Translating Science into Action: Using Population and Criteria-based Incentive Programs to Advance Systems Change and Chain of Survival Priorities

David B. Hiltz, NREMT-PAmerican Heart Association

Conflict of Interest Disclosure

• Commercial/industry– Full-time employment by the American Heart

Association

• Potential intellectual conflicts– Full-time employment by the American Heart

Association

Objectives

• Discuss the rationale for addressing acute event and SCA

• Visit current recommendations regarding acute event and SCA

• Review the history of HEARTSafe

• Discuss adapting HEARTSafe to address system change and COS priorities

BIG Issues

• CVD-SCA is number one killer

• 220,000 to 335,00 OOH SCA each year

• 70-80% occur in/around home

• 95% death rate

• Not a reportable cause of death:

National Center for Vital Statistics

Other Issues

• VERY few get bystander CPR

• Fewer get good CPR

• Less than one-third of kids get CPR before EMS

• Large numbers of

people will die this

year from SCA

Recommendations

• “Community Coronary Care Units”• Organized response to emergencies• EMD• Citizen CPR• Early defibrillation• Effective BLS and ACLS • Early detection of ACS• Early definitive intervention

Lay responder defibrillation significantly increases

survival after cardiac arrest if the program is able to

defibrillate prior to EMS arrival and the PAD

emergency response plan is effectively

implemented and sustained.

Translating Science Into Action

• We have evidence based guidelines

• We have excellent training programs

• We have top notch instructors

• “Top down” strategies DO NOT WORK

• Local situations

require local solutions

Changing Behavior

• Commercial marketing expensive and often ineffective

• Social marketing experience is good

• Incentive change methods offer a less expensive option

Disclaimer

• This presentation will discuss incentivizing and guiding implementation of strategies to save lives.

• The intent HEARTSafe is to permit the evolution of funding sources at the community level.

Emergency Medical Care Advisory Board –EMCAB-

• The board advises the DPH/OEMS on the development of EMS policy

• Established by statute• Appointed by Commissioner• Key stakeholders

GENERAL LAWS OF MASSACHUSETTSChapter 111C: Section 13 EMS system advisory board; membership;duties; advisory committees

HEARTSafe History

Howard Koh, MD,MPh Former Public Health CommissionerNow Director , Division of Public Health PracticeHarvard University

Charge by Koh to PIER Committee of EMCAB

“Develop a program to increase awareness regarding CPR and early defibrillation and improve survival in all communities”

No problem!

Oh…and no, there isn’t any funding

~Jerry Garcia of the Grateful Dead

“Somebody has to do something, and it’s

just incredibly pathetic that it has

to be us.”

Mike and David

Mike and David

HEARTSafe Community

A population and criteria based incentive program designed to advance systems change and chain of survival priorities.

HEARTSafe Community

Get credit or earn points in the form of Heartbeats for specific activities relating to the designed criteria.

The number of Heartbeats required is specific to both the activity and the population base.

Population Based

• Up to 5,000 population: 40 heartbeats

• 5,001 – 30,000 population: 50 heartbeats

• 30,001 – 50,000 population: 60 heartbeats

• 50,001 – 100,000 population: 70 heartbeats

• 100,001 – 150,000 population:80 heartbeats

• 150,001 population or more: 90 heartbeats

Criteria Based

• Conduct community CPR training sessions.• All EMS first response-designated vehicles*

have been equipped with AEDs • Placement of a permanent AED with AED-

trained personnel in public or private areas • Advanced Cardiac Life Support (paramedics) *  • An ongoing process to evaluate and improve the

“Chain of Survival”in the community.

HEARTSafe Community

Is NOT limited to promoting AEDS!

“Heartbeats”

Core to HEARTSafe

HEARTSafe Incentives

Bragging rights!

HEARTSafe Community

Massachusetts Department of Public HealthOffice of Emergency Medical Services

Presented this _______day of _______in the year_______

In recognition of the community efforts to improve survival from sudden cardiac arrest and for meeting the criteria to be

designated aHEARTSafe Community.

Commissioner, Department of Public Health

HEARTSafe Community

Massachusetts Department of Public HealthOffice of Emergency Medical Services

Presented this _______day of _______in the year_______

In recognition of the community efforts to improve survival from sudden cardiac arrest and for meeting the criteria to be

designated aHEARTSafe Community.

Commissioner, Department of Public Health

HEART Safe

Community®

Mass. Dept of Public Health

Initial Funding

Promotion

• Announced at Statewide EMS Summit

• Strategic alliances

• Roadside signs

Program Operations- Launch

• Letter and worksheet

• Direct mail campaign to municipal leaders

• Media Advisory

Process

Process

Self tabulation-requires communication

across lines

• Inventory current achievements

• Launch strategies to meet criteria

• Submit to DPH OEMS and Regional EMS

• Schedule designation

• Notify AHA

HEARTSafe Designation Events

The Partnership for a Heart Healthy and Stroke Free Massachusetts

• A coalition of more than 100 organizations and agencies (est. 2001)

• Funding from the U.S. Centers for Disease Control and Prevention

• Devise strategies to reduce illness and death related to heart disease and stroke among Massachusetts residents

±0 10 20 30 405Miles

HeartSafe Communities

Towns

Coast

County Boundaries

State Boundary

Region Boundary

One Hundred and Forty-Four Massachusetts HEARTSafe Communities

Region 3

SUFFOLK

PLYMOUTH

DUKES

as of May 19th, 2006

Region 4

Region 2Region 1

BERKSHIRE

WORCESTER

FRANKLIN

HAMPSHIRE

HAMPDEN

NORFOLK

MIDDLESEX

ESSEX

BRISTOL

by Emergency Medical Service Regions and Counties

Region 5

BARNSTABLE

NANTUCKET

HEARTSafe Community Designation requires that a Community VIGOROUSLY support community training inCPR and strategic public placement of AEDs for trained users

Source: Massachusetts Office of Emergency Medical Services, May 19, 2006

Unique Designations

Unique Designations

Pending Designations

Unique Request

Promotion at ECCU

Outside of MA

Connecticut

“We looked at the program and saw it as an excellent way to promote awareness of the signs and symptoms of heart attacks and to improve the systems response to incidents.”

Gary St. Amand Health Program Associate

State of Connecticut Dept. of Public HealthHeart Disease and Stroke Prevention Program

Connecticut

“Strategic placement of AEDs and larger numbers of people trained in CPR increases the survival rate for cardiac arrest patients.”

“We would like to see all 169 of Connecticut’s municipalities strive to adopt the HEARTSafe Community designation.”

J. Robert Galvin, M.D., M.P.H. DPH Commissioner

HEARTSafe RI

Increase:• number of lay bystanders trained in CPR • number of First Responders who are

equipped with AEDs• ensure appropriate pre-arrival instructions• improve the performance of our prehospital care

system

and make a lifesaving difference.

HEARTSafe RI Lifesaving Potential

Location Estimated SCA Frequency Lives Saved at Current Survival Rate – 5%

Goal – Lives Saved at 20% Survival Rate

Rhode Island 1000 50 200

RI Recommendations

• Systems reviewed

• Discussion

• Revisions

• Consensus

RI Recommendations

• Organization

• EMD

• CPR

• AED

• LEA-D

• 12 Lead ECG

• ACLS

HEARTSafe RI PSA

Inside RI

Proposed Support from the AHA

Project implementation staff, volunteers and support.

Proposed Support from RI DOH

• Endorsement of program

• Use of the RI DOH stylized name and logo

• DOH staff and resources for program implementation <0.05 FTE?

• Funding for HeartSafe signs in the amount of $1,200$15.50 to $16.00/sign (delivery and initial art charges included).

HEARTSafe Review Process

Completed HeartSafe applications are sent to the RI DOH

Applications are reviewed for completeness by RI DOH

Applications are reviewed for content by RI DOH using a special panel appointed by the Director (Division of EMS staff member, ASAB members [2], AHA ECC staff member, and AHA ECC Committee member)

Determine Disposition No recommendation for Designation

Notification and guidance

for applicant

Recommendation for Designation

Community notified of successful designation by RI DOH

Designation event scheduled

AHA prepares paper plaque

Community orders signs if desired

AHA prepares media advisory and distributes to media contacts asneeded. (Additional communications activities as needed)

Designation

Data entry into RIDOH system

Benefits

• Low cost mechanism for the advancement of efforts to reduce disability and death from SCA and other cardiovascular emergencies.

• Improved dialog with community leaders and stakeholders.

• Visibility for the DOH/DPH at the community level across State.

• Use a previously and proven program.• Platform for other DOH/DPH efforts and

programs.

Where is the DATA?

• We are certain that this is changing behavior

• NEMSIS data set implementation will provide additional insight and validation

• Until then, we believe that the absence of hard data should not stand in the way of a perfectly good idea!

So David, How Can We Do This?

• Identify what the issues are, or more appropriately design the collective vision for YOUR ultimate community based coronary care unit.

• Use existing resources to package.

• Form alliance with your State or local board of health.

• JUST DO IT!

Not Always So Easy!

HeartSafe Materials

http://www.mari-ecc.org/

Where Can We Go From Here?