public access defibrillation put us in a unique position to offer a high-value program.

1 Somes v. United Airlines, [1995]; and Talit v. Northwest Airlines, [1995]
2 Richard A. Lazar, “Understanding AED Program Legal Issues” [White paper], (2007)
3 British Columbia Good Samaritan Act, chapter172, 1996; Ontario Good Samaritan Act, chapter 2, 2001; Quebec Civil Code, article 1471, 1991; Nova Scotia Volunteer Services Act, chapter 497, section 3, 1989
4 Yukon Territory Emergency Medical Aid Act, chapter 70, 2002; Alberta Emergency Medical Aid Act, chapter E-7, 2000; Northwest Territories Emergency Medical Aid Act, chapter E-4, 1988; Saskatchewan Emergency Medical Aid Act, chapter E-8, 1978

Avian Influenza (H5N1)

Influenza is in the news again as the flu season hits full stride. No, it is not the H1N1 strain that is garnering attention this year, rather the avian influenza (H5N1) strain, which is commonly called the bird flu.

Recently a man in China has died from the H5N1 flu, the first reported human death in 18 months. The death prompted the local government to cull thousands of birds to prevent the spread of the virus. At this time no other cases have been discovered.

[youtube=http://www.youtube.com/watch?v=_jlKXAPXiSQ]

What is H5N1?

H5N1 is a particular strain of avian flu that can cause infection in humans, first discovered in Southern China in 1996. Over 300 humans in twelve different countries have died from the H5N1 bird flu.

The majority of H5N1 cases in humans have been due to the handling of infected birds. 60% of those who have been infected with H5N1 have died. The following people have an increased chance of contracting the avian flu:

  • Individuals who breed and handle poultry
  • Travellers visiting infected countries
  • Those who eat undercooked poultry

Spread

The virus usually spreads from farm to farm, and then from bird to bird, via air or bird droppings; the virus can also be carried on feet of rodents, spreading virus further.

From one country to another, virus is spread through international trade of poultry; migratory birds have also been known to spread virus, while wild ducks can pollute water supplies.

The virus can survive in cool temperatures in contaminated manure for 3 months; in water, up to four days at 22 degrees Celsius and 30 days at 0 degrees Celsius. This resilience allows ample time for the virus to affect other birds. Infected birds are then able to spread the virus from country to country through migratory patterns.

H5N1 avian influenza: Timeline of major events

Pandemic Potential

All influenza viruses have the potential to can change. It is possible that an avian influenza virus could change so that it could infect humans and could spread easily from person to person. Because these viruses do not commonly infect humans, there is little or no immune protection against them in the human population. If an avian virus were able to infect people and gain the ability to spread easily from person to person, an “influenza pandemic” could begin.

Symptoms

Infection of the H5N1 virus causes typical flu-like symptoms in humans such as:

  • Fever
  • Sore throat
  • Cough
  • Muscle aches
  • Eye infections
  • In several fatal cases, severe respiratory distress secondary to viral pneumonia

Prevention

The best way to minimize the spread is rapid destruction of all infected or exposed birds, which involves proper disposal of carcasses, rigorous quarantine and disinfection measures (virus is killed by heat, 60 degrees C for 30 minutes) and common disinfectants such as formalin and iodine compounds.

Currently there is no vaccination for H5N1. The best prevention on a personal level is to use protective gear when handling birds that may be infected, as well as avoiding live-bird markets in infected areas. It is also very important to avoid undercooked poultry and egg products.

For organizations worldwide it is a reminder to be prepared. As the H1N1 pandemic becomes a thing of the past, we need to be vigilant and ready for the next pandemic, which substantiated the H5N1 strain.

In order to protect yourself and your organization it is vital that you have in place a pandemic plan that covers the following areas:

  • Communication tools and protocols
  • Human resources policies
  • Vaccine and antiviral usage
  • Personal protective equipment strategies
  • Infection control measures

Outlook

In August 2011, the Food and Agriculture Organization of the United Nations warned of a possible major resurgence of the H5N1 virus in the coming months, saying migratory birds appeared to be carrying it and infecting domestic poultry in Bangladesh, China, Egypt, India, Indonesia and Vietnam.

While we have no way of knowing exactly when the next pandemic will take place, by having the right tools in place we can mitigate the potential risks.

While you can’t always foresee an emergency situation, you can always ensure you are prepared.

AED Failure: an Avoidable Problem

Maintaining Automatic External Defibril­lators (AEDs) is perhaps the most impor­tant step in an AED program. Staff at a Washington D.C. gym learned this the hard way when a 55-year old man named Ralph Polanec collapsed.

The staff members at the gym rushed to grab their AED but could not get the device to turn on and deliver the life-saving shock Ralph’s heart needed.

Despite the best efforts of EMS personnel and friends at the scene, Ralph’s heart nev­er restarted. Later it was found out that the batteries had been removed from the de­vice when they lost their charge, they had never been replaced, effectively rendering the AED useless.

“He shouldn’t have died. I was very upset that the equipment wasn’t working, be­cause if it had been working, it might have saved him, it’s no good if it doesn’t work,” said 77-year-old Ruth Polanec, Ralph’s stepmother.

AED Failure

Ruth is not alone in her reaction. As it turns out, battery problems are one of the leading causes of potentially deadly AED failures.

AED failureA recent study shows some 1,150 deaths were tied to AED failures over a 15-year pe­riod, and nearly one in four of those failures were caused by problems with batteries. Dr. Deluca, the study’s lead author, determined that 23.2 percent of the AED failures were due to battery/power failures, while 23.7 percent were due to problems with the pads or connectors.

Even though the report describes a variety of maintenance related problems, DeLuca is quick to note that AED failures appear to be very rare. “I don’t want to send the mes­sage that these devices are unsafe or that they don’t work,” DeLuca said. “Most of the time they do work and they save lives.”

AED batteries generally last up to five years. But it is important to implement an AED program that regularly checks for error mes­sages and could alert users about low batteries.

AED maintenance is key to having a successful AED program, step up and keep your AED program running smoothly. Visit 

 


Understanding the Risks of Heart Disease and Stroke

If you would like to understand your risk of heart disease and stroke, then try this quiz out. It only takes a few minutes and gives a lot of great feedback w/ personalized summary.

Risks of Heart Disease and Stroke

The quiz is part of the Heart and Stroke Foundations new campaign to “make death wait.”

Their goals are to reduce deaths due to heart disease and stroke by 25% by 2020. That’s 25,000 lives – the size of a typical town – that could be saved every year.

Follow this link to try out the quiz:
http://ww1.heartandstroke.ca/hs_Risk.asp?media=risk_MDW_Twitter

As a health care consulting and cardiac care training firm, one of Global Medical Services’ goals is to bring exceptional health care and training to everyone. Part of the way we do this is by generating awareness for terrible health conditions such as heart disease and stroke. If you would like to donate, volunteer, or find out more information about the “Make Death Wait” campaign, please follow this link:
http://mdw.heartandstroke.ca/actions

You Don’t Need to be a Doctor… AED Facts

These days anyone can save a life. Automated External Defibrillators (AEDs) make it possible for bystanders to perform life saving actions with little or no training. Voice prompts and simple instructions make AEDs incredibly easy to operate, giving any rescuer the chance to act.

For those of you who don’t know, an AED is a small machine that can analyze a heart rhythm. It can determine whether or not the heart rhythm is beating effectively, if not, the AED can deliver a shock that will likely restart the heart.  An AED will only advise the individual using the device to deliver a shock if the heart is in a rhythm which can be corrected by defibrillation.

AED Facts

Signs of cardiac arrest include: no breathing, no movement or response to initial rescue breaths, and no pulse. Often the only “cure” of sudden cardiac arrest is rapid defibrillation with an AED. 

AED Facts
http://www.heartandstroke.com

• In Canada, 35,000 to 45,000 people die of sudden cardiac arrest each year

• AEDs are safe, easy to use, and can be used effectively by trained medical and nonmedical individuals. Trained responders have effectively used AEDs in many public settings, including casinos, airport terminals, and airplanes. Trained laypersons can use AEDs safely and effectively.

• An AED is an efficient and effective means of achieving rapid defibrillation in both the out-of-hospital and in-hospital setting.

• Sudden cardiac arrest occurs with a frequency of roughly 1 per 1000 people 35 years of age or older per year.

• Any location that has 1000 adults over the age of 35 present per day during normal business hours (7.5 hours/day, 5 days per week, 250 days per year) can expect 1 incident of sudden cardiac arrest every 5 years.

• For every one minute delay in defibrillation, the survival rate of a cardiac arrest victim decreases by 7 to 10%. After more than 12 minutes of ventricular fibrillation, the survival rate of adults is less than 5%.

• Currently there is evidence to support a recommendation to use AEDs for children over the age of 1, but not for children under the age of 1.

• Across Canada, some provinces regulate the use of AEDs, while other provinces do not. Information about individual provincial regulations can be obtained from the provincial Heart and Stroke Foundation offices.
___________________________________________________________

With time being a major critical factor for surviving cardiac arrest, it is imperative that the public have widespread access and training to AED devices. Public Access Defibrillation (PAD) trials have demonstrated a doubling of survival rates (from 15% to 30%) in facilities with high likelihood and with trained staff always available.

Spread the word, AEDs = Lives Saved

 

 

Vancouver Plane Crash – 10/27/2011

First responders such as paramedics, fire rescue and police put their lives on the line everyday when answering emergency calls. Thursday’s plane crash in Vancouver that left many injured was not a typical emergency call for our first responders; or a typical afternoon for those who witnessed the accident.

In case you haven’t heard about the crash or would like to check up-to-date information on the accident, visit the Vanoucver Sun here:
http://www.vancouversun.com/news

Vancouver Plane Crash

Moral obligations of bystanders have been making headlines recently.

http://vancouver.openfile.ca/blog/curator-blog/curated-news/2011/canadian-doctors-bystanders-have-moral-obligation-perform-cpr.

Should strangers rush in to save someone who is in trouble? We would like to think if something terrible happened to us and someone witnessed it, they would come to our aid. But yet, in many cases people are either too stunned or not equipped to deal with an accident. Fortunately yesterday’s plane crash had a silver lining and that lay in the efforts of our first responders and those bystanders who put themselves in harm’s way. As the plane burned up on the road, many people who witnessed the accident rushed to the scene through the smoke and fire to save those who were trapped in the wreckage. Due to their outstanding efforts they were able to retrieve all those who were trapped.

Unfortunately even with the efforts of bystanders and EMS personnel the pilot succumbed to his injuries. Currently the co-pilot is in critical condition, with burns covering up to 80% of his body. We can only hope that he and the others who were injured pull through and recover from this horrific accident.

Had those brave individuals not put their own lives at risk to save others, it is possible many more passengers may have died. This crash highlights the importance of all first responders, whether they are fire rescue, paramedics or police. Those who ran to the burning plane to save those inside now know what it’s like for our first responders who put themselves on the front lines every day.

At Iridia  we have the opportunity to work with fire rescue personnel and paramedics. We understand what they do and why they do it. Accidents like this make us feel grateful that we get the chance to work with those who make it their duty to save lives even if it means putting themselves at risk.

We are very proud to work with those who responded to this accident, as well as all the first responders we work with every day. As a leader in the development of medical education, it is our mission to provide physicians, nurses, and other health care professionals with the most up to date information and skills enabling them to provide their patients with the best possible care.

The FCABC Conference Catches Fire Yet Again!

This year’s Fire Chiefs’ Association of BC Conference and Expo in Abbotsford was another resounding success, with over 125 departments represented. It offered an excellent opportunity for fire services personnel to network and provided us a great chance to  reconnect with so many industry leaders from across the province.

Our newest team member, Steve Nordin, was front and center on the trade show flow, sharing a booth with our EMS AED provider, Medtronic. We were also fortunate enough to have Dr. Allan Holmes address a packed room of delegates on Wednesday morning as he spoke on the topic of pre-hospital care and Medical Responder Training.   We thank the crowd for their engagement and are proud to announce that in the coming days we will formally be offering Medical Direction for EMR programs.  Stay tuned for more information on that by way of a mail circular destined for your mailbox.

On behalf of the entire Iridia team, we would like to thank the FCABC and their event sponsors for hosting such a quality event. We look forward to seeing you all again in Richmond in 2012, and in the meantime, stay safe!

Heart Month 2011

heart month

Diana Pozza, Director of Corporate Relations for the Heart and Stroke Foundation of BC & Yukon recieves a $500 cheque from Global’s VP, Vern Biccum

Heart Disease and Stroke are, unsurprisingly, primary causes of death in Canada. According to the most recent Statistics Canada survey from 2007, they are responsible for 129,139 annual deaths (28% of all Canadian deaths) and there is evidence that this number is dramatically growing. With obesity, high blood pressure and diabetes on the rise, heart disease is expected to swell in upcoming generations. Heart and stoke prone ethno-cultural communities like Aboriginals are growing and our national demographic is ageing with the Baby Boomers. Also, lifestyle changes have led to sedentary work environments, poor diets, high sodium intake and increased stress which all contribute to heart disease and stroke. We are facing what the Heart and Stroke Foundation calls the “Perfect Storm”.

Each year, the Heart and Stroke Foundation organizes Heart Month, one of the largest fundraising campaigns in Canada in the battle against these two killers. Heart Month brings together tens of thousands of Canadians who volunteer and donate to raise funds for this worthy cause. As it is an issue that is very significant and personal to us, Global donated $500 from our month’s AED sales. We value and appreciate the hard work the Heart and Stroke Foundation is doing and we are thankful to have them as a partner against heart and stroke disease.

Toronto EMS Creates a New Kind of Paramedic

Paramedics aren’t usually called upon until after someone’s had an accident or an injury, but the Emergency Department of a hospital ranks among the most expensive of places to treat a patient.

Toronto EMS

To ease that demand, Toronto’s EMS program has decided to try something different: visit people’s homes before their need becomes an emergency. Under the city’s Community Paramedicine Program, emergency workers note the living conditions of patients who are, for example, housebound or suffering psychological problems and flag their cases for follow-up. Later with the patient’s permission, Community Paramedics pay them a visit. They interview the patient; sometimes they examine the patient or take a look at the patient’s prescription medications and help to arrange more regular care through community nursing, social workers, or hospital outpatient services.

 Toronto’s EMS

For many people whom are marginalised or living on the fringes of society, paramedics are their first -or even sole- point of contact with the health care system as they rely on emergency services to manage their chronic or unaddressed health care issues. Many of these people whom have fallen through the cracks in the system have become so used to their isolation that they have to be convinced or cajoled into accepting the services that exist for them. By turning paramedics into front-line medical professionals who make house calls, organizers of the program say Community Paramedics have helped to reduce repeat 911 calls by 80%.

“It is unsustainable to wait for the phone to ring and to respond to those life-threatening emergencies,” said Michael Nolan, the president of the Emergency Medical Services Chiefs of Canada. “We believe strongly that paramedics have more to offer by being pro-active.”

The program is gaining attention in other parts of the country as well. “It’s about keeping people healthy so that they don’t need the emergency services; they never deteriorate to that point.” said Penny Price, Alberta Health Services’ Health Integration Manager.

At the moment, there is no program like this in BC, which presents an interesting possibility.

In 2009, BC’s paramedics held a job action mainly over what they considered unacceptably low wages. At times, a junior BC paramedic’s pay can be as low as $2/hour while standing by between calls. In Toronto the starting wage for a paramedic is around $27‑$30/hour.

If you took an average of the various arguments flying back and forth in 2009, you’d probably find supporters of the paramedics saying that this financial position is untenable for junior and part-time paramedics trying to build a career in emergency health care. In response, you’d find detractors saying that the union’s overall proposed wage hike was enormous from a percentage standpoint (31%) with unjustified pay levels (the union claimed it was seeking wage parity with the Vancouver Police). Eventually the strike was broken when Victoria legislated the paramedics back to work with a 3% pay raise.

If Toronto’s success with its community program were to be repeated in BC, it seems there would be a substantial savings in emergency healthcare money and resources, the public would enjoy more comprehensive care, and the paramedics would have an opportunity to retool their wage structure.

Whether or not it represents a potential win-win scenario for paramedics and the BC Ambulance Service brass lies in a couple of questions: would those who opposed the paramedic’s demands reconsider if the paramedics offered services like the one in Toronto alongside their regular duties? To those who supported the paramedics (and the paramedics themselves), do you think it would be fair to ask them to take on programs like this as a condition of a more substantial wage increase?