COUNCIL OF THE CITY OF PHILADELPHIA COMMITTEE ON PUBLIC SAFETY - - - Room 400, City Hall Philadelphia, Pennsylvania Tuesday, February 21, 2006 1:15 p.m. - - - PRESENT: COUNCILWOMAN DONNA REED MILLER, CHAIR COUNCILMAN JAMES F. KENNEY COUNCILMAN JUAN RAMOS COUNCILMAN FRANK RIZZO RESOLUTION 051158 - Resolution authorizing City Council's Committee on Public Safety to conduct Public Hearings to examine ways to increase the number of people who have been trained in Cardio-Pulmonary Resuscitation. - - - V A R A L L O Incorporated Litigation Support Services Eleven Penn Center 1835 Market Street, Suite 600 Philadelphia, Pennsylvania 19103 215.561.2220 215.567.2670 2
Good afternoon to everyone. The Committee on Public Safety's public hearing is now in session. Will the Clerk please read the title of the resolution.
Resolution 051158, resolution authorizing City Council's Committee on Public Safety to conduct public hearings to examine ways to increase the number of people who have been trained in Cardio-Pulmonary Resuscitation.
Thank you. For the record, in attendance today -- I don't need a quorum because we're not voting anything out -- to my left is Councilman Frank Rizzo and to my right is Councilman Juan Ramos and Councilman Jim Kenney, and I am Councilwoman Donna Reed Miller, Chair of the Committee. Before the first witness comes up, I'd like to read an opening 3 2/21/06 - PUBLIC SAFETY - RES. 051158 statement. I was first made aware of the problem of the bystander rate in Philadelphia by the Fire Commissioner, Lloyd Ayers. He told me that a large number of people in this City are not prepared. They are not prepared to administer aid to a fellow citizen if they need help in the event of a heart attack. By the time rescue crews arrive, usually irreparable damage has been done. If a bystander has been there to give CPR to a victim of a heart attack, his or her chance of survival would have increased dramatically. Heart attacks don't always just happen on the streets. A large majority of attacks occur in the home. This is even more tragic. Family members may know something needs to be done, but too often they may not know how. This leads to instructions on the telephone more often than not that is not very 4 2/21/06 - PUBLIC SAFETY - RES. 051158 effective. A family member is trying to make a call under duress and has to have the state of mind to perform a procedure that they may not be familiar with. This is why we are here today in conjunction with the Fire Department, the American Heart Association and Thomas Jefferson University. We want to bring this problem to the forefront. Each of these organizations here are going to discuss and explore the problem and offer some solutions. Each and every Philadelphian is the first link in the chain of survival. If we can increase the number of citizens who are trained to react to an emergency such as a heart attack, we will be offering victims of heart attacks an increased chance of survival. Would anyone else on the Committee have anything they want to say? (No response.)
Okay. We have you sort of in panels. So would 5 2/21/06 - PUBLIC SAFETY - RES. 051158 Commissioner Lloyd Ayers and the Fire Department, other persons from the Fire Department, please come to the witness table and identify yourself for the record and proceed with your testimony. Good afternoon. COMMISSIONER AYERS: Good afternoon, Councilwoman. I'm Lloyd Ayers, Fire Commissioner for the City of Philadelphia. CHIEF HALPER: Ralph Halper, Regional Director of Emergency Medical Services. CHIEF BUTTS: George Butts, Director of EMS Training for the Philadelphia Fire Department.
So who is going to start first? Commissioner? COMMISSIONER AYERS: I'll begin. To the members of the Committee, I'd like to say good afternoon.
Good 6 2/21/06 - PUBLIC SAFETY - RES. 051158 afternoon. COMMISSIONER AYERS: I'm Fire Commissioner Lloyd Ayers, and I am here to testify, along with Chiefs Butts and Halper and Captain Touchstone, on the importance of Resolution 051158, which addresses the need to increase the number of our citizens who know and will perform Cardio-Pulmonary Resuscitation, commonly known as CPR, in the event of witnessing a sudden cardiac arrest. Here in Philadelphia too few people know what to do when faced with such an emergency. In order for a person to have the best chance of surviving a sudden cardiac arrest, someone must take immediate action. The actions to take are simple ones: Recognize the emergency, activate the emergency response system, call or have someone dial 9-1-1, and start CPR. The question is, who is that someone going to be? The American Heart Association has identified four links that comprise 7 2/21/06 - PUBLIC SAFETY - RES. 051158 the chain of survival: Early access to emergency medical services by calling 9-1-1; early CPR; early defibrillation, electrical shock to the heart; and early advanced care. Each link in the chain is dependent upon the others. Remember, the chain is only as strong as its weakest link. The first two links in the chain, early access and early CPR, rest in the hands of the bystander, the average citizen who witnesses a sudden cardiac arrest. The bystander must act before EMS arrives. The bystander is the one who will help a victim of sudden cardiac arrest by recognizing that there is an emergency, calling 9-1-1 and beginning CPR. When a person suffers sudden cardiac arrest, when they collapse because their heart is no longer beating properly, they need help as quickly as possible to increase their chance of survival. Without blood circulating, the 8 2/21/06 - PUBLIC SAFETY - RES. 051158 victim will begin to suffer brain damage in as little as four minutes, and will be beyond hope of survival in as little as ten minutes. Bystander CPR provides the circulation needed to keep the blood flowing to the brain and vital organs. This, in effect, slows down the clock and increases the likelihood that a victim of sudden cardiac arrest will have the best chance of survival when professional help arrives. The Fire Department will bring the next link in the chain of survival, early defibrillation, in about four minutes. It's during those four minutes that the bystander must act. Through education and training, by increasing the number of people here in Philadelphia who know what to do when faced with a family member, loved one, co-worker, any citizen of Philadelphia or any visitor suffers sudden cardiac arrest, we can increase the chance for victims to survive the event. 9 2/21/06 - PUBLIC SAFETY - RES. 051158
Thank you. We can move on to the next witness. CHIEF HALPER: Sure. Good afternoon, Council President, members of Council. My name is Ralph Halper and I'm here to testify along with Commissioner Ayers and my fellow colleagues on the impact of the proposed Resolution 051158 encouraging citizen CPR. A model of success: One model of success in increasing the survival of sudden cardiac arrest is in the west coast city of Seattle, Washington. There, 45 percent of the people who suffer cardiac arrest survive. In Philadelphia, five percent survive. Over the past 30 years, Seattle has trained 19 percent of their population in CPR. In Philadelphia, four percent have been trained. In Seattle, bystanders start CPR 44 percent of the time. In Philadelphia, bystanders start CPR 10 percent of the time. Studies have shown that the 10 2/21/06 - PUBLIC SAFETY - RES. 051158 more people trained in bystander CPR, the more citizens are willing to act in an emergency, resulting in a higher rate of patient survival. Here in Philadelphia, too few people know what to do when faced with sudden cardiac arrest. For these reasons, we encourage the passage of Resolution 051158, encouraging the training of citizen CPR. This concludes my testimony.
Thank you. CHIEF BUTTS: Good afternoon, members of Council. I am Chief George A. Butts of the Philadelphia Fire Department. I am currently assigned to the Philadelphia Fire Academy as the Emergency Medical Services Training Chief. I am here to testify, along with the Fire Commissioner, Lloyd Ayers, and EMS Battalion Chief Ralph Halper on the merits of 051158. By bringing attention to this critical issue, we hope 11 2/21/06 - PUBLIC SAFETY - RES. 051158 to improve the survivability of cardiac arrests involving the citizens and visitors of our City. As illustrated in the testimony preceding mine and the testimony to come, the importance of CPR cannot be understated. The Philadelphia Fire Department's EMS Training Unit certifies and maintains the CPR certification of close to 3,000 City employees. This training touches more than just our members. It touches their families, their neighbors and their friends. It stretches beyond just their employment with the City of Philadelphia. As I sit here before you, I can say with pride that this training has saved lives and that this training has made a difference. But for our great metropolis, these 3,000 are not enough. As previously stated, our great city can and should do more in this area. The question can be asked what can we do. The key to the answer can be 12 2/21/06 - PUBLIC SAFETY - RES. 051158 found in education and training. The biggest obstacle of getting involved is often the fear of not knowing what to do. There is no easier fear for knowledge to overcome. So what can we as citizens do? We can take advantage of the available CPR training at hospitals, AHA training centers, the Red Cross and other certified training centers. This training and education will help us to realize that there is nothing to fear in coming to the aid of someone in cardiac arrest. This training and education will help us to realize how easy it is for us to learn CPR. With education and training comes preparation, and with preparation comes comfort, and with comfort comes confidence. The fact is that most cardiac arrests are witnessed by family members, friends and co-workers. I ask as citizens of this great city, you look around and ask yourself if your family member, if your friend, if your co-worker 13 2/21/06 - PUBLIC SAFETY - RES. 051158 was in cardiac arrest, would you know what to do. As a city government, we should endeavor to make more learning opportunities available to our citizens. As leaders, we should encourage the public to take CPR classes. We need to commit to making sure that no City worker in any City workplace has ever the need to say the words "if only I knew what to do." We should lead the way in giving our citizens the confidence to get involved in the event of a cardiac arrest. With this in mind, the Philadelphia Fire Department, with the permission of Chief Ayers, commits to training selected members of other City agencies as CPR instructors so they can provide that instruction in their agency. The citizens of Philadelphia should come away from this hearing with the understanding that learning CPR and accepting their responsibility for their 14 2/21/06 - PUBLIC SAFETY - RES. 051158 part of the chain of survival yields great returns on the small investment of taking a CPR class. We of the Philadelphia Fire Department will be there for you, but the value lies in raising the response rate of our citizens to cardiac emergencies and, therefore, raising the survival rate of our citizens in cardiac arrest. Remember, you can save a life, and it's easier than you think. I thank you for this opportunity to address Council.
Thank you. Thank you all for your testimony. I have a few questions, and I know Councilman Rizzo also has a question. What are the signs of cardiac arrest? If someone is having a heart attack, I don't know that I would know that. What are the signs? Anyone can answer that. CHIEF BUTTS: The signs and 15 2/21/06 - PUBLIC SAFETY - RES. 051158 symptoms of a heart attack vary, but usually it's chest discomfort radiating into the neck or down the left arm, sweating. There can be dizziness, nausea. Very often sometimes when these symptoms are minor, they're overlooked as flu-like symptoms, but recognition is extremely important.
So I guess if someone had those symptoms and then they began to pass out, I guess that's what would help you understand that they're having a heart attack. CHIEF BUTTS: Well, even before that happens, it's a good idea to start your part of the chain of survival and get help for that person. You don't need to wait until they pass out. If someone says, I have chest pain and I'm having trouble breathing, it's time to get started.
Okay. CHIEF BUTTS: The clock starts ticking then. 16 2/21/06 - PUBLIC SAFETY - RES. 051158
Thank you. Councilman Rizzo. I have other questions, but you can go on.
Commissioner, the big utility companies like PGW, Exelon, Comcast, SEPTA, I would hope that -- and I look back to when I worked for a utility, that that was a very important part of corporate policy, that all employees, not just the ones that were working in an environment that -- as you can imagine, knowing CPR when you're working in a crew on energized electrical wires. I mean, that's an absolute requirement. But it didn't stop there. It worked its way through the entire company, where even the people that worked in the office were well trained in the area of CPR. Maybe it wouldn't be a bad idea 17 2/21/06 - PUBLIC SAFETY - RES. 051158 to send a letter to the Presidents of the various corporations to get -- I mean, can you imagine if you had every SEPTA driver -- and I don't know whether SEPTA drivers know how to administer CPR -- if a person on their bus would become ill. I don't know if all the PGW employees that work on the street are trained. You would think so, because, again, of the environment that they work in. I know PECO, Exelon, all of their employees are well trained, for obvious reasons. Comcast, what a presence they have. So, again, I guess our numbers are skewed a bit because we really don't know how many of the people that I just mentioned are out there to be able to respond. And as far as I know, I've never heard any executive ever say, Don't get involved. Just the opposite, Do what you can do to help. Same with our Sanitation workers. I have no clue whether they could come to the aid of a 18 2/21/06 - PUBLIC SAFETY - RES. 051158 fallen citizen. So maybe the best place if we want to bump these numbers would be to go where we could get the most response almost immediately and have a plea for the big corporations to step forward and make sure that that training hasn't fallen between the cracks. To be real candid, what effect do you think it has -- because I've had people tell me that they probably wouldn't respond or want to know, be trained, because they're afraid of getting sick with some communicable disease. Candidly, do you think that that has had an effect on the numbers? COMMISSIONER AYERS: Well, I believe that there are many factors that feed into this, why our rate is so low, but I also believe that education as to how to properly do CPR and also that coupled with the research, the great research that's been done by doctors, not 19 2/21/06 - PUBLIC SAFETY - RES. 051158 only here in the United States but around the world, that are telling us that even people who are shy that way, who may not normally intervene with compressions and mouth-to-mouth resuscitation, that we have other ways that we can get people to do mouth-to-mouth. But more especially, the research says that as long as the chest compressions are going, that's something, that you have circulation in the body, that you have whatever remaining oxygen is in the blood that is going to the brain and other vital organs so that this person has a chance so that when we get there, they're in a state that they're more shockable as far as the AEDs, all of those things that we have to bring to bear upon their survival, that these things are the things that we have to educate people to. Also, we have to educate people that it's important to get involved, that just because you touch a person doesn't mean that you're going to get some 20 2/21/06 - PUBLIC SAFETY - RES. 051158 communicable disease. So the more you educate the population, the more readily they'll intervene and be intervening with education, understanding what they're doing and how important it is.
The first part of my suggestion on the big companies. COMMISSIONER AYERS: I think that that's a real key piece, that we plan on doing that, that that's part of what we want to look at as far as going forward. CHIEF HALPER: Council, sir, I believe some of the major CPR agencies in our City, such as the American Red Cross and the American Heart Association, might have some work in that area. And the American Heart Association is here. They may be able to address that later on as far as CPR in the private sector.
And one of the things that we're going to do after these hearings is put together a 21 2/21/06 - PUBLIC SAFETY - RES. 051158 task force to figure out -- we talked about this already -- to figure out the outreach and education efforts that we're going to take moving forward. So that's a very good suggestion.
I have a question. What is Seattle doing different? I mean, do you know what they've done different, because they have so many people trained? I mean, have they had an outreach program to corporations? What are they doing? CHIEF BUTTS: Seattle had a very public effort to, and a concentrated effort, to train a large number of their citizens in CPR. For Seattle, this has been an ongoing event for about 30 years. This didn't just happen for them. It involved all facets of the city, the private companies, the city itself. They had billboards. They had an entire advertising campaign to get people 22 2/21/06 - PUBLIC SAFETY - RES. 051158 interested and on board.
What about the issue of getting sued if someone administers CPR, the issue of being sued? CHIEF BUTTS: There are what are called good samaritan laws, which say if you go in to help someone and you're trying to help them, that you are exempt from any legal action. One of the problems that has plagued the situation is that people for those reasons will stand by and do nothing, and that is far worse than attempting to do something. As the Commissioner pointed out, research has shown that just the compressions, without even getting involved in the mouth-to-mouth, just the compressions greatly improve a person's chance of survival. And connected to that, 80 23 2/21/06 - PUBLIC SAFETY - RES. 051158 percent, studies have shown, 80 percent of the cardiac arrests that occur occur with a family member or a friend. And I'd like to believe that I think most of my family and most of my friends will probably do mouth-to-mouth on me if I collapsed.
Well, at least if they hit your chest. See, I just learned something. I didn't know that that's the important part, to keep that blood flowing. That's real important. CHIEF HALPER: Just to understand that and how that works is that in our atmospheric air now, we have approximately percent of oxygen in the 19 100 percent of air that we're breathing. 20 So when you breathe in, you're getting 20 percent oxygen. Then when you exhale, you're exhaling yet another 16 percent or maybe 15 percent. So your body is utilizing four to five percent of the oxygen. And then when you exhale it, 24 2/21/06 - PUBLIC SAFETY - RES. 051158 you're exhaling 15 percent of that. So the theory is is that if you do chest compressions without the mouth-to-mouth airway breathing, that you're still circulating that percent 7 of oxygen in the person's body. And the 8 American Heart Association will address 9 later the science of CPR and explain 10 that, of how that still benefits the 11 patient. 12
All 13 right. Any other members have any 14 questions? 15 Councilman Rizzo.
Commissioner, I don't want to get off track, but could you describe the difference between the advanced life support versus the basic in the response of the person who is having a heart attack? Describe, if you could, the difference in the two responses. COMMISSIONER AYERS: Okay. The difference in the responses as related to 25 2/21/06 - PUBLIC SAFETY - RES. 051158 a basic life support unit, which has two emergency medical technicians on board who are trained, emergency medical technicians, they're licensed by the State of Pennsylvania and that they are authorized to do all of those things that an emergency medical technician would do. They would come to the scene. They would assess the scene. They would immediately begin CPR or take the CPR operation over if bystander CPR has started. They would begin to give oxygen to that person, along with the compressions and breaths or whatever has been done. And that oxygen, just the oxygen and the continuation of the compressions is something that would help that individual, because, one, if the compressions were taking place, they would have hopefully adequate blood pressure in the system to keep that oxygen going to the vital organs. The supplement of the oxygen is going to raise that for that patient. 2/21/06 - PUBLIC SAFETY - RES. 051158 They would start to package that patient, put that patient in the medic unit and do the next best thing for that patient, and, that is, get them to the area hospital. An ALS unit coming up on the same type of a heart attack situation, they would assess the scene. They would begin to take over where the bystander CPR had started. They would look at that patient. They would give that patient oxygen or possibly intubate that patient, which would be the difference, where the oxygen would be going by tube into the lung versus by bag into the lungs. But the most important thing is, they will continue those chest compressions, package that person and get them on the way. Other things that an advanced life support paramedic would be able to do would be to begin to start to take an intervention into the body by way of tubes, needles, tubes, starting a drip, 27 2/21/06 - PUBLIC SAFETY - RES. 051158 things like that. They can do those types of things. Also, they have the ability to put other drugs and chemicals in the system that would hopefully assist in helping that patient. The one thing that both of them would do if that heart had started that I didn't mention was, they would apply the defibrillator. They would take a reading, see where it is at and they will shock that patient. So both of them would do almost the exact same things.
Commissioner, is there any question that if a constituent is having a heart attack, that response is important but advanced life support is obviously the best care a person experiencing a heart attack can have? COMMISSIONER AYERS: Well, the materials that I have been reading and the report out from doctors, a consortium of doctors from around the world, tells us that an advanced life support 28 2/21/06 - PUBLIC SAFETY - RES. 051158 intervention is not the end-all to that patient, that the advanced life support -- of course, I would want to have the better advanced life support, but the most important thing is the oxygen, the compressions and the handling of that patient, making sure that your link is handled properly, which is getting that person to the higher level of care. That is the most important.
Both are doing that, but I'll use the word the stepped-up care comes from -- if you're having a serious heart attack, the advanced life support can provide more care than obviously it says. Advanced is one level of service, basic is another. And I'm not going to go where you think I'm going. I just want to understand. COMMISSIONER AYERS: No. I understand. I would like to say that I would have to understand that more, I believe, the American Heart Association understands some of those comments and 29 2/21/06 - PUBLIC SAFETY - RES. 051158 some of those conclusions that doctors came to. They did not say that advanced life support was no good, but some of the things that we thought in the past, before 2002, in the early '90s, that we would have this great advancement in cardiac care just by having two EMTs, I don't think that they have the same percentage of thought that what advanced life support brings to the game when you start talking about advanced life support, emergency medical technicians and the difference. I believe that there is a difference. I believe that if you can have advanced life care, that is what would be good, but I believe that an emergency medical technician, two emergency medical technicians and two paramedics on the scene taking care of a patient, getting that patient packaged and to the hospital will give that person the opportunity to survive. I believe that. 30 2/21/06 - PUBLIC SAFETY - RES. 051158
Thank you. Commissioner, isn't the main difference between the advanced life and the basic life the intravenous administration of drugs? Isn't that really the basic difference, that they're able to administer intravenously certain drugs that are critical in the care? COMMISSIONER AYERS: That's one of the differences. Another difference is that they can read the strips on the monitor a little bit better.
EKG. COMMISSIONER AYERS: Exactly. And be able to forewarn the hospital during the hay system that we have a person, this is what their rhythm is looking like, and it gives some more advanced warning to the receiving hospital on what they need to do. 31 2/21/06 - PUBLIC SAFETY - RES. 051158
How many runs a year, both basic and advanced, does the Department respond to a year? COMMISSIONER AYERS: Gosh, 207,000, something like that last year.
Of the 207 or so thousand, how many of those are severe cardiac arrests? Have you been able to break them down into need for transport to the hospital? I understand there's a wide range of stories throughout the City and throughout the history of the Department as to the use of EMT and ALS units by the public, ranging from severe cardiac arrest and death to, I have a doctor's appointment, and anywhere in between. Have we been able to break down what people call the Fire Department for on the medical side? COMMISSIONER AYERS: Yes, we have. We have. And one of the things that we have found is that for advanced life support, they're about 20 percent of 32 2/21/06 - PUBLIC SAFETY - RES. 051158 our calls. They average around 20 to 25 percent.
And advanced life support would be what categories of illness or injury? COMMISSIONER AYERS: A category where you would absolutely be looking at this patient as in trouble, in dire need of medical attention, and that we need to get them to a hospital right away.
So the person would die without medical attention potentially. COMMISSIONER AYERS: The person could die without medical attention.
That's the -- 19 COMMISSIONER AYERS: And that 20 could be everything from heart attack to sometimes with auto accidents, it's the same thing.
But all of those serious cases are about 20 percent of the 200,000? 33 2/21/06 - PUBLIC SAFETY - RES. 051158 COMMISSIONER AYERS: About percent.
And the 5 rest of them fall into what kind of 6 categories? 7 COMMISSIONER AYERS: Basic life 8 support. 9
Give me an 10 example. A bicycle accident? A dog 11 bite? 12 Part of the whole -- and this 13 is a little bit off the subject, but part 14 of this whole debate on ALS versus basic 15 is the types of injuries or types of 16 medical conditions that your people are 17 dealing with and in what ratio and in 18 what frequency they are. 19 So I think it's important for 20 the public to understand that every EMT call or every 9-1-1 call for medical treatment is not a cardiac arrest where someone is potentially dying. It's about 20 percent of those calls. So the rest of them have to fall into other 34 2/21/06 - PUBLIC SAFETY - RES. 051158 categories that are less life-threatening, I would assume. COMMISSIONER AYERS: That's correct, Councilman.
And that that would be appropriate for EMT or even first-responder. We still do first-responder? CHIEF HALPER: Yes, we do. COMMISSIONER AYERS: Yes.
So we have the engine company, the ladder company go out to a potential medical call and then they assess the situation and call whether they need an EMT or an advanced life support system. COMMISSIONER AYERS: Well, they may communicate it to that incoming unit, but along with every first-responder run, we do send a medic unit. There are times --
So the medic unit and the first-responders go at the same time? 35 2/21/06 - PUBLIC SAFETY - RES. 051158 COMMISSIONER AYERS: That's correct.
What determines whether it's an advanced life support system or a basic life support system? COMMISSIONER AYERS: What they are presented with. They'll make an assessment, they'll look. It could be a situation where there's a problem with the person's airway, a problem with the person's circulation or open bleeding, a problem with circulation like the heart or a problem with their circulation like open bleeding. So they would assess that.
For this discussion and I guess more for a future discussion, I'd be interested in knowing of the 200 or so thousand calls, the 20 percent and what the 80 percent entail just in general terms, what types of response, whether it's anecdotal or whether it's actually -- I'm sure you 36 2/21/06 - PUBLIC SAFETY - RES. 051158 guys have reports that are filed as a result of any kind of contact with the public so we would know what those other type of medical events are, I assume. CHIEF HALPER: In the broadest term, in the most general terms, the way I usually explain it is that basic life support provides external treatment and care. Advanced life support provides invasive procedure into the person's body, as the Commissioner said, with a tube or a medicine or a reading of EKG, things of that nature. So if you're talking about the BLS classification of calls, they could go from a fracture to a bruise to a cut to a child delivery, things of that nature that can be handled on the outside of the patient.
Is part of the 20 percent also gun-related shootings and those kind of things? CHIEF HALPER: That is correct.
So it's 37 2/21/06 - PUBLIC SAFETY - RES. 051158 cardiac arrests, shootings, serious -- CHIEF HALPER: Trauma.
-- trauma? CHIEF HALPER: Penetrating trauma. The serious would be the upper thorax of a knife or a bullet wound.
And that amounts to percent of our 200,000? 10 CHIEF HALPER: That's about 10 11 percent. That's an advanced life support 12 case, but the whole advanced life support 13 bracket would be 10 and 10, maybe 10 14 medical and 10 trauma. 15
Okay. All 16 right. Fine. 17 The other question I have 18 relative to the administration of CPR, I 19 remember when I was much younger, before 20 I was in Council, my dad as a Battalion Chief was an instructor at the Fire Academy, and I remember having all these pieces of equipment, the bresusciani (ph) and the doll and the thoracic section. We'd all learn how to do that stuff and 38 2/21/06 - PUBLIC SAFETY - RES. 051158 were all taught how to do it properly. Are there times when it shouldn't be administered? And the reason I ask this question is, in order for a person to determine the need for it, does the heart need to have stopped or is the heart in just -- and people from the Heart Association could also kind of respond to this question. Is the heart in a weird rhythm? Is it proper to do it then? Is it proper to do it only when the heart has stopped? Are there times when people are in distress where it's administered and they're worse off for having CPR administered to them? I mean, I know that might not be a large number of cases, but I'm just curious as to trying to educate people as to when it's appropriate to do it, because I know people, it would be the first thing they did. I don't know whether or not that's a good thing either. So can you respond, and then 39 2/21/06 - PUBLIC SAFETY - RES. 051158 maybe the Heart Association people could respond. COMMISSIONER AYERS: I'd like to say that I believe that we have many experts in this room that will be able to answer those questions. Of course, I've tried to do the best that I could with the limited knowledge that I have in those areas. So I would suggest that we have the opportunity to bring some of the experts to the -- is that okay?
The Heart Association is coming on next. That's the next panel.
Thank you. Commissioner, in reference to advanced life support and basic -- for lack of a better word, I'll use the word 40 2/21/06 - PUBLIC SAFETY - RES. 051158 creative dispatch. Will we send an advanced life support unit for something that we know doesn't require advanced life support? Are they just in the rotation? If it's where they're stationed and there's someone that fell off a bike, will we tie up an advanced life support unit or could we send the closest basic and keep that advanced life support unit available when we really need them? Because I hear one of our problems is that sometimes we've got the advanced life support tied up on issues that don't require advanced life support. COMMISSIONER AYERS: Yes, we can, and we do try to make those distinctions and do that type of a dispatch. But one of the things that we find is the amount of demand that is placed on the system, for the most part, it precludes that opportunity. And we have a staged response that we've set up. So that advanced life support unit may very well have to take the next case, 41 2/21/06 - PUBLIC SAFETY - RES. 051158 which would be a basic life support type of an event, even though the dispatcher knows that. There may not be another available unit for some distance. So those are some of the things that we are in the process of improving in the Fire Department, both with technology as well as with experience, having people who can actually hear the call, be able to, if you will, decipher the call and give the best response to the AED fire communications worker, that dispatcher, in that dispatch. So we are working on those things, and that is available, but, again, the demand on the system sometimes precludes that type of an opportunity.
Thank you. Thank you, Commissioner. Are there any other questions of these witnesses? 42 2/21/06 - PUBLIC SAFETY - RES. 051158 (No response.)
Thank you. Thank you, Fire Department. Our next group of people will be from the American Heart Association, Dr. Charles Bridges.
Thank you. Councilwoman Miller and members of the Committee on Public Safety, my name is Dr. Charles Bridges. I am Chief of Cardiothoracic Surgery at Pennsylvania Hospital and Associate Professor of Surgery at the University of Pennsylvania Health System. I'm a former member of the American Heart Association's Southeast Pennsylvania Region Board of Directors. Joining me today to my right is Ed Stapleton, an Associate Professor of Emergency Medicine and Director of Pre-Hospital Education in the Department of Emergency Medicine at the State University of New York-Stoney Brook. On behalf of the American Heart 43 2/21/06 - PUBLIC SAFETY - RES. 051158 Association, thank you for holding a hearing to raise awareness of this important issue and to discuss ways to teach more Philadelphians Cardio-Pulmonary Resuscitation, commonly referred to as CPR. Also, thank you for providing the American Heart Association with this opportunity to testify today. We would like to thank the members of the Philadelphia Fire Department and its emergency medical services for all the outstanding work that they do. Their testimony here clearly outlined the issues facing Philadelphia. We hope that this hearing serves as a catalyst to raise awareness of why it's important that as many Philadelphians as possible learn CPR, and brings us together to find ways to get Philadelphians that training. All of this will help to save many lives. The American Heart Association would also like to take this time to 44 2/21/06 - PUBLIC SAFETY - RES. 051158 discuss what CPR is, offer a national perspective and some best practices, and discuss some options available to increase the bystander rate. CPR is a combination of breathing, known as ventilation, and pushing on the chest, known as compressions, delivered to victims thought to be in cardiac arrest. Cardiac arrest is often caused by an abnormal heart rhythm called ventricular fibrillation. That is when the heart quivers, but does not pump any blood. The victim in ventricular fibrillation cardiac arrest needs CPR, which can support a small amount of blood flow to the heart and brain to buy time until normal heart function is restored. Just last year, the American Heart Association, continuing its practice of science-based research, issued new guidelines for CPR. This revision was based on the most comprehensive review of resuscitation 45 2/21/06 - PUBLIC SAFETY - RES. 051158 literature ever published and incorporated the input of 281 international resuscitation experts over a 36-month period. The new guidelines, simply put: Rescuers should push hard, push fast, allow full chest recoil, minimize interruptions in compressions and provide a shock to the heart called defibrillation promptly when appropriate. Defibrillation eliminates the abnormal heart rhythm and allows the normal heart rhythm to resume. Decades of research have shown that more people can survive sudden cardiac arrest when CPR is performed within a particular sequence of rapid events. This sequence is, one, recognizing early warning signs of a medical emergency; two, activating the emergency medical system; three, performing basic CPR; four, providing defibrillation; and, five, accessing early advanced care such as oxygen and medications. The common term for this 46 2/21/06 - PUBLIC SAFETY - RES. 051158 sequence by EMS and the medical community is the chain of survival. While specialized programs are necessary to develop strength in each individual link, all of the links must be connected. Weakness in any link lessens the chance of survival for a victim of cardiac arrest. We mention the chain of survival because as we focus on one particular link, CPR, we cannot ignore the critical actions preceding CPR and following CPR. The chain of survival begins when a medical emergency is recognized and the EMS system is activated by calling 9-1-1. This can be done either by a witness or by the person who actually is experiencing the symptoms.
This link can be strengthened through public education and awareness. For a number of years, the American Heart Association has offered educational and public service programs, 47 2/21/06 - PUBLIC SAFETY - RES. 051158 print materials and websites designed to make the public aware of what to do when a cardiac arrest occurs. Participants in classes on CPR and American Heart Association-sponsored school site and work site training programs learn the warning signs of heart attack, how to recognize a person in cardiac arrest and to quickly call the EMS system when a person collapses. Performing CPR immediately after recognizing cardiac arrest is the next critical step. CPR should coincide with the efforts to activate the EMS system. As I said earlier, CPR buys time for a cardiac arrest victim until a trained responder can arrive with a defibrillator, other proper medical equipment and transport the victim to advanced care. Effective bystander CPR provided immediately after cardiac arrest can double a victim's chance of survival. We are here today because in order to 48 2/21/06 - PUBLIC SAFETY - RES. 051158 strengthen this link, we should rely on trained citizens, bystanders or witnesses to the medical emergency, rather than emergency responders to begin performing CPR, because with rare exceptions, too much time has passed to wait for emergency personnel to begin CPR. Studies show that if bystander CPR is not provided, a sudden cardiac arrest victim's chances of survival fall approximately 10 percent for every minute of delay until defibrillation. Few attempts at resuscitation are successful if CPR and defibrillation are not provided within minutes. There are several ways to ensure that bystanders initiate basic CPR before emergency responders arrive. The most widely advocated is citizen CPR training. Community-based CPR training programs endorsed and conducted by the American Heart Association have trained laypersons in CPR in training centers, work sites and school sites across the 49 2/21/06 - PUBLIC SAFETY - RES. 051158 City. These courses are offered throughout the City through a training center network. A number of representatives from these centers are with us today. These courses are taught under the supervision of a certified instructor. The courses teach students how to recognize that an emergency exists, recognizing the signs of heart attack and stroke, how to check the victim for signs of circulation, emphasize the core skills of CPR; that is, pushing on the chest and breathing for the victim, calling 9-1-1 and child and infant CPR. These comprehensive courses generally require three to four hours to complete, often involve a test, and the participant, upon successful completion, receives a certification card. These courses are the mainstay of American Heart Association's efforts to train citizens to help save a life. 50 2/21/06 - PUBLIC SAFETY - RES. 051158 However, we realized that we were not reaching as many people as possible. There are a number of barriers to consider and address when designing a CPR training program. Cost, ability to find instructor volunteers or lack of awareness of the importance of knowing CPR skills are just a few of the barriers. Many people are also embarrassed to practice CPR skills in public or are afraid of failure or think that they are physically unable to perform the skills. I would like to turn it over to Ed Stapleton. Mr. Stapleton is a widely recognized expert in his field and has worked extensively with the American Heart Association's Emergency Cardiac Care program for a number of years. Mr. Stapleton will discuss some advances in tools and techniques to train large numbers of people CPR quickly. Mr. Stapleton.
Thank you. 51 2/21/06 - PUBLIC SAFETY - RES. 051158 First of all, it's an absolute pleasure to be here, because certainly we recognize the importance of this initiative in terms of really having an impact. What I'd like to do is go over some statistics of importance on this issue. And this an interesting video. This is the actual original performance of CPR 40 years ago by the inventor of CPR. CPR hasn't been around for that long, but he found that with simple mouth-to-mouth breathing and chest compressions, you could in fact perfuse vital organs such as the brain and extend the time in cardiac arrest where a person could be saved. As was mentioned, American Heart Association publishes guidelines about every five years that analyzes the science to show progression. There's been very innovative things that I'll talk about later in these new guidelines that give us great hope for improving 52 2/21/06 - PUBLIC SAFETY - RES. 051158 what is right now a dismal national survival rate of about five to ten percent. So heart disease is the number one cause of death, and there are about 340,000 pre-hospital deaths a year from sudden cardiac arrest. Think about that for a second. That's almost a thousand a day. When we think of the magnitude of terrorism and all these things, you'll never see numbers of this magnitude. So it is an enormous problem and, to a great extent, these people could be saved with proper care. And it is a very interesting thing, that sudden cardiac arrest is. It's mainly propagated by an abnormal heart rhythm called ventricular fibrillation, which can happen in the absence or presence of a heart attack. Someone can go into ventricular fibrillation spontaneously, and the only effective treatment of this rhythm is early defibrillation. What CPR does is 53 2/21/06 - PUBLIC SAFETY - RES. 051158 keep the vital organs perfused until such time that defibrillation can occur, and extends the period of time that people can be resuscitated from cardiac arrest. And as was mentioned, with each minute that passes -- this is another powerful statistic -- the chance of survival decreases by about percent. 10 There have been numerous studies that have validated this particular statistic. So that's an extremely sensitive time frame. A good example of that was at O'Hare Airport, which is one of the most successful defibrillation programs in the United States, where they were able to save about 60 to 70 percent of sudden cardiac arrest victims as compared to five percent nationally by having a good CPR defibrillation program at the airport. And what they did that was so brilliant was to put defibrillators every minute of a brisk walk. So that you have about two minutes round trip to a 54 2/21/06 - PUBLIC SAFETY - RES. 051158 defibrillator any point in the airport. It was a very strategic and interesting program. So they had an enormously successful survival rate because they thoughtfully put together a program that involved both CPR and defibrillation. This is a fellow who was a benefit of a program we did in Long Island. His name is Muhammad Shaw, and he's years old. And he sort of 12 illustrates what can be done with a good 13 CPR program and defibrillation program. Muhammad Shaw had a cardiac condition where he collapsed suddenly at school, and CPR was started immediately because they had trained rescuers in the school. They also had an AED in the school, and Muhammad Shaw was shocked by a teacher at the school and, in fact, converted to a normal rhythm almost spontaneously, and the interesting case is, CPR was started immediately. Muhammad was shocked in three minutes. The ambulance in Long Island arrived in 55 2/21/06 - PUBLIC SAFETY - RES. 051158 minutes. So having the community care there was the critical element of his survival. No doubt about it. Nobody would argue that. And in most EMS systems, you really can't rely in terms of sudden cardiac death on EMS as the main factor for this.
That's very 10 important to realize. 11 Now, I'm also from a big city, 12 New York City, and I was head of the CPR 13 Certification Program for many years, and 14 we said, How are we going to get more people? You have the same challenge. You have a million and a half people. How do we get a critical mass of people? Because the interesting thing is, having these large companies is a very important strategy, but 70 to 80 percent of cardiac arrests occur at home. So unless you train a critical mass of population, people will not be subject to receiving CPR. You can't rely on the public to do it necessarily, except each individual in 56 2/21/06 - PUBLIC SAFETY - RES. 051158 their own home. So we decided to do a video and see if people can learn CPR just from the video alone with the mannequin instruction. We published this in a New York state journal, and basically what we found is, the video had some effect, but really people need mannequin practice to learn CPR. It's a psychomotor skill. At the end of the day, that's what you have to know to be successful. Well, an introverted person named Alan Braslow worked with a big company many years ago where he developed a video self-instruction system. It took minutes to take, and he had people -- 18 it was video self-instruction where they 19 watched the video and learned CPR as they 20 were watching the video, and it took 22 21 minutes. And several studies have been 22 published since then that have shown not only this 22-minute video -- this is the irony of it. Listen very carefully -- was equal or better than three hours of 57 2/21/06 - PUBLIC SAFETY - RES. 051158 traditional CPR instruction. You say, Well, why would that occur? Twenty-two minutes of self-instruction was better than three hours of traditional instruction. Well, the truth was, people during those minutes did CPR and 8 practiced and reenforced and learned CPR. 9 So it was a very -- the original one was 10 32 minutes. The more recent ones are 22 11 minutes. And what it is, is a kit as you 12 saw previously on the screen, you see on 13 the desk there, where each individual 14 gets a mannequin, a video and a book, and 15 they can actually take it home and learn 16 CPR at home with their family and train 17 their other family members. 18 One of the most successful 19 strategies for implementing this has been 20 in schools. I did a study where I went 21 to Minnesota and I trained 96 students in 22 three classes. It took me two hours. Those students went home and trained 288 people. For my efforts for two hours in a classroom, 384 people were trained in 58 2/21/06 - PUBLIC SAFETY - RES. 051158 CPR. Had I used the traditional approach for teaching CPR, I would have trained six to eight people. So this is the new paradigm. This is the new invasion that allows us to train large numbers of people very quickly. Well, guess what? Somebody did a lot better than I did. In Denmark, they did a National First Aid Week where they had seventh graders in Denmark, 35 students, learn through this self-instructional methodology, who in turn went home and trained their family members, and in three weeks, trained 100,000 people in CPR. That is a powerful multiplier. That's the beauty of this particular strategy. It's a strategy that allows you to train a large number of people. Thank you very much.
Thank you, Mr. Stapleton. Let me point out that in the 59 2/21/06 - PUBLIC SAFETY - RES. 051158 time it took for us to testify, you, your staff, a family, a mother, a classroom, a group of seniors, a faith-based group or a group of neighbors could have learned CPR core skills using the CPR Anytime program and be ready to help save a life. The American Heart Association appreciates this opportunity to testify. We would like to present each member of the Committee, as well as each member of City Council, a CPR Anytime program so that you can train your staff, yourself and people in your community how to perform CPR. We stand ready to work with the City of Philadelphia, the Philadelphia Fire Department, Jefferson and other stakeholders to increase the bystander CPR rate in Philadelphia. We would be happy to answer any questions.
Doctor, 60 2/21/06 - PUBLIC SAFETY - RES. 051158 thank you. When a person is in the state of fibrillation, ventricular fibrillation, at any time is there a situation when a person that has a heart attack that is not in that state and if you gave them the shock, you could hurt that patient? How do you know whether to use the shocking devices or not, or doesn't it hurt if a person isn't experiencing ventricular fibrillation?
Let me answer all of your questions. First of all, in terms of does it hurt, the vast majority of times the answer is no. If a person is actually not in ventricular fibrillation and happens to be in, let's say, a normal heart rhythm, other than it being a little bit uncomfortable, the vast majority of times the heart is still going to maintain its normal rhythm in the presence of a shock. The other thing is -- so that there's very little downside to shocking someone in a situation when they don't 61 2/21/06 - PUBLIC SAFETY - RES. 051158 actually have ventricular fibrillation. The other question is, how do you know that they have ventricular fibrillation. The vast majority of time when people do have a heart attack, there are some other symptoms, such as chest pain that was alluded to. But female patients, for example, are less likely to have chest pain, are more often to have nausea, vomiting and GI symptoms as signs of a heart attack. So chest pain is not necessary, although it is often a clue. And when your heart arrests -- cardiac arrest means that the heart stops pumping blood effectively -- you will pass out within a short period of time. You won't maintain consciousness if you in fact have cardiac arrest. So it's usually fairly clear that this kind of emergency has occurred and it's not often difficult to recognize. And, like I said, if you're wrong, there's really very little downside to it.
Doctor, just 62 2/21/06 - PUBLIC SAFETY - RES. 051158 one final question. Are you aware, either of you, of any hesitation on the part of government? I'm hearing that there are organizations that have an interest in providing the defibrillators to various government agencies to, as an example, a recreation department to put them at various locations. Why would anyone in government, a decision-maker, resist having those devices on their premises?
I'll be able to answer that. I don't know why, but as a practical measure, people will talk about a cost ratio benefit of defibrillators, meaning if you had three people in an office, would it be appropriate to purchase a defibrillator, being the probability of cardiac arrest was so low in that office, that when you thought about it in the long haul, this would not be the place to put a defibrillator. In a building such as this, I would hope you have a defibrillator in 63 2/21/06 - PUBLIC SAFETY - RES. 051158 this building, and if you don't, you're a little bit behind the curve, very frankly, because typically a building like this in New York state -- for example, all government buildings have defibrillators on the premises, so do all health clubs. It's a requirement by law. And, in fact, New York state has defibrillators in every single school in the whole state. So where there's a large probability of cardiac arrest or a large concentration of people, you should have a defibrillator on the premise.
I'll give you an example. What about a recreation center that has basketball courts, tennis courts? Perfect place, obviously, to have those devices.
In New York state, it's legislated, for example, in health clubs you have to have a device. So in places where there is relative high risk, not so much -- basketball center, 64 2/21/06 - PUBLIC SAFETY - RES. 051158 if it's a young audience, it may not be -- it could be arguably not a great place, but in health clubs, for example, where there are people like me running on treadmills, you'd probably need a defibrillator.
We're going to be -- and, again, not for today, but we're going to be talking about this in the future. So if we could impose possibly to have you back to talk about this.
We do. We actually have a young man that died on a basketball court, and his family wants to donate defibrillators to recreation centers, and one of the issues that the City states is the liability issue and the fact that defibrillators, I think, maybe years ago, batteries failed, who is liable, those kinds of issues. 65 2/21/06 - PUBLIC SAFETY - RES. 051158
Well, the truth is -- well, let's take it from two points of view. These defibrillators in terms of recognizing cardiac arrest, recognizing ventricular fibrillation are highly reliable, in the 99 plus percentile. That's how reliable they are. I would gladly put one on and run around the block if you'd like me to. That's how reliable they are. As far as the maintenance of the defibrillator, that's true. It's not very difficult maintenance, but that should be one of the things you consider in setting up programs, is how well you define maintenance and what the responsibilities of the users are. You have to check the batteries. You have to check the expiration of the pads. These are not very difficult things to do. The batteries now have a life of about five years. In the past, they had a life of about two years. So somebody on the premises has 66 2/21/06 - PUBLIC SAFETY - RES. 051158 to take responsibility for that, but it's not a big deal. It's just that people do it -- they put a defibrillator on the wall, but they don't put a defibrillator program in their facility. That's the big difference.
In preparing for these hearings and you're talking about heart attacks all the time, and I guess at my age, I know lots of people that are dying from heart failure, and it makes you real conscious all the time. So yesterday I was at the gym walking around the track and I'm looking all around to see, well, what's the emergency system here, because I also need a defibrillator. But basically you did say that in New York -- you're from New York, 67 2/21/06 - PUBLIC SAFETY - RES. 051158 correct?
That all health clubs and gyms have to have defibrillators. What about rec centers, public playgrounds?
I don't know the margins of that recommendation. I know it specifically targeted health clubs. I would see rec centers to be a lesser risk, let's say, than a health club, because a health club obviously is going to have an age factor associated with that. I don't know -- I don't think rec centers, but every school is required to have a defibrillator on the premises, every single school.
I don't know what that is here in Philadelphia, whether that's a requirement or not. I don't ever remember seeing one. I do think we do have some here in Philadelphia. 68 2/21/06 - PUBLIC SAFETY - RES. 051158
I'll let you know, that was an unfunded mandate by the Governor and that schools were expected to buy their own defibrillators.
I believe we do have one or two here in City Council. We had an emergency a few years ago, and after that, they wanted to know how many staff were trained, I think, in CPR and able to use a defibrillator. But if something happened right now, I really would not know who to call. Would you?
Well, other than 9-1-1, but I'm talking about somebody right here.
Because this is a very complicated building, no 22 disrespect, but the response time of this building, it's not an easy building, once you get through traffic, once you get here, to respond to -- 69 2/21/06 - PUBLIC SAFETY - RES. 051158
Urban EMS. That's always a difficulty. I worked New York City EMS system for years, and 5 you have vertical times and you have the 6 complexity of that. There are real 7 challenges for EMS in a city like this. 8 But the key thing for cardiac arrest is 9 to have people trained in CPR, which you 10 can do in 22 minutes, and have a 11 defibrillator on the premise when it's 12 appropriate, such as a building like 13 this. Those are the two variables. 14
Those are 15 exactly our goals, to make sure that we 16 have more people trained, not just in 17 Philadelphia but in these buildings also. 18
Any other 20 questions for the American Heart 21 Association? 22 (No response.) 23
Just on the 70 2/21/06 - PUBLIC SAFETY - RES. 051158 issue I had raised earlier. I know it may be somewhat far-fetched and not necessarily a high percentage issue, but are there times when it shouldn't be administered, or is it safer to administer it when you think it's necessary? I understand the defibrillators are designed in such a way that they can monitor what the shock intensity is needed and administer it, but when an individual is actually compressing the chest, are there any times when it's not advisable?
Again, those are the extremely rare circumstances when it would potentially be injurious to someone who has a chest injury, for example, to give CPR, but, I mean, those situations --
People pass out for other reasons other than cardiac arrest or defibrillation. I mean, if somebody goes down on the sidewalk, the 71 2/21/06 - PUBLIC SAFETY - RES. 051158 first instinct would be for somebody to start to administer CPR. Is there an issue relative to that being dangerous to a person or is it better to err on the side of safety?
Number one, it's better to err on the side of safety. Number two, those are the kinds of issues that the training programs will deal with, is training you how to recognize appropriate circumstances when you should be using CPR. But having said that, there is, again, almost no downside, and the upside is far greater. Rather than waiting to be sure that this is in fact cardiac arrest, you're much better off using CPR, even if it's occasionally inappropriate.
Thank you for your testimony. We'll ask for Thomas Jefferson -- is Thomas Jefferson Hospital here? Please come forward. Good afternoon. 72 2/21/06 - PUBLIC SAFETY - RES. 051158
Please proceed with your testimony. Please state your name before the testimony.
My name is Rick Kleindienst from Thomas Jefferson University Hospital. Good afternoon, members of the Council. I want to thank Councilwoman Miller and the other City Councilmembers for allowing me the opportunity to testify on the resolution 14 to increase the number of people trained in CPR in the City of Philadelphia. This is an important initiative that will help save lives of those who work and live here. This resolution has the possibility of impacting lives greatly. My name is Rick Kleindienst. I have been a paramedic for 12 years. I have also been an educator in emergency medical services for ten years. I'm currently the manager of the American Heart Association Training Center at 73 2/21/06 - PUBLIC SAFETY - RES. 051158 Thomas Jefferson University Hospital, also known as JeffSTAT EMS Training Center. Our Training Center offers formal training programs in Cardio-Pulmonary Resuscitation, also known as CPR, and the use of automatic external defibrillators to over 2,000 people annually. Our instructors provide training to all different groups of participants, including laypeople from the community, healthcare professionals such as doctors and nurses. Our instructional staff is well versed in the benefits of CPR. Quite simply, the more people we train, the more lives we save. This afternoon I'm going to review some of the different types of CPR training options available to community members. CPR is easier to learn than many people think. I am also going to briefly review the curriculum of the American Heart Association's CPR program and provide you with an overview of how CPR 74 2/21/06 - PUBLIC SAFETY - RES. 051158 programs are conducted, including a possible hands-on demonstration, which you saw in the tape. Last, I will provide some guidance for making a CPR training referendum a reality. There are many types of CPR training programs. Most people attend a formal training program in the classroom course. Here an American Heart Association's certified instructor reviews the importance of the chain of survival and teaches the layperson how to recognize the signs and symptoms of a stroke and a heart attack. This is followed by a review of steps on how to resuscitate a victim that has collapsed from sudden cardiac arrest. The instructor then discusses and demonstrates the steps in CPR and how to use an automatic external defibrillator. The last and most important portion of the course is, the hands-on practical training then begins. Course 75 2/21/06 - PUBLIC SAFETY - RES. 051158 participants are given the opportunity to practice skills, such as ventilation and compressions, under the guidance of a CPR instructor. It takes approximately three to seven hours to complete a training program, depending on the type of course that they choose. For one, the Heartsaver AED course will be the most effective program for this initiative. This course is three hours in length and teaches participants how to perform adult CPR, relieve a foreign body from a choking victim and initiate rescue breathing using a barrier device. It also provides instruction on the operation of an automated external defibrillator. The AED has proven to be a life-saving device when used in conjunction with CPR. Course participants will receive a certification card that provides them proof of being trained in CPR or the AED or both. This will be valid for a period of two years. 76 2/21/06 - PUBLIC SAFETY - RES. 051158 The American Heart Association recently developed a new CPR training program called CPR Anytime. With CPR Anytime, the participants receive convenient training in their homes via a 22-minute DVD. The training kit comes with an inflatable mannequin which can be used to practice breathing and compressions. There is no instructor to oversee performance or answer questions that the participant may have. However, this type of self-learning training program can be effective for some people and is certainly a convenient form of education.
Now I'd like to provide you with a brief demonstration, which you saw in the videotape, so we'll just continue with the testimony. I would also like to take a few minutes to demonstrate a portion of the CPR Anytime program, which, again, you saw before, so we'll move on to 77 2/21/06 - PUBLIC SAFETY - RES. 051158 continuing with the testimony. One organization cannot handle the amount of training that is required in order for the resolution to be successful. We will need to get many agencies to work together to provide training to the citizens of Philadelphia. This includes Philadelphia Fire Department, American Heart Association, the American Red Cross, the Emergency Medical Services Training Centers in the area, hospitals and perhaps even individual instructors who exist in the Philadelphia community. There are potentially hundreds of thousands of people who need training, and the City will need to reach out to each and every instructor to get them involved. Councilwoman Miller will need to appoint an administrative oversight committee to coordinate these initiatives. We will need to develop a campaign to get community members to 78 2/21/06 - PUBLIC SAFETY - RES. 051158 attend these training programs. We will need to clearly communicate the benefit of them personally, their families, friends and community at large. We will need to offer training programs at convenient times and locations in the community and make it as easy as possible for everyone to participate. Hopefully the local media can help us publicize this information and help us get the community involved. We will also need to identify ways to fund such a large project. This may include grants, private donations, in-kind donations and fundraising drives. Corporate sponsorships could help the resolution be successful also. Companies like Home Depot, K-Mart, Wal-Mart and other large businesses may make considerable donations to the cause, especially because of the fact that everyone in the community benefits from CPR training. Training more people in CPR 79 2/21/06 - PUBLIC SAFETY - RES. 051158 will save lives. Other cities such as Seattle, Washington, who have worked aggressively to train their community members in CPR, have reaped the benefits. We can make this a reality in Philadelphia, too. I would be happy to answer any questions that you have regarding CPR training. Thank you.
In your testimony, you answered one of my questions, and that was just how long the training actually -- before you had to be retrained, how long the certificate actually lasts. So it's two years. So every two years you have to do it again?
I don't have any more questions. Did the other person from Jefferson testify? 80 2/21/06 - PUBLIC SAFETY - RES. 051158 SPEAKER: I'm not going to testify. Thank you.
You're just here to be supportive. Okay. All right. I want to thank everyone for coming in today. I think that this is a very important issue. Other public safety issues have been given a lot of attention over the past year actually, and we wanted to make sure that this was brought to the attention. And we plan to put the oversight committee, or whatever we want to call it, a task force, et cetera, together so we can all start working on ways to educate and outreach to our citizens. Is there anyone else here to testify on this resolution? Come up to the table and tell us your name and anything else you want us to know about you.
Thank you. My name is Kathleen Cassidy and I'm from the American Red Cross. I wasn't prepared to 81 2/21/06 - PUBLIC SAFETY - RES. 051158 testify today. I just wanted to identify myself and just to say as part of this committee that goes on past this hearing, we'd like to be involved in it.
Thank you. Red Cross is everywhere. Anyone else want to testify on this resolution? Come on up. CAPTAIN TOUCHSTONE: My name is Mike Touchstone. I'm the Deputy Director of the Philadelphia Fire Department Emergency Medical Services Training Institute, and I'm also American Heart Association Training Center faculty for the City of Philadelphia Training Center. Having listened to the testimony, I thought I could provide a couple of points of clarification. There were questions about heart attack and questions about cardiac arrest, and it 82 2/21/06 - PUBLIC SAFETY - RES. 051158 seems that we haven't differentiated between the two. When we're talking about CPR and citizen CPR, we're talking about addressing the issue of cardiac arrest. The education component that all of these agencies that here testified to is the part that we can bring to allow the citizens, the bystanders, the people that own the first two pieces of the chain of survival, to actually take the action that's needed. Heart attack is a different issue, and there are issues connected to education of the public that could address understanding of what a heart attack is. Cardiac arrest and the issues of using the AED are related to specific cardiac rhythms. One of the Councilmembers asked what's the difference and how do you know if it's V fib. The machine knows. There will not be shocks delivered to somebody who has a 83 2/21/06 - PUBLIC SAFETY - RES. 051158 perfusing rhythm based on the machine's ability to differentiate between those rhythms. So the risks in that sense are very low. There's only one rhythm that could be presented as a problem, and it's a perfusing rhythm of ventricular tachycardia, which is relatively rare. The treatment for that in fact is delivering energy. It's just a different way of delivering it. We really need to get the issue to the public so that the people at home, where most of the cardiac arrests occur, that's where the action needs to happen, and we need to take it to them. All of the other pieces of the chain of survival belong to us as the Fire Department, early defibrillation, early advanced life support. The resolution, as I understand it, is about taking education to the people that live here so that the people that live here and are visitors have a greater chance to survive. 84 2/21/06 - PUBLIC SAFETY - RES. 051158 The distinction is clear that CPR done early is what's going to make the difference. The Fire Department will arrive generally within four to six minutes and will bring the other pieces. If we don't have those first two pieces of the chain of survival, then the rest of the chain doesn't exist. I really have nothing else to add, but I'd be willing to entertain any questions if you have any.
Officer Touchstone, I guess the education has to be very basic where we start from, because people have to clearly understand the difference between a heart attack and cardiac arrest. Is that what you're saying? CAPTAIN TOUCHSTONE: Absolutely. And they also have to be educated as to the low potential of risk, both liability and, as someone mentioned, the issues of communicable diseases. The risk to a person that's willing to act is 85 2/21/06 - PUBLIC SAFETY - RES. 051158 very, very low in both of those realms. You're not going to get a disease generally doing CPR and you're not going to be held liable for a bad outcome. Essentially, by the time you're doing Cardio-Pulmonary Resuscitation, the person is already on the last step towards death, and you can't do any harm to a dead person. You can only help and possibly increase their ability to survive the event. So the education component will remove the fear and hopefully train people to be comfortable to take the action, because it's not hard. It's easy for a person to save a life.
Okay. CAPTAIN TOUCHSTONE: Thank you for the opportunity to speak.
My name is Mike Mooney. I'm the Regional Manager of 86 2/21/06 - PUBLIC SAFETY - RES. 051158 Emergency Cardiovascular Care programs for the American Heart Association. I've been asked just to make a point of clarification. We recognize that the situation that has come about as a result of the dismal survival rate of cardiac arrest in the City has taken place over a long period of time. It's a complex issue that requires a complex solution. We at the American Heart Association have a variety of programs, as well as commitment of the organization to making sure that we can help address all links in the chain of survival. Our CPR Anytime program is the most recent program. It was referred to earlier, the 22-minute video-based self-learning program, and we also offer other classroom-type programs which are what we call traditional programs, all the way up through the advanced cardiac and advanced pediatric life support programs provided to the physicians and 87 2/21/06 - PUBLIC SAFETY - RES. 051158 nurses and paramedics in the City. We join our colleagues here in support of a good overall addressing of all the different issues that are at hand here and understand that this is not a simple solution.
I really think the CPR Anytime program is really -- I'm sure it works, because if it didn't work, you wouldn't be advertising it, but it's really a good -- I've signed up for CPR, but then I couldn't figure out where I was going to carve out a half a day to go to training. It sounds like the CPR Anytime program is a program that can work for me and people that have heavy schedules, because I've always wanted to learn CPR, but I've never actually taken a class. So I look forward to learning more as we go along.
And when you look, as Ed pointed out earlier, 80 percent of all cardiac arrests happen in the home. And you can imagine how difficult it is 88 2/21/06 - PUBLIC SAFETY - RES. 051158 for the common person to place priority on this issue and carve out, as you say, a half a day for training, where we can actually get to them, get them the basic skills of CPR and recognition necessary to provide help in only minutes. So 8 we agree fully. 9
Anyone 16 else to testify on this resolution? 17 (No response.) 18
Seeing 19 none, this Committee is in recess to the 20 call of the Chair. Thank you. 21 (Committee on Public Safety 22 adjourned at 2:40 p.m.) - - - 89 CERTIFICATE I HEREBY CERTIFY that the proceedings, evidence and objections are contained fully and accurately in the stenographic notes taken by me upon the foregoing matter on February 21, 2006, and that this is a true and correct transcript of same. ______________________________ MICHELE L. MURPHY RPR-Notary Public (The foregoing certification of this transcript does not apply to any reproduction of the same by any means, unless under the direct control and/or supervision of the certifying reporter.)