What's in Name ?

Will Hamilton Wentworth District School Board choose Style over Substance ?

 

Dear HWDSB Trustees, I am  sure you are all aware that at this time the School Council at George R. Allan Elementary School is diligently exploring every possible funding option to raise the $150,000 required to replace the school playground which will be lost during the upcoming construction. In fact the Council is considering a $10,000 purchase of architectural drawings a requirement of a number of grant applications including the AVIVA grant. HWDSB has it made clear to School Council that there is no money in the construction budget to pay for replacing the playground and that cost must be borne by the school community.

The lack of available funds for playground equipment begs the question - If there is no money for playground equipment, where is the money coming from to pay for a name change? The obvious follow-up question is - What will the name change cost? The third question would be - Is an expensive and unnecessary name change an appropriate use of scarce dollars?

It is hard to imagine that a name change will cost less than $100,000 by the time legal costs, document costs, clerical expenses, signage and construction (including defacing the facade of one of west Hamilton’s most venerable buildings) and a myriad of other incurred costs and expenses are added up - name changes tend to be a little bit like renovating an old house, full of hidden and unexpected costs. 

 

In the current tight economic climate, where School Boards spend a preponderance of time contemplating resource allocation, it seems irresponsible to even consider taking on this unnecessary expense.  An old shipping container with a cardboard sign proclaiming “School” can be a wonderful place of learning but absent play, physical activity and physical wellbeing effective learning cannot take place - the evidence that supports this simple truth is unequivocal.  It is an interesting coincidence that internationally recognized research into the linkages between physical activity and learning is being led by a parent that has three children attending G.R. Allan.

Perhaps HWDSB would consider forgoing the optional name change of G.R. Allan Elementary School and commit the funds that would have been spent on a name change to the fundraising initiative for the new playground. Given that money is not available to pay for all of the items on everyone's wish list this option represents the best possible outcome for our children. Realizing the full potential of every child must remain of primary importance in all of our efforts. Prioritizing the funding for renaming a school versus providing appropriate and safe play space should be a straightforward decision for duly elected Trustees. 

Should you have any questions, comments or concerns please feel free to contact me directly by e-mail

Best Regards, Blake

Blake Hurst

Hamilton ON

blake.hurst@cogeco.ca

 

Until our Leaders Buy-In .......

 Survival Rates for Cardiac Arrest will continue to founder

Public Access Defibrillation (PAD) programs should be one of the most effective lifesaving initiatives in human history.  We won’t scratch the surface of the lifesaving potential of PAD - CPR/AED - programs until leaders at every level of society wholeheartedly buy-in.  I am continually disappointed by how few individuals in leadership positions attend CPR /AED training.  When the message from the top is “this is something we are doing as an organization but it’s not important enough for me to get personally involved” that attitude trickles down through the entire organization or community.  Of the over 100 CPR/AED classes I teach each year it would be safe to say that the most senior person(s) on staff attends less than 25 per cent of the time.

The difference in the attitude of everyone in the room is palpable when the Principal or the Owner or the Director or the Minister is down on his or her knees performing chest compressions alongside the rank and file.  Learning how perform effective CPR and deploy an AED to save another human beings life is not beneath the lofty station of  Government and Private Sector CEO’s, Elected Officials, School Board Directors, School Principals, Minor Sport Executives or Church Leaders.  A commitment to the well-being of the individual, demonstrated through grassroots participation, makes a powerful statement.  Think of a Corporate CEO or the Mayor of a large city pledging a dollar amount to mental health versus lacing up her shoes and running a half marathon to help raise money and awareness and then giving a talk at the award ceremonies.

The spread of effective community based cardiovascular emergency response programs is dependent on the hands-on involvement of leaders in every sector.  When leaders attend the training and learn firsthand how easy it is to perform effective chest compressions, deploy an AED and achieve a life changing outcome for a cardiac arrest victim the conversion from sceptical adult learner to PAD champion is instantaneous.  Once converted these influencers use their new found knowledge and passion to affect change in their own organizations as well as in other organizations that they influence.

Having leaders with hands on knowledge of resusciation is a critical factor in clearing the risk aversion hurdle that bogs down program implementation in many organizations and communities. I’ve sat in dozens of Board meetings listening to untrained Board Members engage in long winded debate about the risk associated with purchasing an AED and training staff in CPR. I’ve also seen one person that has recently taken a CPR course put the whole issue to bed with a brief testimonial of what they learned and experienced during their training. An enlightened leader can and will find a way to clear all of the hurdles - cost, training schedules, ongoing program maintenance, risk management – and move directly to the ultimate objective of being prepared to respond to cardiovascular emergencies.

When leaders do attend my classes I stress the role of the leader in a real life resuscitation scenario, which is not necessarily to get down on their hands and knees and perform compressions or attach defibrillation pads.  A good leader should take command of the situation and provide clear direction to the team – “Can you please go and Call 911” – “Can you please go out to the road to meet the Paramedics and show them where we are” – “Can you run and get the AED” – “Can you start chest compressions and can you two stay here to switch off when he gets tired”  - “Can you please keep everyone that doesn’t need to be here far far away” – “Can you go to the office and bring the copy of Jim’s medical information sheet for the Paramedics”.  Of course if the leader hasn't taken the training they have no idea what tasks need to be completed in order to save the victims life.  Either a corporation or  taxpayers are paying these individuals good money to lead and they should not be allowed to abdicate their responsibilities at the most critical times.  I have investigated many PAD saves where the successful outcome could be attributed in large part to a trained responder with innate leadership skills taking a step back from the patient in order to take effective command of the entire situation.

Nothing kills more people than cardiac arrest, 40,000 a year in Canada.  Until very recently survival rates for out-of-hospital cardiac arrest have been dismal, less than 5% in most communities. Automated External Defibrillators and simplified CPR protocols are now at the centre of programs that are routinely achieving save rates north of 65 per cent.  Despite the proven game changing, life giving potential of the new protocols they have struggled to gain a meaningful foothold, particularly in Canada. Only when our leaders and influencers buy-in to community based resuscitation programs at both a micro and a macro level will we begin to realize their potential which is measured in lives saved.

Idiot is a word derived from the Greek - idiōtēs - Person Lacking Professional Skill

 

Recently I’ve been reading too many articles where community leaders, resuscitation experts (?) and advocates for cardiac response programs are trumpeting the fact an untrained responder, even an “idiot” (their word, not mine), can deploy an AED, not make the situation worse and maybe even make it better. While this simplistic idea may seem true on its face, there is a logical argument, supported by strong evidence, that untrained responders do in fact make things much worse. In his research Peter Ko showed that survival in a group of patients that received a shock from an AED but poor CPR was 8%, while survival in the group that received a shock plus quality CPR was 53%.

 

The goal of having dead people remain dead is being achieved with overwhelming efficiency, in the 85% to 95% range, in most communities. If the primary goal of a resuscitation program is not to make dead people worse off the untrained responder model is perfect. If the goal is to improve survival rates for cardiac arrest then every time untrained responders are the only people on scene it reduces the chance of saving a life and the patient  is made worse off by virtue of the fact that she is being given a smaller chance at survival.  The entire community is also worse off, family and friends remain dead while tax dollars are squandered on an ineffective program.

 

This is far more than an issue of semantics. When advocates for resuscitation programs present their case to funders - municipal councils, provincial or state governments, corporate executives, school boards -  and the funders push back on cost, as they are programmed to do, the first cost cutting measure put forward is to cut back on training.  

“The machine is idiot proof, even if an untrained responder applies the machine improperly or fails to deploy the machine at all the patient can’t be made worse off.” explains the advocate proudly displaying his advanced knowledge of defibrillation science

“Well by that logic” says the funder “why pay for any training at all. If the machine is so simple an idiot can use it we should just buy a dozen machines, hang them in our buildings and call it a done deal.”

The advocate, anxious to walk out of the meeting with something, accepts the offer of 12 AED and no budget for training and another ineffective PAD program is born. What funders need to know is that to build an effective program that maximizes the number of lives saved investment must be made in every link in the chain of survival. The evidence is clear and unequivocal, most patients that survive cardiac arrest benefit from the proper use of multiple links in the chain.  Funders can take comfort in the fact that if the trained responder model breaks down and an untrained person attempts the resuscitation they can’t make things worse, but it is far from ideal when that happens.

If your are an “expert” trumpeting the “idiot proof” operation of AED’s please reconsider your words or at the very least downplay this aspect of the machine. If you are an advocate for effective resuscitation programs in your organization or community please push for more training opportunities for all stakeholders and potential responders.

In Memory of Brock

http://globalnews.ca/news/939093/alberta-mother-raises-defibrillator-awareness-in-sons-memory/

Lock & Key versus Willy Nilly

Everything under the stars, whether made by man or found in nature, is seeking equilibrium. All forces seen and unseen gravitate toward Momma Bear – not to hot, not cold, but just right. Canada’s national broadcaster, the CBC, recently aired an expose on Automated External Defibrillators on their consumer information show Marketplace. Most of the opinions and concerns expressed on the broadcast and in the blogosphere afterward seemed to come from one end of the spectrum or the other. 

Some “experts” were promoting Public Access Defibrillation (PAD) programs where every aspect of the program was rigorously controlled and monitored. Only targeted, trained responders who are working under medical directives from an overseeing physician can deploy an AED. These responders attend re-certification training on a regular basis and before they deploy an AED in a real emergency they must check their wallet card to insure that it has not expired. The devices are kept under close scrutiny, perhaps even lock and key while their readiness status is checked daily. A rigid response protocol must be adhered to anytime there is a suspected cardiac arrest. Anyone not following the protocol explicitly will be spanked, regardless of patient outcome.

Other “experts” were promoting the Willy Nilly model (or Higgledy Piggledy, your choice) where AED’s are scattered generously and randomly around the community. Because the device is so simple to use the success of the program relies on the innate ability of untrained responders to do the right thing in an emergency. If the responder has ever watched a 45 second PSA with attractive young women pushing on a patient’s chest to the beat of an old Bee Gee’s song they will certainly be able to perform effective CPR.   Hopefully, someone associated with the program will check the readiness of the equipment on a somewhat regular basis – but perhaps not. 

The most effective PAD programs lie right in the middle of these two extremes. Well-designed programs are based on a targeted responder model and the greatest number of people possible should receive some level of training, from a half day CPR “C” certification course to a 40 minute overview of the AED and how to perform a chest compression. Individuals not trained in Basic Life Support are encouraged to get the AED and use it to the best of their ability if they find themselves in a situation where no trained responder is present. However the hope is that at some point during the resuscitation attempt a trained responder will get involved and help insure that all of the links in the cardiac chain of survival are being addressed appropriately.

All medical emergencies follow a natural tiered response algorithm. The chance that the very first responder to a motor vehicle collision is an osteopathic surgeon that can immediately assess and begin to treat a shattered tibia are pretty slim. The first responder is most often a good Samaritan that may know little more than how to call 911. Then a passing off duty firefighter, paramedic or nurse may stop and begin to help out. Then the on-duty paramedics, police and firefighters arrive with their tools and knowledge and prepare the patient for transport to hospital. Once at the hospital a team of Emergency Room Doctors and Nurses assess and treat the patient.  If the ER Doctors believe that the patient’s leg requires surgery the Osteopath is paged and a surgical suite is booked. Our goal has to be to build communities where a similar algorithm is in place for cardiac arrest. The initial witness to the patient collapse calls for help. The next people to arrive on scene are lay responders that regularly use the facility and are trained in CPR and proper AED use. By the time the Paramedics arrive these lay responders have performed quality CPR and deployed the AED and the patient’s heartbeat has been restored. The Paramedics stabilize and transport the patient, the ER Docs cool the patient, Cardiologists assess and treat the patient and when all of this goes to plan the patient is home, neurologically intact within a couple of weeks.  If you take the trained lay responders out of this model it collapses almost every time. An enormous body of evidence including the scientific review of tens of thousands of out-of-hospital cardiac arrest cases shows this to be a simple truth.

Place AED’s throughout the community wherever people gather. Insure that they are highly visibly, easily accessible and properly maintained. Train as many people as possible how to recognize and manage a cardiovascular emergency (cardiac arrest, heart attack and stroke).  A great initial target (on the road to everyone knowing CPR /AED) would be to train 25% of the people that are regular facility users. The training can be extensive or brief but it should be formal. Pay for the equipment and training using public or private money, doesn’t matter. If you are able to increase the percentage of cardiac arrests where a properly trained and equipped responder arrives on scene within 6 minutes of patient collapse you will see an increase in survival rates for out-of-hospital cardiac arrest in your community. Uber regulated programs will not achieve this goal and neither will uber lax programs

Cardiac Arrest in Cottage Country

When you go into cardiac arrest it is almost assuredly your day to die. Survival rates for out-of-hospital cardiac arrest have historically been dismal, less than 4% in most communities. Over the past decade there has been a measurable improvement with select North American cities now reporting survival rates in excess of 15% and even as high 20%. Improved survival rates can only be achieved by implementing programs that decrease the time from patient collapse to the first shock with a defibrillator.

Studies have reported survival rates for defined locations (airports, casinos, schools) as high as 75% when the first shock is delivered within 3 minutes of patient collapse and 50% at the 6 minute mark. Survival is possible up to the 12 minute mark but very unlikely beyond that time. Recognizing this reality the Ministry of Health and Long-term Care in the Province of Ontario now requires all Ambulance Services to submit a response time plan that includes a percentile target for responding to Sudden Cardiac Arrest in 6 minutes. Below is a list of the targets submitted by the three largest cottage country Ambulance Services.

http://www.health.gov.on.ca/english/public/program/ehs/land/responsetime.html

The New (2012) Ontario Ambulance Response Time Standard

• Muskoka - The target is 8 minutes 75% of the time
• Actual 2011 response times for SCA - 6 minutes 25% of the time
• Haliburton - The target is 6 minutes 33% of the time
• Kawartha - The target is 6 minutes 45% of the time

Note: These times do not include the time from patient collapse to EMS notification and time from EMS arrival on scene to the delivery of the first shock.

The fact is most cottages will not experience 6 minute response times. This is not an indictment of local EMS, it is simply a reality, an intentional reality – we love our cottages because they are remote.

If you do not have an Automated External Defibrillator (AED) at your cottage anyone that goes into cardiac arrest on your property will in all likelihood die. The gift of life, an AED plus appropriate training including CPR, for friends and family, can be acquired for less than $2,000 all in. The training also includes a discussion on recognizing and managing Heart Attack and Stroke , two additional time sensitive cardiovascular emergencies which typically have poor outcomes when they occur at the cottage.

Think of all the ways you could spend two grand on your cottage and what the benefits of that purchase will be. To learn more about protecting the lives of family and friends at your cottage please contact me.

 

Leading Cause Prevention Strategies

Blake Hurst

29 Mericourt Rd.

Hamilton ON

L8S 2N5

 

905 527-0462

905 978-1023 cell

 

blake.hurst@cogeco.ca

www.leadingcause.ca

 

 

 

The First Commandment of Resuscitation

The First and Great Commandment of Resuscitation -

Thou Shalt not have a Favourite Link in the "Chain of Survival"

 

It is called a chain because every link is critical. No one who truly understands how resuscitation works would lobby government for funding or policies to strengthen just one link in the chain. We need to build comprehensive community cardiac response programs that address and strengthen every link. I read an online debate from British Columbia this week arguing the merits of legislating mandatory CPR training versus mandatory AED placement. There is no question of "or" the only correct answer is "and".

In Ontario we have a physician group lobbying for mandatory CPR and I marvel at their naivety. In Manitoba they are hanging AED's all over the province with no mandatory training requirement, setting up a future filled with lost opportunities to save a life. The evidence is clear and unequivocal every link in the chain makes a significant contribution to improving survival rates for out-of-hospital cardiac arrest. Bystanders must quickly recognize the situation and spring into action, quality CPR must be started immediately, an AED must be applied soon after, EMS must get to the patients side quickly, ER physicians must cool the patient and the patient must take ownership of his/her rehabilitation. If you are engaged in advocacy to improve outcomes for cardiovascular emergencies in your community you must, must, must advocate for strengthening every link in the chain, not just your pet link.

Every cardiac arrest patient needs several things to go right if they are to survive neurologically intact to discharge. After reviewing tens of thousands of cardiac arrest data sets resuscitation researchers have proven beyond a shadow of a doubt that multiple inputs are required to achieve good outcomes.

We live in an evidence based world. Respect the evidence.

Three Thoughts for CPR Instructors and Students

Every person that attends CPR training represents a potential life giving resource, like a bottle of water in the desert, their attendance cannot be squandered. The next time you teach or take a certification level CPR course it may be helpful to keep these three thoughts in mind.

1. Doing something is NOT better than doing nothing - Instructors give their students a free pass when they utter the dreaded "doing something......" line. In most of the classes that I teach some student knowingly expresses the "doing something" sentiment. I gently correct them and point out that CPR is only effective when it is performed properly. Poor CPR produces results that are exactly equal to, not better than, doing nothing.

The reason that people take four or five hours out of their busy schedule to take a CPR course is to acquire a toolkit for protecting the life of a person experiencing a significant cardiovascular event. The excellent science published over the past decade gives us a clear indication of what works and what doesn't work in cardiac resuscitation. CPR instructors must teach the methods that work and CPR students must endeavour to learn and perform those techniques to the best of their ability. Teaching and learning effective CPR is the only way to improve survival rates for cardiac arrest in our communities. We trivialize and demean the process when we tell students that "doing something is better than doing nothing"

2. You DO NOT have to break ribs to perform effective CPR - I cringe every time I hear this. It seems there is a legion of CPR instructors out there that hammer on the idea that if you're not breaking ribs you're not doing it properly, including professional responders that brag to their students "I've done CPR over a dozen times and broken ribs every time." I don't know where to begin with this one, it is just wrong on so many levels.
First of all the science is clear and unequivocal, the majority of survivors do not have broken ribs. More importantly our job as CPR instructors is to bring down the barriers to the public getting involved with a patient when they witness a cardiac arrest. Telling lay people that in order to help that person they will have to break their ribs has precisely the opposite effect. Effective CPR does not require breaking ribs, it is okay to speak to the possibility of broken ribs, but it should be put in proper perspective and the whole discussion should only take up a few seconds of class time. I ask all instructors to please stop with the broken rib bull, and I implore all students the next time your Instructor plays the broken rib card, call his bluff.

3. Count using numbers, 1 and 2 and 3 and 4 ....  NOT old Bee Gee's songs - The Stayin' Alive gimmick is an excellent tool for promoting Bystander CPR in 60 second Public Service Announcements, it is not an appropriate technique to teach to a student that has signed up for certification level CPR training. I've met hundreds of people that can't remember the name of "that song you're supposed to sing" but I've never had a student that can't remember how to count to 5.
When you count properly, 1 and 2 and 3 and 4 and 5 and 1 and 2 and 3 and 4 and 10 ...... many excellent things happen for the patient. With very little practice students can develop a cadence that will produce a rate of 100 bpm, plus or minus 5, virtually every time. Proper rate makes a huge contribution to survival. When you push down on "One" and come up on "And" work is distributed equally between the two critical functions of chest compressions, pushing blood out to the brain and internal organs and allowing the heart to refill with blood on the upstroke. This drives a nice even circulation pattern that helps keep vital organs oxygenated. Finally when you count out loud using numbers, not Bee Gee's songs, all of the people assisting you with the resuscitation know exactly where you are in the CPR cycle and can perform their tasks accordingly.

The four hours that you spend teaching and  learning CPR and other Basic Life Support skills represent an opportunity to give life to another human being, in all likelihood a co-worker, a family member or a friend. It is a kind of sacred trust and should be treated with the appropriate respect.