 Welcome. This is Craig Thomas, your host on Much More Medicine, part of Think Tech Hawaii's live stream series and assisted as always by our engineers Rich and Ray. And today we have three folks from the Hollywood Fire Department. It's wonderful to see you. Since there are three, why don't you each introduce yourself and give a little word about what you do with the Fire Department. Let's start with you, Charles. Good morning, I'm Charles Grip with the Hollywood Fire Department. I'm a fire captain. I have little more than 24 years now. And currently I'm assigned to our Training and Research Bureau's Medical Section, our AD and CPR particularly. Excellent, thanks. Good morning, Barry Burnett. I'm a Firefighter 3 in the Hollywood Fire Department. That's over 15 years. I'm also with the Training and Research Bureau in the Medical Section with the Cap Charles Grip here taking care of pain with the AD and CPR program. And Libby. Good morning. I'm doing medical direction with the Hollywood Fire Department. I'm Libby Char. Welcome all of you. Thank you. What we're going to be talking about today is what to do when someone collapses. Often those collapses are due to what can turn into what we call sudden cardiac death. We hope that is the outcome. And it's a chance for everybody walking around to intervene in a moment of urgency or I think crisis is a fair moment. And the intervention can be life saving. And we're going to talk about what's called the chain of survival, sort of the steps that are essential and the key role that both lay people but then fire department and ultimately EMS and the emergency departments play. And I would point out that it's highly likely sometime in your life people have a chance to do this and it's probably a family member or friend because it's somebody near you and it's also when you least expect it. So you know I've had a few different sort of life threatening events as when I've been out in the community not when I've been working in the emergency department and having the training and the basic steps honestly can save a life. So I was hoping one of you would introduce the concept of chain of survival and then we'll kind of talk about the elements and proceed. Well, I mean I would share with you my father died of a sudden cardiac arrest 25 years ago and my mother was there. And so they talk about the chain of survival which she never was taught but we'll share that with you and what she did was when it took place she ended up calling 911 which is the first step access early access to the 911 system to get help there. And then secondly she started compressions which was mentioned there over the phone from the 911 operator and so that'll be your second step early BLS, early basic life support. And then thirdly in our chain is early access to the defibrillation AED back then 25 years ago they didn't have that but the next step was advanced cardiac life support to get there. So those chain those steps in the chain of survival are very important and so for the community we really emphasize if something was to happen to go ahead and call 911 get help there. Locally we have a tendency to call our family members Auntie and Uncle and father and mother and brother. Sometimes not even in Hawaii. Yes yes and so really encouraging the folks to go ahead and call 911 get that help there immediately. And again if it's a cardiac arrest or compressions get the AED on scene there's a lot of AEDs out there in the public access that people can use. Very simple to use. There's instructions to them they talk to you. That can really make a difference in outcome somebody in setting cardiac arrest. I'd like to emphasize what you just said which is they are simple to use and you shouldn't be afraid to try. I'm aware of a study where they went into a class full of sixth graders they gave them the machines and said oh that mannequin needs resuscitation this machine might help see if you can figure it out. They all did fine and they did about 30 seconds. Now that's sixth graders we're a little slower but it's just follow the voice prompts. Exactly. Exactly. So okay and then what happens. So then our department to the 911 system our department when the fire will show up or possibly HPD or HPD as well they have AEDs on their squad cars now then we'll wait for our city county EMS folks to show up as well to put everything together but really it's getting that AED on scene quickly and starting those compressions. Time is everything. Yes absolutely. And so one of the reasons fire departments integrally involved and HPD too is they're far more fire stations and far more police vehicles all over the island and there are EMS bases. So just by geography the chance of getting somebody with an AED and another set of hands to do CPR you know it's gonna happen a lot quicker. Yes. And with the advent of devices in the community besides it can be even quicker yet. A good example would be the Hono International Airport, the Daniel K. No Airport, the public access AEDs all over there. Yes. There's other venues that have them as well and I've known of a few type of stores that have actually deployed their AED and the outcome is positive. Mm-hmm. Yeah the the actual numbers for they don't get deployed very often but they have a good save rate because if they're deployed it's quick. Yes. And so that's actually something to really always remember here. Somebody goes down make sure 911 gets called. If you have access to an AED get somebody to get it for you and start CPR. So the what's what do you consider the essential time ideally to get interventions in place shock CPR to maximize the chance of survival. I would say as soon as possible. That's absolutely true and as possible. That's key. Any help there? For where every minute where CPR is not done your chance of survival decreases by about 10%. So it's really really important to get that CPR started early and that's going to be the public that's not even us because it's going to take minutes for us to get there. The public is on scene. It's really key and and even if the CPR is not perfect it's better than no CPR. And the AEDs I mean I know older generation that hasn't ever seen them before they're a little bit intimidated by them. You can't hurt somebody with it. You can't shock somebody that doesn't need a shock. You can't push the wrong button and hurt anybody. And the machine just talks you right through everything so it there's no need to be afraid of it. You just open it up and it'll walk you through step-by-step. Exactly. Pretty much you have to open the lid and it'll put the pads on as it instructs you and go from there. So they're honestly spectacular devices. But Dr. mentioned about there as soon as possible but we have 43 fire stations with only 20 ambulance on the island. I'm sure you are aware of. So our response times are greater. Us getting there in a reasonable time. Usually four to six minutes on average is crucial but that four to six minutes when we have bystanders performing CPR is where chances of survivability are greater. Right and so what you just described was the reason that on the order of 25 years ago I think it was started getting training and AEDs into HFD and then a few years after that the police vehicles for the same reason. The closer somebody with a device and training is to you and training is more doing the CPR making sure they actually do apply it. It's not that it's hard to do the better. I think in fact I think we've learned over the years that it's doing a good job of the basics is what actually matters. And there's been an interesting development relatively recently on in CPR and the recommendations for how it's done in the community and also how it's done by medical providers have sort of evolved. And one of you take a little swing at that because I think it actually reduces the barrier to lay CPR and also hopefully improves the effectiveness of what we call a professional CPR. So the stigma before was with the community CPR was doing mouth-to-mouth. Right. They've gotten away from that and what we call any hands-only CPR now where it's just compressions. Statistically they show that compressions and getting the heart help pumping and circulating the oxygen in the blood is more valuable than stopping to give two breaths. So now with our community CPR teaching hands-only CPR people are more willing to help because that mouth-to-mouth portion has been taken out of that series. Yeah and obviously it's quite likely you'll be dealing with a stranger so that's a little intimidating but in fact not a big deal but still it turns out it's not a benefit either. So as you say the compression-only CPR is appears to be I think in lay people's hands at least as effective maybe more so than trying to do that conventional. So that's a big change. I should talk a little bit about the evolution. I'd say evolution is probably the right word in provider CPR. So for us in the home fire department we went through American Heart Association. We have now morphed if you will into high-performance CPR with Dr. Char Ball on board to our department back in 2014 and it's continuous compressions. We do a ventilation every 10th compression. So not like the traditional 30 and 2 we continue and recent times in 2017 we changed it a little again from the compressor only doing one minute of compression and we switch off. We have a demonstration that will provide you and you'll see that. That has proven even better results as far as raw skills return a spontaneous circulation that we're seeing more in the field. So that vent of going to this high-performance CPR is really beneficial. I just want to touch on what Barry mentioned about the community CPR. We've been going out throughout those communities and different work groups organizations and some of the folks in those sessions have said when they took CPR before they were afraid to do it in the public because of mouth to mouth. Now with hands only CPR they're willing to help. I always mentioned to them that they're an extension of the first responder community because they're there right on when it happens they witnessed a lot of it and they can help. As we keep saying time is essential and you know is it so is it fair to say so CPR I think is gradually evolved over the years but the recognition has become how important it is to start it and have very minimal interruptions and to do adequately vigorous compressions which is of course why you're talking about switching off. Is that a fair sort of summary of what we're now realizing is the essential. The high-performance CPR is just a more efficient way to do it. You know I think CPR used to be complicated. You had to count and was it 30 and 2 or 15 and 1 or 5 and 1 and you know what if I do it wrong I don't want to hurt somebody I don't want to do mouth to mouth they were all kind of barriers to doing it. So the way it is now it's so simple and so streamlined you know you tap and shout and if the person's unresponsive call 911 get the AED and just start doing chest compressions and that's it. It's absolutely as simple as that and so what Honolulu Fire Department and the other first responders across the state EMS and and all the other fire departments we're just doing a very efficient way of CPR we call high performance CPR and that's what Captain Grip just mentioned. And after the break we are going to have a demonstration of the high performance CPR but the other piece of that is the compressions are the same for everybody. So don't worry about the bag valve mask and if you have an AED by all means hopefully got somebody else with you get it put on because that's very important. But the compressions are the other thing to watch and you'll see that they're fast they're deep and they're hard work which is why people switch off. I guess the one other caveat is we're an ocean state and so if it's a drowning instead of normal cardiac related collapse ventilation still matter but for almost everything else get help in fact repetition is beautiful so why don't you do a brief summary of the chain of survival as it relates to the video which we'll see after the break. We'll do okay so somebody goes down if when you shake them they say what are you doing? You're done. I mean you still need 911 my sense is lay people particularly shouldn't worry about the pulse and otherwise make sure 911's called get an AED if you can and get to work and and so we'll intro the video after the break and talk about some other elements of education and aspects to improve community survival. Thank you we'll read you in a minute. This is Think Tech Hawaii raising public awareness. This guy looks familiar. He calls himself the ultra fan but that doesn't explain all this. He planned this party, planned the snacks, even planned to coordinate colored shirts but he didn't plan to have a good time. Now you wouldn't do this in your own house so don't do it in your team's house. Know your limits and plan ahead so that everyone can have a good time. Hey, hey, are you okay? No pulse, not really starting CPR. I got an AED. We're going 8, 9, 10. Begin CPR. 8, 9, 10. 8, 9, 10. 8, 9, 10. 8, 9, 10. 8, 9, 10. Stay clear of patient. Analyzing. Stay clear of patient. Shock delivered. Begin CPR. Not this one, next 10. Not this one. 8, 9, 10. This one, next one. Yep, coming up. Doing proper. Welcome back. Again, this is Craig Thomas, your host of Much More Medicine with Charles Berry and Libby from the Home of the Fire Department and you've just seen them doing CPR and in fact applying an AED to a mannequin that is representative of a victim of sudden cardiac arrest. And so Berry, I wonder if you kind of explain to people what they saw, what's applicable to laypeople and what they can expect to see when you arrive and also a little bit about the AED. Sure. So what you seen there was us coming in, finding a possible patient on the floor, assessing him if he's responsive, one, tapping, shouting, checking if he was breathing, any pulse, there was none, went straight into compressions. Next person came in with the AED as I was continuing the compressions, turned it on. We have a metronome that's a beat of 100 to 120 hours just set at about 110 and started to apply the pads, continued our CPR without disruption. As a third person came in, we have a BVM which is a bag valve mask in a first responder field, and we were able to give one vent every 10 compressions. And as you've seen, we switched off. It was speeded up a little, but normally we switch off every minute so that our quality of compressions is maintained, especially on our recoil. If it was a layman person in the public, they would come on the same way, check for responsiveness, make sure the scene is safe. If he's not breathing, activate the 911 system, call out for an AED, start compressions. The next person if there was an AED would come and apply it pretty much the same way it was shown there. They're very simple, very user friendly. They have pictures, they have verbal prompts. It's very, very easy to use. And basically continue compressions until another person that's trained could help pick over if they get tired. Or the person wakes up. Or the person wakes up, exactly. That's the ultimate goal. So, perfect. That's a very nice description of what happens. And a couple points just from the looking at it from the lay person's perspective. So, first of all, of course, won't have bag belt masks, don't need to worry about ventilation at all. It is important to shout out and try to make sure somebody's getting 911. And we're going to talk a little bit about how you might get access to an AED also. But I think the other important point is AEDs are really safe. You can't hurt yourself or the patient with them. And if you've been trained, you know, open the door, pull out the pads, follow the prompts. And if you haven't been trained, that's still how you do it. So, it's really okay. You'll want to do it. Because time again is everything. I don't know if the literature has been updated. It used to be that not only the 10% per minute you were talking about, but somewhere around five and a half minutes after collapse. So, this isn't when 911 was called or somebody started CPR. This is after the somewhere around five and a half minutes after collapse, the chances of survival go way down. It's not that they go to zero. But five and a half minutes is not very long. And so, if you're near the fire station, yeah, okay. There's a police officer in a blue and white driving by, yeah, okay. But overall, the people who are at the scene are the ones who make the difference. The other thing that you sort of alluded to, these guys are fit. They swap off every minute. Why? Because if you don't, you start pushing less hard and it gets a little slower and pretty soon it's not adequate. So, hopefully by the time whoever started it is playing out and somebody else has bought an AED, there are other people to tap in and take over. What did I miss? If they call 911, even if they've never been trained, the 911 operator can talk them through how to do chest compressions. And even mediocre chest compressions are way better than no chest compressions. Absolutely. Go ahead and try it. You're not going to hurt somebody. At that point, their heart's not beating and they're not breathing. So do what you can. Try. Compatible with death. So, I just want to emphasize, yes, they are dead. Maybe you can help bring them back, but you can't make them deader. So, that's right. Do it. You can do it based on the video you just saw. Let the 911 operator help you. Or, better, get training. Let's talk a little bit about current HFD training and outreach and then maybe some areas where I'd focus on, we hope the community does in the future. I don't know which of you would type with Charles. I think it's you. So, only in the party department we do hands-only CPR training for the community and groups. We have a website or email address, hfdcprathonolulu.gov. Encourage anybody to use that. Go ahead and send us an email. Bear and I have been around the island, went to different groups recently. Just to get everybody out there trained in CPR. And we always mentioned though, like he was mentioned at the very beginning, it may not be a stranger. It may be a family member. Oh, I think it's often, if not a family member, a friend or a co-worker. Or, for reasons unclear to me, when HPD first got the AEDs, it seemed like it was always a retired officer. It was astonishing. Three quarters of the time the person in cardiac arrest is somebody that you know. Either a co-worker or a family member or something because that's where you spend your time. Exactly. So, we're really pushing the community to get involved and to learn it. We want to build our numbers up like we had years ago. And so, that being said, give us an email. So, just to circle back to that to make sure people know what I'm pretty sure I'm hearing you offer, is if you contact HFD and say, you know, my book club, we got 18 people, we got eight people, we would love to have training, you'll figure out a way to make it happen. Absolutely. We have gone out to groups ages from third grade to senior citizens. So, the age bracket is very broad. We did a Tai Chi class a couple weeks ago of retirees and a lot of them was just, maybe they couldn't physically do the CPR, but educating them on the steps and the process and how it's done was very valuable. Then, in turn, they can pass that on and if they have groups, like you said, book clubs or whatever to call us, you might want to get a hold of these guys, we can come out and teach. That's another avenue. We look for 10 to 12 in a group. If it's smaller than that, every third Saturday of the month, our museum, our Farty Point Museum is open and we're riding their coattails as far as taking CPR at that. Excellent. I encourage everyone to take advantage of this resource. I hope that you get better penetration in the schools and for those of you able to watch right now, the brochure and the website contact are being displayed and it's definitely been shown that the more people in the community know CPR, the better chance we all have of surviving. So, I'd like to thank all three of you for coming and for our listeners for joining us. Thank you very much. Thank you. Thank you.