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  1. #1
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    Default Newbie wondering about FF's vs Medics as CPR Instructors

    Hello from Vancouver.

    My name is Dwight and I have some newbie questions related to deploying AEDs in high-rises, in particular who could or should be doing the follow-up CPR/AED teaching. The idea is to bring defibs into closer proximity to people that EMS crews can have difficulty accessing.

    I'm trying to get up to speed on what percentage of professional firefighters you would estimate are qualified to teach CPR to the public. I'd also like to understand if paramedics do this. Finally, what is your take on the politics of FF's vs Medics in this?

    My personal theory of smart AED placement is that they should be centered around elevators (for high rises), not in a lunchroom somewhere or in a security guard's desk etc. that few would know about in an emergency. Accordingly, people with fire keys come to mind when I think of elevators, but EMS authorities may feel that such education would best be left to paramedics or specialist CPR instructors. This would be as follow-up to AED installations in the bigger buildings.

    I would much appreciate it if someone could separate out the actual issues for me, with some advice on the division of labor, as it were.
    Last edited by ElevAED; 09-19-2010 at 05:45 PM. Reason: correcting haste


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    Considering your in Canada my opinion won't count for much, but around here the responsibility for that kind of thing would fall back on the individual property owner. They have building codes and state statutes that pretty much dictate when and where an AED needs to be placed. The latest edition of CPR classes that I've observed include information about finding and deploying an AED, additionally our CPR classes are kinda at a crossroads. If you're just a basic citizen your gonna be taught hands only CPR and if your an EMT/Paramedic or work in any type of definitive care facility (Hospital, Doctor's Office, Skilled Nursing Facility) you're going to be taught the latest edition for traditional CPR. If somebody is ALS capable around here they aren't going to typically use a normal AED unless they're off duty or as a last resort due to extenuating circumstances. Even the poorest of the volunteer departments with staff trained higher than EMT-B carry AEDs with a manual over-ride mode.

    The intent of "public" AED placement isn't so that Fire and EMS can use them, the AEDs are being placed there so that the patient will receive the earliest possible defibrillation, which on a witnessed arrest is "hypothetically" as long as it takes for the second or third witness to walk to the defibrillator cabinet and back plus about 60 seconds. The only politics involved should be between the politicians who pass the laws that dictate their placement. I'm kind of biased in my opinion on the Fire vs. dedicated EMS debate since I'm both.

    Addressing the portion about who normally provides CPR training to the public around here is the American Red Cross, while everyone who is a healthcare provider (Doctor, Nurse, Paramedic, EMT, First Responder, CNA) is required by a state law to have a specific Healthcare Provider CPR/First Aid class from the American Heart Association. A number of the fire departments have either their Medical Coordinator or the Public Relations official trained as a CPR instructor and every ambulance company and Hospital has more than one CPR instructor on staff. Also every public swimming pool and public school regularly provides CPR classes to school age children.

    In fact if I had a choice of whether to have a heart attack in a classroom full of fourth graders without any teachers present or in the break room during break in any of the manufacturing plants around here I would pick the classroom of children. First reason is that even though every one of the plants is required by law to train employees in First Aid/CPR and carry AEDs, most of the employees can't competently perform CPR. Had a code last week in the middle of a plant during shift change, where nearly everybody on the two shifts witnessed the arrest. Not a single one of the 50 or so employees present knew how to perform CPR. The other reason is all of the AED storage cabinets in all of the schools in the county have an alarm that trips a notice in the county dispatch center that covers most of the screen telling the dispatcher which school, building, floor, and ID # AED just got deployed. So not matter which school I'm in there'll be an ambulance there in about 5 min. or less.

    Your best bet would be to contact the individuals around your who are involved in building code enforcement, because most locales have some sort of regulation regarding AEDs and those individuals would be the ones most likely in the know on the latest details that apply to your specific situation.

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    Thank you for your generous and detailed comment, Kan. I'm in Vancouver but also work out of Seattle, where the AEDs are largely manufactured.
    ...the responsibility for that kind of thing would fall back on the individual property owner. They have building codes and state statutes that pretty much dictate when and where an AED needs to be placed.
    There does seem to be a patchwork of regulations evolving around AED deployment, and their incoherence is what makes me think elevator lobbies should become THE place associated with AEDs.

    For example, in Utah they have to be within 425 ft of the residents, and if you place one AED in the lobby of a high-rise there, you probably have that building covered under that regulation, at minimum cost and with maximum exposure. Place it beside the pool, though, and suddenly the upper floors are out of range, with many of the residents unaware of its presence and its exact location when an SCA develops. I do think they will be mandated to be on passenger elevators in good time, just as emergency phones were.

    The intent of "public" AED placement isn't so that Fire and EMS can use them, the AEDs are being placed there so that the patient will receive the earliest possible defibrillation, which on a witnessed arrest is "hypothetically" as long as it takes for the second or third witness to walk to the defibrillator cabinet and back plus about 60 seconds.
    Agreed, because residents and workers in high-rises are harder to get at for EMS crews, and the time-to-shock must be as short as possible. I feel that defibrillation must be handled in-house, realistically, if SCA victims are to have any chance or to escape brain injury.

    The only politics involved should be between the politicians who pass the laws that dictate their placement. I'm kind of biased in my opinion on the Fire vs. dedicated EMS debate since I'm both.
    I had 'office' politics in mind there, namely the roles of FF-EMT's vs EMS paramedics, as to who might best educate residents in high-rises about AED issues after an installation of one. From my readings on this excellent Forum, I'm learning that the line is so blurred that I need not take account it. If I place an AED in a high-rise it is clear to me that either party could do the follow-up with full knowledge of the issues, and direct the residents to CPR or AED education resources.

    ... all of the AED storage cabinets in all of the schools in the county have an alarm that trips a notice in the county dispatch center that covers most of the screen telling the dispatcher which school, building, floor, and ID # AED just got deployed. So not matter which school I'm in there'll be an ambulance there in about 5 min. or less.
    That's impressive, and the first time I've heard of networking AEDs in real time across a whole county. That's rarely seen even with building complexes.

    Your best bet would be to contact the individuals around you who are involved in building code enforcement, because most locales have some sort of regulation regarding AEDs and those individuals would be the ones most likely in the know on the latest details that apply to your specific situation.
    Deployment is so ad hoc and subject to the JHA's whims that you are convincing me to deal with the local rescue professionals as my reps. I'm not seeing any reason to distinguish EMT from EMS people, and it's very clear that local knowledge of the legal landscape and other realities will be required.

    Thank you again for your valuable insights and information.

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    The AED cabinets have an audible buzzer built into them, and the fire alarm system already notifies us of alarm gets pulled. So with a little creativity the installers got the fire alarm systems to treat the AED cabinets like fire alarms without setting off the entire system. If the school administrators weren't afraid of what the high school students might try with an AED, they wouldn't have decided to purchase cabinets with buzzers in the first place.

    It also doesn't hurt to only have two public school districts and one k-8 private school in the county and that the administrators for all three get along great with one another and the board of commission that runs the county. The current chairman of the board places a big emphasis on education and public safety.

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    Quote Originally Posted by KanFireman View Post
    The AED cabinets have an audible buzzer built into them, and the fire alarm system already notifies us of alarm gets pulled. So with a little creativity the installers got the fire alarm systems to treat the AED cabinets like fire alarms without setting off the entire system. If the school administrators weren't afraid of what the high school students might try with an AED, they wouldn't have decided to purchase cabinets with buzzers in the first place.
    The idea of integrating with the fire alarms is intriguing to say the least. As an AED administrator I would hesitate to set up a possible source of false alarms, should some curious kid or addled meth addict decide to look inside anyway. Our enclosure design (for lobbies) has a polycarbonate window in the door, full size, so I do hope that would help satisfy people's curiosity. I prefer an AED like the Philips Onsite that is one piece and doesn't really need a carrying case, again so that the curious can see everything they need to through the window.

    OTOH, I don't see a fire alarm beating a 911 call from the original SCA location by much if anything. And having a live person making it has to help the dispatcher send out what's needed and only if.

    Another alternative - a wireless alarm on the door - could light up the building security's monitors. But again this points to elevator lobbies as the strategic spot, because that area is monitored 24/7 and often by video.

    I am finding that there are a host of options around locks (they have their place, summer camps e.g.) and alarms and the degree of protection the enclosures afford. Our design is all-weather to limit some options - please. ;-)

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    Quote Originally Posted by ElevAED View Post
    Hello from Vancouver.

    My name is Dwight and I have some newbie questions related to deploying AEDs in high-rises, in particular who could or should be doing the follow-up CPR/AED teaching. The idea is to bring defibs into closer proximity to people that EMS crews can have difficulty accessing.

    I'm trying to get up to speed on what percentage of professional firefighters you would estimate are qualified to teach CPR to the public. I'd also like to understand if paramedics do this. Finally, what is your take on the politics of FF's vs Medics in this?

    My personal theory of smart AED placement is that they should be centered around elevators (for high rises), not in a lunchroom somewhere or in a security guard's desk etc. that few would know about in an emergency. Accordingly, people with fire keys come to mind when I think of elevators, but EMS authorities may feel that such education would best be left to paramedics or specialist CPR instructors. This would be as follow-up to AED installations in the bigger buildings.

    I would much appreciate it if someone could separate out the actual issues for me, with some advice on the division of labor, as it were.
    Around here most of the CPR instructors are either EMT or Medic, but it is about equal as to fire service or EMS service.

    I don't think it matters.

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    I'm trying to get up to speed on what percentage of professional firefighters you would estimate are qualified to teach CPR to the public. I'd also like to understand if paramedics do this
    Depends, how many are certified as AHA or Red Cross instructors? Just being a firefighter (what difference does "professional" make anyway?), or a paramedic for that matter, doesn't qualify someone to teach anyone anything. There's a reason both of those organizations have Instructor classes above and beyond CPR certification. Joe Blow the auto mechanic could take an Instructor class, you don't have to be in healthcare or public safety to teach.

    Finally, what is your take on the politics of FF's vs Medics in this?
    WTF? What does that even mean?

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    Id say most firefighters and EMTS would be better instructors than most of the people the ARC and AHA field as instructors. The lion's share of instructors outside of those that teach for fire/ems or medical facilities have never performed CPR in their life.

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    Quote Originally Posted by emt161 View Post
    Depends, how many are certified as AHA or Red Cross instructors? Just being a firefighter (what difference does "professional" make anyway?), or a paramedic for that matter, doesn't qualify someone to teach anyone anything. There's a reason both of those organizations have Instructor classes above and beyond CPR certification. Joe Blow the auto mechanic could take an Instructor class, you don't have to be in healthcare or public safety to teach.
    I will be advocating the use of AEDs in and around elevators, so my thinking was that a fireman or working paramedic would best represent the firm and the project, which involves the regulations around high-rises. I should have clarified that.

    Re: the politics, I have seen some turf flareups between firemen and paramedics, ALS et al, but granted, they don't seem to be significant. Glad to hear it.

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    Quote Originally Posted by ElevAED View Post
    I will be advocating the use of AEDs in and around elevators, so my thinking was that a fireman or working paramedic would best represent the firm and the project, which involves the regulations around high-rises. I should have clarified that.

    Re: the politics, I have seen some turf flareups between firemen and paramedics, ALS et al, but granted, they don't seem to be significant. Glad to hear it.
    Most places require you to be off-duty to teach a class. While off-duty you don't wear your uniform. So, why does it matter where they work. Put an ad in the paper stating you need cpr/aed instructors at that location to teach x number of people.
    FF/Paramedic

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    Quote Originally Posted by TNFF319 View Post
    Most places require you to be off-duty to teach a class. While off-duty you don't wear your uniform. So, why does it matter where they work. Put an ad in the paper stating you need cpr/aed instructors at that location to teach x number of people.
    Granted, and there is no intention here to abuse the uniform or committed working hours. But as a previous message mentioned, many or most CPR instructors have never performed CPR in an actual emergency, and their backgrounds outside the CPR world could be anything.

    High-rise buildings are said to be among the more difficult for accessing SCA victims by EMS, ergo this project to place AEDs in the lobbies, to get inside the "circle of death" that, despite 911's best efforts realistically will claim the majority of arrest cases unless an AED is accessed, in-house, within 5-6 minutes. So it's best to have people who know the limitations of ALS delivery and its infrastructure, dynamics and protocols from their daily working experience.

    Beyond that, there is a fraternity among FF's and those who respect the profession that is unmatched, in my mind, not to mention their accountability. It's all built on trust, and if you are trying to architect the deployment of AEDs, as we are, then it makes sense to look for people who would be best qualified in all aspects, above and beyond the CPR itself.
    Last edited by ElevAED; 09-23-2010 at 12:25 PM.

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    I guess I am missing what you are trying to say. I don't understand why a layperson needs all that extra info. Train them in CPR, AED, and rapid 911 notification. If you are hoping the Fire Department or EMS Department will help convince building owners to spen extra money, forget it.
    FF/Paramedic

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    Quote Originally Posted by TNFF319 View Post
    I guess I am missing what you are trying to say. I don't understand why a layperson needs all that extra info. Train them in CPR, AED, and rapid 911 notification.
    The training of the lay people in these buildings is part of follow-up after the AED installation and is optional. The focus is on getting a first AED in place.

    If you are hoping the Fire Department or EMS Department will help convince building owners to spend extra money, forget it.
    As it becomes the law, as it is in Oregon e.g. it's easy to convince building owners to save money, not spend it. Under a "50-50 law" that is being adopted, buildings with more than 50,000 sq ft and/or 50 people using it a day need an AED.

    The owner(s) save by avoiding fines and severe liability risk, and if an OD FF can point out that just one AED in the lobby is required to comply, even for a 25 floor building, then responsible building owners can get legal for less than $2K, and are glad someone told them. If the OD FF gets a few hundred bucks in the process, both the public and owners' interests are safeguarded and FF's get some payback for their expertise.
    Last edited by ElevAED; 09-23-2010 at 03:06 PM.

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