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HEARTSafe: Empowering Communities for Cardiac Arrest Survival
The Citizen CPR Foundation (CCPRF), founded in 1987, has endeavored to ‘strengthen the chain of survival,” a metaphor used to define the series of actions improving the chance of survival for thousands of victims of sudden cardiac arrest.
Its mission starts with education for the lay rescuer and continues through interventions provided by EMS dispatch, EMTs and paramedics, emergency department personnel, and specialists in intensive care units.
The mission of CCPRF is to save lives from sudden cardiac arrest by stimulating effective community, professional, and citizen action.
Its three core values:
- CPR and AED use saves lives.
- Collaboration among citizens, professionals, communities, and organizations is key to survival from sudden cardiac arrest.
- Action on best practices in science, education, and implementation improves outcomes.
CCPRF’s HEARTSafe Community Program
CCPRF has served as the planning host for the Emergency Cardiovascular Care Update Conference, a biennial conference featuring current information and trends on CPR, which has evolved into the Cardiac Arrest Survival Summit. CCPRF hosts the event with the support of its founding partners, the American Heart Association, and the American Red Cross.
The CCPRF’s HEARTSafe Community program is a set of criteria and guidelines designed to improve outcomes of sudden cardiac arrest emergencies through a specific set of training, preparation, and response protocols.
The criteria supports and encourages communities to put the cardiac arrest ‘chain of survival’ into action through CPR instruction, public access defibrillators, and aggressive resuscitation protocols for first responders and area hospitals.
Communities that strive to become HEARTSafe must meet CCPRF criteria. Upon completion, they receive signage and official recognition as a HEARTSafe Community to demonstrate a commitment to citizen health and safety.
There are now more than 600 local legacy HEARTSafe communities in existence as the organization adds more.
HEARTSafe Core Strategies
The core strategies in becoming a HEARTSafe Community entail strengthening local stakeholder collaboration; encouraging data collection, analysis, and dissemination; facilitating the implementation of lifesaving strategies; promoting public education and training; improving the delivery of high-quality resuscitation and post-arrest care, and enhancing the impact of cardiac arrest therapies.
Richard Shok, BSN, RN, NRP, EMS-1 is CEO of Code One Training Solutions and chairperson of the Citizen CPR Foundation Program Advisory Committee.
Shok notes the survival rate from sudden cardiac arrest has remained stagnant for years, despite numerous initiatives communities have put into place.
“This initiative is based upon the National Institutes of Health recommendations and 13 tactical elements we've established to give communities a framework to be able to build upon their preparedness for cardiac arrest emergencies, using evidence-based principles,” he says.
- The program includes 13 strategic and tactical elements:
- Establish a high-performance lead agency and community team
- Use data to drive regional strategies and localized tactics
- Train citizen rescuers
- Recognize and celebrate the actions of rescuers
- Develop educated and responsive citizens
- Establish telephone-guided CPR and utilization of AEDs
- Develop a planned and practiced response to sudden cardiac arrest
- Establish strategically placed and 24/7 accessible AEDs
- Establish a 911-integrated AED registry and means for identifying and adding undiscovered and new AED
- Ensure first responder agencies are defibrillation capable, and undergo appropriate
- training, have device maintenance plans, dispatch policies, event debriefing, and
- medical direction.
- Establish high-performance resuscitation
- Establish a process for continuing quality improvement and public reporting of cardiac arrest data on an annual basis
- Ensure meaningful primary and secondary health promotions are in place and tailored for the community
Shok says a community first expresses an interest in the program after which the CCPRF presents it with online toolkits that help lay the groundwork.
“Then we have a team of mentors who help these communities with feedback, advice, and guidance through the entire process as well as connect them with other communities doing the same exact thing so they can collaborate,” he adds.
“It’s great that we've built this really strong network of like-minded folks who are putting together the best practices for survival from cardiac arrest.”
Growing Within the Community
Interest in the program continues to grow, Shok says.
Shok notes it is key to get all community stakeholders involved.
“I actually just started the process as a citizen in my own city in Virginia,” he notes. “We have met with the mayor, the fire department, the medical director for the EMS department. It’s going to take a number of other individuals we've identified like neighborhood groups, the library system, the school system, and local hospitals.
“Leadership from all those entities have to come together to be able to work on this project collaboratively and do their part to establish it. It's not like, ‘Oh, I'm the fire chief and I can get this all done myself.’ That’ll never happen with the amount of legs this type of project has been able to reach into each entity and work.”
A community can work on the 13 steps simultaneously or one at a time, Shok points out.
It’s important to establish who are the stakeholders and who will be taking the lead, he adds.
“It’s a great program and has a wide impact that can affect many lives, even if it’s just taking that first step in starting looking at the tactics and finding ways they can get involved even if they don't go all the way to get a designation. Improving the cardiac arrest survival rates is going to make a huge difference.”
There are successful implementations throughout the U.S.
Ashley Terrana, an EMS captain for the Palm Beach Gardens (Florida) Fire Rescue notes “We started the process of building our HEARTSafe Community because our cardiac arrest data showed that all neurologically intact (CPC 1 or 2) cardiac arrest patients had one thing in common: they all received bystander CPR and/or early intervention AED before our arrival.”
The 2023 CARES data for the community of a little more than 59,000 indicates overall survival – with good or moderate cerebral performance – at 10.6 percent and an Utstein Survival of 85.7 percent.
Since the program’s inception in 2022, the department has trained more than 6,000 people in hands-on CPR/AED and has installed public access AEDs in all city buildings and parks.
Additionally, the department has registered more than 289 AEDs on PulsePoint.
Johnson County, Iowa has a population of 152,000 residents and is the home of the University of Iowa, one of the nation’s top 20 medical schools.
In 2023, Iowa City was named one of the best places to retire. Johnson County Ambulance Service (JCAS) is the largest county-run ambulance service in Iowa and provides 911 coverage throughout the county’s 623 square miles.
“With less than 25 percent of our population under the age of 18 and less than 15 percent of our population over the age of 65, we have a wide variety of medical emergencies in both the rural and urban setting,” notes Fiona Johnson, JCAS director.
Medical Knowledge in the Community
Johnson notes the community is rich in medical knowledge and has a desire to learn.
“That in conjunction with being named one of the best places to retire, we knew we needed to do everything in our power to make Johnson County a place where you have the opportunity to enjoy a well-earned retirement by providing all the lifesaving tools available,” Johnson says.
That includes having medically-trained 911 dispatchers, police officers equipped with AEDS, 40 24/7 AED kiosks strategically placed through the county, PulsePoint, AED registry, and a rigorous QA/QI process to analyze cardiac arrest care – all of which are part of the 13 critical criteria required to become a HEARTSafe community.
Johnson County Iowa became the nation’s fourth HEARTSafe community in February 2023 as a result of a partnership between JACS and the Rotary-Kerber HEARTSafe Community Campaign, which Johnson says provided immense support, with Dr. Linda Kerber having established the committee in honor of her late husband, Dr. Richard Kerber, a renowned cardiologist.
“There are many entities providing CPR training and it was challenging trying to gather all the data from so many different agencies,” says Johnson of the challenges in establishing the program. “Having an active multi-disciplinary planning committee was important as they often had contacts that I was not aware of.”
HEARTSafe Benefits
The committee has seen the program reap benefits.
Case in point: assisting local high schools with becoming Project Adam HEARTSafe school,” says Johnson.
Project ADAM began in 1999 in Wisconsin after the death of Adam Lemel, who at age 17 collapsed and died while playing basketball.
“There was a cardiac arrest event last year that occurred in a cafeteria and the school nurse started CPR,” says Johnson. “The AED that had been recently installed in the area was retrieved, a shock was delivered, and the student regained spontaneous circulation allowing him to make a full recovery.”
At a recent homecoming parade, a participant started feeling unwell and went into cardiac arrest.
“A nearby officer providing traffic control recognized the signs of cardiac arrest and immediately started CPR,” says Johnson. “Bystanders stepped up to assist with CPR and the officer procured an AED from his squad car. A shock was delivered and the patient made a full recovery.”
“These success stories would not have been possible without community involvement to ensure the first three links in the chain of survival remained intact,” Johnson notes.
“Implementation was successful for us due to the strong support of our city manager and city officials,” Terrana notes of Palm Beach Gardens’ efforts. “Building a HEARTSafe Community is the ultimate investment in your citizens. It is creating a community filled with lifesavers who are able and willing to intervene in one's time of need.”
Johnson’s advice for other communities looking to implement the program is that the HEARTSafe endeavor is not a one-person job and it is vitally important to incorporate community partners to enhance access to all the lifesaving efforts already occurring in the community.
“A multi-disciplinary team for your planning committee will be very helpful,” she says. “Find people that have a drive, a love, a passion for this life-saving endeavor and make sure they are on your team. Sharing success stories is wonderful. Get out into the public eye as much as possible to provide hands-on CPR. Empower everyday superheroes with the lifesaving skill of CPR. Find a community partnership in a local Rotary Club, Elks club, or young professionals and incorporate them into the mission.”
