Santa Cruz County Grand Jury • 2007-2008

Aed Automated External Defibrillator — a computerized medical device that automates the

Published: January 23, 2008 20 pages
View Original PDF

Findings and Recommendations 28 findings

F1
The 911 system for most of Santa Cruz County is administered through the Santa Cruz Consolidated Emergency Communications Center, commonly called Net Com. Additional public safety answering points for the 911 system are in Scotts Valley and at the University of California’s Santa Cruz campus. Response: The Santa Cruz Consolidated Emergency Communications Center (NetCom) PARTIALLY AGREES. In addition to the primary public safety answering points (PSAP) mentioned within the Finding, it should be noted that Cal Fire maintains a secondary PSAP located in Felton which receives transferred 9-1-1 calls relating to fire incidents occurring within the unincorporated areas of the County not serviced by a Fire District. Response: The Santa Cruz County Emergency Medical Services Integration Authority (EMSIA) AGREES. It is important to note that many 911 calls are made by cell phones. When 911 calls are made by cell phones on or close to major roadways, the California Highway Patrol acts as the public safety answering point. Calls are then routed to the appropriate jurisdictional dispatch center.
No recommendations for this finding
F2
Net Com is an up-to-date, modern facility. Dispatchers have access to computer- aided dispatch systems that allow them to rapidly send police, fire, and medical assistance when needed. For medical calls involving a person not breathing, such as sudden cardiac arrest, Net Com was able to dispatch Emergency Medical Service units within 60 seconds 92 percent of the time in 2006. Response: NetCom AGREES. Response: The EMSIA AGREES.
No recommendations for this finding
F3
The Emergency Medical Services Integration Authority (EMSIA) — consisting of the Aptos/La Selva Fire District, Central Fire District, Scotts Valley Fire District, City of Watsonville Fire Department, and City of Santa Cruz Fire Department — provides first responder Advanced Life Support (ALS) medical services to the urban areas of the county. Response: The EMSIA PARTIALLY AGREES. The EMSIA consists of 12 Fire agencies in Santa Cruz County; Aptos/La Selva Fire District, Ben Lomond Fire District, Boulder Creek Fire District, Branciforte Fire District, Central Fire District, Felton Fire District, Pajaro Valley Fire District, City of Santa Cruz Fire Department, Scotts Valley Fire District, UCSC Fire Department, City of Watsonville Fire Department, and Zayante Fire District and acts as a liaison between the fire service, the County, AMR, and other EMS related entities. It is the five agencies listed in the finding , not the EMSIA, that actually provide advanced life support services. The remaining agencies provide basic life support (BLS) medical services within their jurisdictions. - 4 Surviving Sudden Cardiac Arrest
No recommendations for this finding
F4
The remainder of the county receives first responder Basic Life Support medical services from a variety of smaller fire departments and the California Department of Forestry. Response: The EMSIA MOSTLY AGREES. As described in #3, the EMSIA BLS agencies provide BLS Services to much of the county. The California Department of Forestry and Fire Protection (CALFIRE) provides BLS through its contract as the Santa Cruz County Fire Department. CALFIRE and Santa Cruz County Fire Department are not member agencies of the EMSIA.
No recommendations for this finding
F5
American Medical Response (AMR), a private ambulance service, coordinates with the EMSIA agencies for first responder ALS service and through its contract with the County of Santa Cruz is the sole provider of medical transport in the county. Response: The EMSIA AGREES.
No recommendations for this finding
F6
EMSIA fire agencies are able to provide a paramedic to a medical emergency within eight minutes of dispatch 90 percent of the time in urban areas. Response: The EMSIA AGREES. Urban areas, as defined for the purposes of this finding, are the jurisdictional service areas of the EMSIA ALS agencies (Aptos/La Selva Fire District, Central Fire District, Scotts Valley Fire District, City of Watsonville Fire Department and City of Santa Cruz Fire Department). The actual performance level hovers around 94% of all emergency calls within eight minutes.
No recommendations for this finding
F7
AMR is able to provide an ambulance to a medical emergency within 12 minutes of dispatch 90 percent of the time. Response: The EMSIA AGREES.
No recommendations for this finding
F8
A fire department paramedic is the first one to arrive at a medical emergency about 60 percent of the time. Response: The EMSIA AGREES.
No recommendations for this finding
F9
The expectations of service are carefully listed in the emergency services’ contracts issued by the county to American Medical Response. AMR coordinates its services with the EMSIA to ensure the best possible service to the citizens of Santa Cruz County. Response: The EMSIA AGREES. AED Distribution and Training
No recommendations for this finding
F10
Manual defibrillators, such as those carried by fire department and AMR paramedics, are expensive and complex and require significant training and experience to be effective. Conversely, automated external defibrillators (AEDs) are reasonably priced and simple to operate by anyone with a minimum of training. Surviving Sudden Cardiac Arrest - 5
No recommendations for this finding
F11
Santa Cruz County does not have a comprehensive policy regarding the distribution and installation of AEDs in public locations. Response: The County AGREES. The County is not required by State law to adopt a policy regarding distribution and installation of Automatic External Defibrillators (AEDs) in public locations.
Related Recommendations (4)
R3
Santa Cruz County should require AEDs in county buildings with more than 100 employees or daily visitors and in county detention facilities, including Juvenile Hall. Response from the County: This recommendation will not be implemented at this time. While the County strongly supports the idea, funds are not available to purchase and install AEDs in all county buildings with more than 100 employees. The County will look for funding opportunities and will consider a phased in approach as part of County budget considerations.
R4
Santa Cruz County should encourage the use of AEDs in the following public locales and private settings: • Public schools • Public swimming pools • Public libraries • Large concerts and other public events • Public golf courses • Churches with a capacity of 100 or more • Private schools • Private recreation clubs • Medium to large hotels and motels • Shopping centers • Medical and dental offices • Private golf courses • Senior citizen centers and care facilities Response from the County: The recommendation is in the process of being implemented by the Emergency Medical Care Commission’s Public Information and Education Subcommittee that is focusing on cardiac care and stroke prevention. The Emergency Medical Surviving Sudden Cardiac Arrest - 11 Services Program will also be adding information about AEDs to the program’s webpage.
R8
The county should develop a strategy for implementing a meaningful public access defibrillator program that meets the criteria of the American Heart Association and American Red Cross recommendations. Response from the County: The recommendation is in the process of being implemented by the Emergency Medical Care Commission’s Public Information and Education Subcommittee that is focusing on cardiac care and stroke prevention. The Emergency Medical Services Program will also be adding information about AEDs to the program’s webpage.
R9
The county should explore funding opportunities to pay for an expanded public access defibrillator program from both public and private sources, possibly enlisting the aid of community service organizations. Response from the County: The recommendation is being implemented by the Emergency Medical Care Commission’s Public Information and Education Subcommittee that is focusing on cardiac care and stroke prevention. Commendation Santa Cruz County’s emergency services teams and organizations for providing the most efficient and responsive services possible under current conditions. Surviving Sudden Cardiac Arrest - 13
F12
AEDs are carried in police patrol cars in Scotts Valley. No other law enforcement agencies in the county require AEDs in their vehicles. Response: The Santa Cruz County Sheriff's Office PARTIALLY AGREES. It is not known which law enforcement agencies in the county require AEDs in their vehicles. Response: The Santa Cruz Police Department PARTIALLY AGREES. Our agency does not require AEDs in all of our patrol vehicles but provides an AED in our supervisor’s vehicle and outside of the main lobby of our police department. Response: The Scotts Valley Police Department AGREES: Scotts Valley Police carries AEDs in our cars. We do not know what the requirements are in other county law enforcement agencies. Response: The Capitola Police Department DISAGREES. Currently, the Capitola Police Department has five AEDs at its disposal. One AED is deployed at the Police Department for use by staff either in the field or at headquarters. An additional AED is located in City Hall for use by City Hall staff serving the public. Three additional AEDs are available and routinely assigned to the Lifeguard Unit located at the Capitola Main Beach, one AED in the Supervisors patrol vehicle and one unit deployed in a primary police cruiser. Additional AEDs are scheduled for acquisition in late 2007 or early 2008. Several of these AEDs have been in service for approximately two years. Eventually, the Police Department intends to equip each primary patrol unit with an AED, requiring acquisition of three to four more devices. It is important to note that an AED also are available at the Capitola Mall and readily available to department staff working at the Capitola Police Department’s Community Outreach Center. Response: The Watsonville Police Department PARTIALLY DISAGREES. Capitola Police Department has many of them. Whether any other police department has them in the car, we don’t know. We accept the jury’s statement that Scotts Valley Police Department does.
Related Recommendations (1)
R5
The county and each city should equip law enforcement vehicles with AEDs. Response: The Santa Cruz County Sheriff's Office AGREES. This recommendation has not yet been implemented but will be implemented in the future. The Sheriff's Office has just purchased a few AEDs for deployment. However, due to the large number of Sheriff's vehicles, full deployment will have to occur in planned stages, along with the training of staff. Response from the Santa Cruz Police Department: The recommendation will not be implemented. Our agency is not a primary responder for medical calls and the Santa Cruz Fire Department staffs paramedics [are] primary responders for such emergencies. In order to outfit our patrol vehicles the department would have to outlay over $50,000 in equipment and training costs. Response: The Scotts Valley Police Department AGREES: The Scotts Valley Police Department has carried AEDs in our patrol vehicles for several years now. Response from the Capitola Police Department: The Capitola Police Department agrees and is the process of acquiring additional AEDs and the requisite training and certification required to effectively deploy the devices in each primary patrol vehicle, office site and the Capitola Lifeguard Unit. Response: The Watsonville Police Department AGREES. Watsonville Police Department will put them in the next two-year budget cycle; FY2009/11 for consideration by the City Council.
F13
The locations of AEDs in the county are not available to Net Com dispatchers. Response: NetCom AGREES.
Related Recommendations (2)
R2
The locations of AEDs in the county should be entered in Net Com’s Computer- Assisted Dispatch system. Response from NetCom: Requires further analysis and may not be implemented because it is beyond this agency’s scope of service. Netcom computer systems possess the ability to be programmed with AED location data tied to fixed telephone locations which would become available to call-takers upon call answering. While the technical capability and capacity exists, there is currently no program or system available to collect and update this location data, nor is there a requirement for businesses and individuals to “register” their AEDs by location. Furthermore, it is beyond the scope of our agency to mandate a registration and to be responsible for the collection of such data. In the event that a responsible agency should someday - 10 Surviving Sudden Cardiac Arrest register, collect, and update AED location data and make it available to our Agency in an electronic format, we in turn could enter it into our computer systems and make it available to call-takers handling 9-1-1 emergency calls. In the meantime, it is important to note that our computerized Emergency Medical Dispatch (EMD ProQA) software is configured to prompt call-takers to question callers who report “cardiac” incidents as to the availability and accessibility of an AED. In the event that a caller answers “Yes” to this prompt, EMD ProQA provides medically approved, step-by-step instructions which allows NetCom call-takers to “walk the caller through” the operation of an AED.
R7
The county should establish a reporting and inspection mechanism to ensure that AEDs deployed in the community are identified by Net Com and thereby viable in case of an emergency. Response from the County: Emergency medical dispatchers at NetCom routinely ask callers reporting suspected cardiac arrests to quickly look around for an AED. It would not be feasible to conduct inspections to ascertain where AEDs are located and to - 12 Surviving Sudden Cardiac Arrest establish and correct a database with any regularity. It is anticipated that in the near future AEDs will be as prolific as fire extinguishers.
F14
When AEDs are deployed in public buildings, they are often not visible and therefore not accessible when needed. - 6 Surviving Sudden Cardiac Arrest
Related Recommendations (1)
R7
The county should establish a reporting and inspection mechanism to ensure that AEDs deployed in the community are identified by Net Com and thereby viable in case of an emergency. Response from the County: Emergency medical dispatchers at NetCom routinely ask callers reporting suspected cardiac arrests to quickly look around for an AED. It would not be feasible to conduct inspections to ascertain where AEDs are located and to - 12 Surviving Sudden Cardiac Arrest establish and correct a database with any regularity. It is anticipated that in the near future AEDs will be as prolific as fire extinguishers.
F15
CPR classes, including training in the use of AEDs, are available through a variety of sources in the county. Need for AEDs
Related Recommendations (1)
R1
The Santa Cruz County Health Services Agency should establish a public education program to enhance the community’s knowledge and awareness of CPR and the use of AEDs as a life-saving measure. Response from the County: The recommendation is being implemented in conjunction with the Emergency Medical Care Commission’s Public Information and Education Subcommittee. The Subcommittee will continue to monitor local out-of-hospital cardiac arrest data and is working closely with Dominican Hospital to improve the survival rate.
F16
While immediate CPR can buy valuable time for a sudden cardiac arrest victim, defibrillation is the only treatment that can save the victim’s life by restoring the heart’s spontaneous rhythm. Response: The EMSIA AGREES. Defibrillation is the most definitive intervention shown to restore spontaneous circulation in cardiac arrest patients. However, studies also show that effective CPR significantly enhances the success of all defibrillation attempts. Proper compression and ventilation (especially with 100% oxygen) is therefore a critical component of this “chain of survival.” To this end, early 911 access is also crucial; the study here in Santa Cruz County showed higher survival rates with witnessed arrests vs. unwitnessed arrests.
No recommendations for this finding
F17
People of any age may suffer sudden cardiac arrest and die suddenly. Response: The EMSIA AGREES. While the predominance of sudden cardiac arrests occur among elderly patients, it is true that no age group is immune from sudden cardiac arrest.
No recommendations for this finding
F18
Sudden cardiac arrest is different from a heart attack although coronary artery disease may reduce heart circulation and eventually result in SCA. Response: The EMSIA AGREES.
No recommendations for this finding
F19
Often the first sign that a person is vulnerable to ventricular fibrillation is an attack that results in sudden cardiac arrest and death. Response: The EMSIA AGREES.
No recommendations for this finding
F20
In Santa Cruz County, approximately 250 people per year are victims of out-of- hospital sudden cardiac arrest. From October 2004 through September 2006, more than half of these victims (51 percent) were not candidates for resuscitation, mostly because too much time had elapsed before emergency medical services could be activated.6 Response: The EMSIA AGREES. The patients in this study who were not candidates for resuscitation fell into one of three groups:
No recommendations for this finding
F21
Some common causes for sudden cardiac arrest include asphyxia due to drowning or other oxygen deprivation, congenital heart conditions, sudden blows to the chest, electrocution, and coronary artery disease. Response: The EMSIA AGREES. The vast majority of cases of sudden cardiac arrest in adult patients across all age groups can be attributed to the presence of coronary artery disease and/or cardiomyopathy, and the subsequent fatal arrythmias which can occur in these patients. The most common cause of cardiac arrest in children is respiratory arrest secondary to a host of causes including drowning, foreign body airway obstruction, and respiratory disease. Sudden blows to the chest, electrocution, and congenital heart conditions are very rare causes of sudden cardiac arrest in any community. “Asphyxia” refers to fatal anoxia from respiratory failure (from drowning, foreign body airway obstruction, severe asthma attacks, etc.) and is a more common cause of SCA in any community, but certainly far less common than cardiac etiologies.
No recommendations for this finding
F22
The worst combination for cardiac arrest survival is if patients collapse without witnesses, and when discovered, receive no bystander CPR while emergency services personnel are en route. In a two-year period in Santa Cruz County, only two of 215 patients in this situation had their hearts begin to beat again, and neither survived. When sudden cardiac arrest was witnessed and immediate CPR was administered, nearly a quarter of the victims regained pulses and 10 percent survived. The survival rate jumped to 19 percent when EMS professionals witnessed cardiac arrest and could begin treatment immediately. There were 16 EMS-witnessed cases in the two-year period, and three of those were found to be in ventricular fibrillation (as opposed to those with no electrical activity or pulse). All three were successfully resuscitated with defibrillation only.7 Response: The EMSIA AGREES.
No recommendations for this finding
F23
Some experts believe that a connection may exist between the use of ‘Tasers’ by law enforcement and sudden cardiac arrest in some individuals. Response from the EMSIA: This concept is very hotly debated among legal, medical and law enforcement experts. Much of the medical data at this time suggests that sudden, in-custody deaths may in fact be attributable to a medical phenomenon known as “excited delirium.” Excited delirium is thought to occur when individuals — often, but not always, drug or alcohol intoxicated — develop central nervous system dysfunction which leads to bizarre, violent behavior. When force of any kind is subsequently used 7 SCA Audit, p. 6. - 8 Surviving Sudden Cardiac Arrest — wrestling with the patient, batons, Tasers, pepper spray — the patient may experience respiratory and cardiac arrest. There is no indication that Tasers particularly are implicated in in-custody deaths any more than any other use of force to try to control and contain a violent or non-compliant subject who suffers from this phenomenon.
No recommendations for this finding
F24
To improve the survival rate of victims of out-of-hospital cardiac arrest in Santa Cruz County, the Emergency Medical Services Integration Authority recommends “promulgating citizen CPR programs, Public Access Defibrillator (PAD) programs, and continued rapid EMS response using all the latest AHA (American Heart Association) recommendations for CPR, defibrillation, and advanced life support care.”8 Response: The EMSIA AGREES. Laws related to AEDs
No recommendations for this finding
F25
Effective July 1, 2007, the State of California will require all health clubs to be equipped with AEDs on site and establish a program of training, maintenance, and record keeping. Response: The EMSIA AGREES.
No recommendations for this finding
F26
Good Samaritan laws protect most citizens from liability if they take action in a medical emergency, which includes using an AED. Conversely, lawsuits have been filed against organizations such as amusement parks and airline companies for not having AEDs readily available.
Related Recommendations (1)
R6
The county should establish a mechanism to ensure that once AEDs are deployed by public agencies, those responsible meet the requirements needed to shield the county from liability by providing training, maintenance, record keeping and medical oversight. Response from the County: State law is clear that individuals and agencies that purchase and place AEDs are shielded from liability if they follow the requirements to maintain them and conduct training as required by the State.
F27
AEDs are now required at FAA governed airports and on all commercial airliners.
No recommendations for this finding
F28
The Federal Cardiac Survival Act of 2000 (Public Law 106-505) directed the Health and Human Services Department to establish guidelines for evaluating and installing AEDs in federal buildings. Conclusions:
No recommendations for this finding

Conclusions 9

Commendations 1

No Responses Found 3

Government entities assigned to respond to this report. No response documents have been linked in our database.

County Service Area No. 4 (Santa Cruz) Special District
Santa Cruz County Board of Supervisors Elected County Office
Santa Cruz County Sheriff Elected County Office