Often it "takes a village" and indeed the entire community to make a significant difference! Hear how the HEARTSafe Community concept is designed to promote survival from sudden out-of-hospital cardiac arrest by recognizing and stimulating efforts by individual communities to improve their cardiac arrest system of care.

1. Strive to Revive! Translating Science to Survival
The HEARTSafe Community Concept
A Lifesaving Innovation
David B. Hiltz
Consultant-Advocate
Team HEARTSafe

2. No relevant financial relationship(s) exist.
Presenter Disclosure Information

3. Often it "takes a village" and indeed the entire
community to make a significant difference! Hear how
the HEARTSafe Community concept is designed to
promote survival from sudden out-of-hospital cardiac
arrest by recognizing and stimulating efforts by
individual communities to improve their cardiac arrest
system of care.
Community Based Strategy

5. WHERE YOU LIVE SHOULD NOT
DETERMINE IF YOU LIVE!
Who Could Disagree?

6. The System is (fill in the blank)!

7. A “Wicked” Problem!

8. Gizmos and Technology Will Save Us?

9. Pharmaceutical Agents?

10. Or a Coordinated and Community Based Strategy?

11. HEARTSafe is a public health initiative intended to
help more people survive after sudden out-of-hospital
cardiac arrest. When someone’s heart suddenly stops,
they will generally not survive unless a number of
interventions take place immediately, including CPR
and defibrillation. In order to facilitate this process, a
strong system must be established to ensure the rapid
execution of each step.
The HEARTSafe Community concept works by
creating criteria that support this “cardiac chain of
survival” and encouraging communities to work toward
them.
HEARTSafe

13. Common Elements

15. In the basic HEARTSafe model, a region (generally a
US state, but county-based and international programs
also exist) establishes a set of minimum criteria its
communities must meet in order to achieve
HEARTSafe status.
The Premise…

16. Analogy?

17. These should be goals that support the chain of
survival, such as widespread CPR instruction, public
access defibrillators, and aggressive resuscitation
protocols for first responders and area hospitals.
Individual communities in each region which meet the
established criteria—such as cities, towns, counties,
even neighborhoods or campuses—can apply to their
home office and become designated as a HEARTSafe
Community. Street signs proclaiming this status are
usually posted at the edge of town. If a community
does not meet minimum criteria, it can take steps to
work toward compliance and eventually earn
accreditation.
HEARTSafe Goals

18. Survival Envy vs. Sign Envy…

21. Each state or regional program is managed
independently, designates its own criteria, and
answers to no external arbiter. For assistance and
advice, there is a strong community of peer support
provided by existing program directors and advocates,
but there is no central authority that certifies or
coordinates all HEARTSafe communities; in any given
area, the certifying authority is merely whichever
regional agency that has been chosen to administer
the program.
Who is in Charge?

22. sus-tain-a-ble
adjective
1. capable of being supported or upheld, as by having its weight
borne from below.
2. pertaining to a system that maintains its own viability by using
techniques that allow for continual reuse: "sustainable
agriculture. Aquaculture is a sustainable alternative to
overfishing."
3. able to be maintained or kept going, as an action or process: "a
sustainable negotiation between the two countries."
4. able to be confirmed or upheld:"a sustainable decision."
5. able to be supported as with the basic necessities or sufficient
funds: "a sustainable life."

25. EMS
FIRE
HEALTH
DEPT
POLICE DEPT
EMA
DIR
HOSPITAL(
S)
CHAMPION
S
CITIZEN
SWHO
ELSE?

26. Improving systems for cardiac arrest care requires
widespread change, and this isn’t possible without
many parties committing to the cause.
Building Support

28. Two overlapping groups will need to be courted:
individuals in positions of power, and the general
public. Although it may be possible to make progress
with buy-in from only one of these parties, movers and
shakers are more likely to listen when there’s a
groundswell of support behind you, and likewise the
public can only accomplish so much without the
implementation of top-down initiatives.
Building Support

29. In some cases, it may be effective to approach the
decision-makers early, establish the HEARTSafe
criteria and accreditation process, and then seek out
local support once you can point to a concrete
incentive. But more often, SCA system improvement
begins at the grass-roots level, with at least partial
community buy-in—when one community or a portion
of a community has made good progress, and local
champions want to expand this progress across the
map.
Building Support

31. Public support can be effected through media
campaigns, and many areas have had success using
low-budget guerilla methods, such as social media
(Facebook groups, Twitter accounts, and so forth).
Local newspapers and television stations are often
interested in reporting on large-scale CPR classes (for
instance, 20-minute CPR Anytime courses for entire
gymnasiums or stadiums full of people at a time), or
human interest stories about recent cardiac arrest
“saves”; this type of coverage can serve as free
publicity and help spread your message. As budget
allows, paid public service announcements can also
be run in local TV, newspapers, billboards, or other
venues.
Building Support

34. Under whose auspices will your new HEARTSafe
program be administered? Most commonly in the US,
this is organized at the state level (through the
Department of Public Health or similar bureau with the
appropriate authority). County-based programs also
exist, and a few national programs have been
instituted in Ireland, New Zealand, and Taiwan.
In general, it’s wise to aim as large as you think you
can succeed with. If a county program is the best that
seems feasible, then create a county program, but if
you can found a new statewide program, go big! It’ll
mean the system is available to more people in more
areas.
Aiming at the Target

36. Most regional governments have the stated goal of
improving public health among their constituents, and
have an infrastructure in place for facilitating this.
Programs like HEARTSafe probably already exist—
just not for sudden cardiac arrest. You merely need to
convince the powers-that-be that SCA is a real
concern (statistics can support you here) which is
worth their time and money to address.
Aiming at the Target

38. Fortunately, establishing a HEARTSafe template and
accreditation system typically requires almost no
money spent by the central office, just a bit of time to
write down the rules and determine which existing staff
will manage the process.
Any financial outlay generally comes from the
community itself, such as the businesses who need to
purchase AEDs or host CPR classes.
Aiming at the Target

39. Every community is different, and the obstacles to a
strong chain of survival are unique everywhere.
Consider the common elements of a program, then
look at your existing community.
What are you currently working with, and what needs
to be changed or added to strengthen your system?
Analyze Your Situation

40. What is the availability of EMS around your
community? Are there areas in which response
times are frequently prolonged?
Analyze Your Situation-Consider Factors…

42. How many hospitals do you have available to you, and
how distant are they? Can they provide therapeutic
hypothermia and emergency PCI?
Analyze Your Situation-Consider Factors…

43. Do you want your program to include support for
supplemental stand-alone public health measures
such as stroke and STEMI care, or to exclusively focus
on cardiac arrest?
Analyze Your Situation-Consider Factors…

45. If your community collects statistics on sudden cardiac
arrest, perusing them can help you to understand
where you’re coming from. Is your survival rate already
fairly good, and you’re simply trying to polish it a bit
and fill a few gaps? Is it quite poor, in which case
many elements of your chain of survival may need
substantial overhaul? Can you pin down specific
neighborhoods or areas that experience unusually
high numbers of arrests, or whose proportional
survival from arrest is particularly poor? How often is
bystander CPR or defibrillation performed? What are
typical response times for EMS? (Depending on the
quality of your statistics, you may be able to answer all
or none of these questions, and that will reinforce the
importance of gathering this type of data in the future!)
Critical Question!

48. One of the key pieces of any HEARTSafe program is
to collect data and track progress. This is typically
done with cooperation from the local EMS agency and
their destination hospitals. When an effective system
for gathering statistics is in place, it allows you to track
the results of your changes. You can determine what’s
working, what isn’t, where you need to focus further
efforts—and when it all goes well, it provides
motivation by revealing the improving numbers
resulting from your hard work. Nearly every existing
HEARTSafe system includes a requirement that
communities establish a system of data-collection,
feedback, and mechanisms for ongoing change.
Tracking Changes

50. No studies have specifically attempted to demonstrate
improved survival after instituting an explicit
HEARTSafe program in a community.
However, when considering criteria for a new program,
we do recommend that requirements should be based
on scientifically-supported measures, such as
increased bystander CPR, early access to
defibrillators, and post-ROSC care.
In addition, the general model of community-level
efforts to strengthen the chain of survival has been
successful (e.g. in Arizona and Wake County, NC) and
is supported by expert recommendations.
Where is the EVIDENCE?

51. WHERE DO WE GOWHERE DO WE GO
FROM HERE?FROM HERE?

55. http://www.heartsafe-community.org/