THIT 406 Ep 39 Sudden Cardiac Arrest
Speaker 1
Thank you for joining us for this episode of Talking Health and the Four Oh six, where we are one community under the Big Sky. I'm your host, Maureen Ward, and I work to promote safe and healthy lifestyle choices to help Montanans avoid common life changing injuries. Today we'll be talking about sudden cardiac arrest with our guest, Janet Trethewey. Janet has worked on and off as a first responder. Years and currently focuses on improving survival rates for time sensitive illnesses. Second, cardiac arrest can happen to anyone, and Janet is going to help shed some light on how communities can be better prepared for these incidents when they. For joining us today, Janet, I'd like to start with what is sudden cardiac arrest like. That the same thing as having a heart attack. You explain that.
Speaker 2
Sudden cardiac arrest is when the heart stops beating. Versus a heart attack where a portion of the heart isn't getting a blood supply. And so it's starting to die. A heart attack can. To sudden cardiac arrest. If enough that heart muscle dies. It's going to stop eating. But sudden cardiac arrest. Itself is typically an electrical problem. The heart isn't getting signal to to cause it to contract where a heart attack is a polling problem. There's usually blockages blockage in an artery. That's causing a part of art muscle to die. One can. The other but. A second cardiac.
Speaker
I.
Speaker 2
Love this quote from a. That sudden cardiac arrest is the most critical medical condition you can have.
Speaker 1
I think about heart problems, you know, and I if I hear sudden cardiac arrest, I might not differentiate that from heart attack without hearing what you just said. You know, mostly this is maybe an older person problem, but then it seems like we've seen more and more in. News recently of some of these younger, athletic people. That have had sudden cardiac arrest like Ronnie James and some local stories here from Montana. You just talk. Us a little bit about who is at. And what community should be looking?
Speaker 2
Typically, and yes, most people who have a sudden. Arrest are older. They have developed issues with their heart or part of the heart. Muscle has died or part of the heart. Muscle isn't getting a good blood supply and those nerves that are sending signals are not working properly and so they do have a cardiac. Rest, but it isn't a an old person condition because there are lots of causes. Cardiac arrest. People can have a congenital condition or a condition they were born with, but there's a problem with the wiring in their. It's about four years. We had a young man down in town. Who was sixteen years old? Playing. He was in. They were running during conditioning at the end of practice and he collapsed from seven cardiac arrest and luckily coaches knew what to do. EMS responders knew what to do and were there. Quickly and. He had a very, very good outcome. He was actually defibrillated with an AED on the gym floor and by the time the ambulance got there, he was awake. And when they did a bunch of tests, they came to find out that he had. A problem with the wiring in his heart that he. Born with. And so that we see quite often. James. Obviously, LeBron James son, he had the same kind of a condition. Was it? Seemed kind of electrical activity problem.
Speaker
Is.
Speaker 2
There's about five of them, so you know, I'm not sure which one, but. Again, he the thing we find with these young athletes that that have the sudden cardiac arrest. This exercise is actually the trigger of the cardiac arrest. Obviously, we want people to be physically active and we want people to exercise. It's just that these things happen where all of a sudden their heart decides that it's not going to fire properly that day. And so that's typically what we see with kids is these heart conditions that they're born with.
Speaker
That.
Speaker 2
Nobody knows about until something happens. Fortunately. They are very reversible in almost all cases. If there is anything in place that will make sure that they can be resuscitated, the classic what everybody talks about too is the more Hamilton, the more Hamilton actually had. A really, really rare event happen where. If the heart is in exactly the right phase of the heartbeat and they take a borrow exactly in the right spot in the chest, it causes the heart to stop and. It's, I mean it's a loop that those happen. Is just. You know, don't go buy a. Ticket that day because you just it it. It was one of those things that just happens, but again, it's really reversible. If all the pieces are in place and. Like the young man in Townsend and like DeMar Hamlin and and Brian James, they were very fortunate. They were in a in a school or in a facility that had trained people that recognized that cardiac arrest right away. They had an AED really close that they were able to get on to that patient real quickly. They followed the. That's the big thing is that the when it says to shock that patient, you need to shock that patient because what happens? Is the electrical activity needs to be reset and that's what this the AED does is resets the electrical activity and so they need to be shocked they need that CPR and obviously somebody 's got to call nine one one and get. Ambulance and fire and everybody else that's going to respond. Get him coming. And so in all of those cases. They had all of those pieces in place. They had that plan in place and they had practiced that. That's the other thing. It I'm a real big strong proponent that just like schools have fire drills and just like schools have. Active shooter. They need to have CPR drills where the janitor or the ones lady or one of the students has a cardiac arrest and how do they respond to that? It just doesn't happen. Without that practice, because people are excited, they're rattled. There's this, you know, person who's. Breathing. They're. Not. And so it's important to have those. Those drills just like they do for fire and and all that. I got a report recently from Billings. They had a guy go down. He had a cardiac arrest at work. They had AE DS in place. Had a. They had practice the plan. They got to him right away. Shocked. They did CPR, the ambulance got there. He had a. By the time the ambulance got there. Him to. Two days later, he's in cardiac rehab. So it's not just schools, you know everybody or people gather need to have an AED, they need to know how to do CPR. Need to practice that plan? They need to do drills. Just like. Do drills for evacuation for any other kind of emerg. And so I think that that's hugely important that people, it's not enough to just hang. On the. It's not enough to know how to call nine one one. We need those other pieces in place and. We can have some really good outcomes when we have those things ready. To go.
Speaker 1
So with schools or businesses that are looking to create this as part of their emergency response plan, what sort of tools or resources are out there? Mean. I think it's easy to say. Just create a plan and practice a. But if this is completely new to an organization and maybe they do have the AED hanging up. The wall. And they've got a few people who have first. PR and AED training. But that's about as far as they've gone. Do you? Like, where do they start?
Speaker 2
We fell with my office.
Speaker
Short.
Speaker 2
Answer get ahold of me. I have plans that I can send them. And the templates then walk them through. Can Google an? Emergency plan or a cardiac arrest emergency plan American Heart Association has the template. College of Cardiology has a template. I wish it has a template. There's tons. Them out there that you can just Google an emergency action plan for cardiac arrest. The nice thing is, and this is the thing I tell schools again too. Is that if you have an emergency action plan for cardiac arrest and a cardiac arrest is the most serious medical condition you have, everything else falls into that plan and no matter what it is, it's so they're bleeding. Or it's a head injury or. Whatever else. The plan works for all those. Things just as well. Well, you take care of what's going on. You you call nine, one, one. And you know, if you practice for a cardiac arrest then something else happens. You know exactly what to do, and so it's not just this isolated. One little thing it it actually covers a lot of of emergencies that happen. And so having that emergency action plan and practicing it covers you for lots of other things as well. Like I said, you can Google them anywhere or you can. Reach out to my office and I can get you a template as well.
Speaker 1
Great. What are some of the frequently asked questions that you get in your office about setting cardiac arrest and how to respond to these emergencies?
Speaker 2
Things that I get are related to where do I find a CPR class and how do I register my AED? The CPR class portion is. Kind of tricky in that it depends on what what your needs are. If you're in a school with kids, young kids, you need to do acpr class that covers rescue breathing and choking and all of that because. Kids are not just miniature adults. You have to do different things for them. If you're working in a setting where you have mostly adults. Taking a hands only CPR class is all you need to do. You don't need to provide rescue breathing for an adult, so it's a much simpler process actually. I tell people, you know, check with their local fire department, check with their local ambulance service, check with their local hospital. Are good places to start to be able to take acpr class. If it's a hands only course that doesn't require an instructor per, say, 'cause the video does the teaching for you and. Several years ago, it's been almost ten years ago. I threw a grant, was able to purchase a bunch of. Mannequins and the videos, and I put them in totes and I distribute them around the state. Typically through EMS agencies, but sometimes through a fire department or something like that. And I handed out all these totes so that people could use the totes and teach CPR hands with CPR. In the Senior Center or to their family or whatever. But it seems that there are a lot of communities that migrated to school. Which is great. And then they're teaching hands on CPR in schools. But look for those. Can do an online hands only CPR class through American Heart Association.
Speaker
CPR.
Speaker 2
Dash heart dot org. And you can get the video and watch it. But like I said, if if you're working with young kids, or if there's a certificate requirement based on policy or whatever, then you need to reach out to someone that's. A class. The other question I get a lot is about AE DS. And in Montana, we have a statute that says an AED must be registered with state of Montana and that is through my office. And what the registration does. Is. One is that part of the registration process. Is getting. The people that are going to respond to that emergency aware site in a perfect world, if someone were to call nine, one, one and say we have someone having a cardiac arrest. The dispatcher would number one be able to pull up on their CAD system, a map that says you have an AED in that facility or next door is. The other thing that they would be able to do is provide CPR instructions over the phone and they'll help arrive. That doesn't always happen in Montana, but it's that's the goal, and that's the ideal. The way that those a DS show up on that map is when they register the AED with state, they notified the dispatch center that they. That AED? The registration process also requires that they have that plan and that they have people who know CPR and how to use the AED, but doesn't preclude anybody from using an A e D a, e, d, S are simple. Turn them on and they talk you through everything. Need to do step by step by. But it is. Ideal to have at least a few people in a facility that knows CPR and know how to use that AED and are trained to use it. In the shopping mall, yeah, there's probably three or four people that know how to use that AED that have been trained, but anybody walking down the mall can pull it off the wall and use it and be successful with it because it walks you through it. The other thing that that registration process does then is it provides liability coverage for the people that do the training and only AED, the Good Samaritan law that Montana has covered. If you use an AED or you do CPR on someone. The Good Samaritan law is. To cover you, but only a D. Or. Doing the training for those AE. It just provides another level of coverage for you. I'm not aware of anyone who has successfully sued someone for having an aid. It's more of the opposite. When you don't have an AED in the expectations. That's when people find themselves being questioned. The other piece that's really important is if you have an AED, you have to check it every month. To make sure that. The batteries are good and the pads are good. The pads have a gel in them that conducts electricity. And over time it they dry out. And so it's important that you check those pads periodically to make sure that they haven't gotten damaged and dried out and then eventually that you have to be replaced. And the same with the batteries. Eventually you're going to die and you need. Replace those and so having. As part of your plan. And somebody that's responsible for checking those AE DS and making sure that they're in good working order is also really important.
Speaker 1
Great. So for businesses or organizations that maybe don't have an AED yet, but they're looking into it? How do they get? About how much do they cost? There any resources to? Assist them in getting one at a cheaper cost.
Speaker 2
Babies can. Out at a little under a thousand dollars for one, and then they go up from there just like any other piece of equipment. The big things I always tell people when they say, well, what AED should I buy? Best one you could afford. And the brand really doesn't matter. Every brand has different features and that's the. That you need. You know what? Works for you. What you want to do is look at what can you afford and getting the best one that you can buy. For what you. Afford beyond that business is a lot of times can get either assistance with purchasing an AED or get. Rebates for purchasing ad or things like that through the insurance companies. Especially businesses that you know, like health clubs and all that they need to have an ad and typically their insurance agency or their insurance plan will either give them a break or give them a rebate or something to help them purchase those. Not-for-profit entities. There's lots of different grants available. Schools, churches, senior centers, libraries, things like that, they call the five for lots of different grant opportunities out there and. So you just have to to look and. See what might be fit their organization. One of the things I tell people is go to your animal groups, your eagles, your Elks, your moose, your lions, the colinas. And if everybody donates a couple hundred bucks. Pretty quick. You've got an AED that the community has helped support through those through those agencies. That's always a a really good option for communities. Hospitals sometimes have the foundation that offer grants for Aeds as well. So getting an ad is really not as difficult as people think in terms of coming up with the funding. The big thing is this sustainability. Again, like I said, you have to plan into your budget every couple of years. Got to replace these ads and replace those batteries. And so. Anticipating that ongoing cost every couple of years is is really important as well as far as where to get one. You can go on. A line and there are as many vendors as there are. You know there's AED plus and I don't know all of the differe. Different companies that offer AE DS. And you just Google and then do. Comparison shopping and see. Got the best, the best bang for your buck. Once you get that AED, then you can reach out to. Office and get it registered. And change the rule several years ago and now the state medical director is the medical supervision for the AA DS Cross state. So you don't have to have a medical supervisor for your add. The reason for that is that when the statute was originally developed, Aedes were really new and everybody was really nervous about them, and now we have twenty years of history that people realized. Yeah, this is not something that's scary. I mean, it is scary, but it's something that medical supervision. Is is a lot more to review cases. If somebody has a question or to answer questions if somebody asked them, but it's not like you have to look in every case. Make sure that. There everything perfect. If that's not important.
Speaker
OK.
Speaker 1
Great. So do you have any? Tips for untrained bystanders out. You know, if someone you know, you're here about the bystander effect, where there's an emergency in a public place and someone always assumes someone else is going to have more training or is going to be more qualified to help that person. Sometimes they just lay there. Without assistance, what would you do to encourage bystanders to help out? What sorts of things can they look for? There a way to tell that it's sudden cardiac arrest? Another medical emergency just by, you know, looking at them or doing some basic assessment or is it just really important to get nine, one, one on the phone and have them help you?
Speaker 2
Being unconscious is a medical emergency. Doesn't matter why you're unconscious, it's not normal. And so being unconscious is a medical emergency. Al nine, one, one. When you look at someone who's having extend cardiac arrest, especially with older people for a short period of time, they may do some funny kind of breathing like fish out of water, gasping, kind of breathing. And so the question is, are they conscious? Are they breathing like you and I are? If they're not, start CPR. If they don't need CPR and they wake up, say stop. On my chest. Score. That's exactly what you want. But if they don't, then you know that you. Their CPR. Young kids sometimes will actually have almost like senior activity. But again, their unconscious, they're not breathing normally. Start CPR if they're having a seizure and they wake up.
Speaker
Great.
Speaker 2
But if they're not, you don't want to delay that CPR. Trying to figure out what's going on. The coaches talk about that with the young man down in Townsend that when he first collapsed he was doing this gasping. Kind of breathing. They thought he was having an asthma attack. And so the first thing they did is they ran and got an inhaler and tried to have him use an inhaler and that delayed starting CPR, probably by a minute. And so again, he wasn't breathing. He was kind of having some seizure activity and it wasn't until that seizure activity stopped that the coaches went. Oh, this isn't a seizure. Then they started CPR. So it delayed care about a minute and that's the the thing that we wanted. To avoid. And so by making sure that as soon as you recognize that they're not breathing normally and they're unconscious, you start CPR and you assume it's a cardiac arrest until otherwise proven. I have a friend who is an ER nurse. And he and his family were out camping, and he was goofing around, and he fell and he got the wind knocked out of. And and kind of dazed him and he woke up to his sister doing CPR on him. He kind of laughed because the first time. Didn't think she liked him that much. And then she crack, crack, crack. But he he was like I was fine with that because she did what she did was supposed to do. She started CPR until it was ruled out that he was fine. So those are the kinds of things that we really want to be aware of is that it's just they're not breathing normally and they're unconscious. If you come upon someone, unfortunately in Montana, because again, most people who have a cardiac arrest, older people. They're unwitnessed. When they have, so we don't know how long they've been out. And so looking at those people, we want to make sure that you, you know, get them on their back. And then you again, if they're not breathing and they're turning blue or turning grey, we start CPR. Again, we don't know how long they've been down and unfortunately that's that's. When things don't have really good outcomes is when they've been unwitnessed arrests because, you know, the brain has gone too long without oxygen. But if they've been, if they're a witness, the rest they have a really good chance of surviving because. People are right there to do something about it. The other question you asked is what do we? You know, people in a crowd are kind of afraid to step up. We talked about people not being bystanders. Stand around and watch. Try standards or responders or people that act and don't be afraid to act. Yeah, it's. It's a very stressful event. I have been twice now in positions where I'm just. Somebody in a restaurant and someone has collapsed. And both times I stepped up. The one time I did CPR and the gentleman survived. The other time it wasn't a cardiac arrest event. Was a diabetic event. But I didn't know that until. EMS got there, but. You just kind of have to say I'm going to take care of this this situation and I'm, you know, first thing you do is say point to a person and say call nine one one. And then that's the everything is that hopefully your. Is gonna. Help you with whatever you need to. They're going to talk you through what needs to be done to help with that situation. So that's really important and just not being afraid to do it. Not being afraid to to step forward and be that try standard or be that responder. Otherwise, they're not going to have a. Outcome we don't want to wait and the reality is for the most part, the people that you would ever do CPR on are people you. No, they're your. They're new Co workers, things like that, and so I think. Less daunting, it's not a stranger. You see some amazing videos of people walking down the concourse at an airport that collapse and you know true strangers. Start CPR. But those are very, very unlikely if you're going to. This person. Or whatever reason. So that motivates you to want to help a little bit more too. The other piece of that is to remember I was just visiting with a lady that her husband had a sudden cardiac arrest that she did. He did not survive and. She felt really, really. She had a lot of survivor guilt for about a year, and finally she went back to the physician who was in the emergency room when they took her husband in and he pulled up her his record. And there was a note in the record that said that based on everything, there was nothing anybody could do. And that finally made her feel better that she had done everything right. But there was just it wasn't. To be a good outcome. And so I think that's the other thing. People need to remember. That you're giving them a really, really, really good shot. But the reality is that survival rates can still about eighty five percent of kids who have a chronic cardiac arrest will survive if it's witnessed adults. If it's witnessed, it's still less than fifty. Of them that survive. But there is that. And so that's why we want to start. For people to never feel bad that they they could have done something better or something different, they did something and that's that's the other thing is that we watch videos. There's a case of a guy. At a health club. Who collapsed with sudden cardiac arrest? And the people that were there. There was an AED there, but they never, ever they brought it. Never put it on the guy. The first thing that was doing CPR, you could tell was really. And it was really bad CPR and the guy still survived and had a really good outcome. So what we? Is even bad. CPR is better than no CPR. So don't be afraid. A certificate has never saved anybody. Somebody stepping up and doing CPR. Is what saves people and. If it's not textbook. Perfect. Is better than nothing. I think that that's the take home message is. Sudden cardiac arrest. Is a fatal event unless we intervene and when we intervene, we give them an opportunity to survive. It's still not a guarantee.
Speaker 1
Yeah, that really is. Is that you know, if the heart isn't doing anything right, you gotta give it at least a chance. Yeah. Going back to Aeds, I think you know that's such a great tool that we have available to us now. Is there anything in the data that tells us that these are working like having these out in our communities is improving survival rates for witnessed sudden cardiac arrests? And what does that look like?
Speaker 2
It's really. There's a program called Cares, which tracks cardiac arrest, survival, and we haven't done this in Montana, but I was just at a meeting where they they actually took the city of Chicago. And they used ten years worth of data, and they map where the cardiac arrest events were happening. And they looked at Tri Standard CPR. And they looked at AED use and. They found. These big areas within the city where there was nobody doing CPR and there were no AE DS. And so they started. They went out and they started teaching people CPR and they started putting AED 's in public places and you can just see those spots starting to light up over that ten year period as those AE DS were starting to be used and the CPR was starting to be. And the survival rates? They went from zero to about fifteen twenty percent. And that's all. So that includes all of the. Arrests as well. But yeah, you. You can track that with mapping looking using that data and so we know that those Aeds are making a difference we know. That teaching people CPR makes a difference. We know that having dispatchers who can coat somebody through CPR over the phone makes a difference. And so if anything, communities can do. Improve those. Those links in the chain of survivals is really going to. A. It is going to improve skywalk.
Speaker 1
Are there any myths you hear about sudden cardiac arrests? And if there are, what do you say to address those?
Speaker 2
I don't. It's really a myth. But if you watch a lot. Television. And you watch a lot of doctor shows and EMS shows, you know, like Chicago Fire and Chicago Med and all the.
Speaker 1
Personally, for me it's Grey's Anatomy and guilty as.
Speaker 2
Dexter do a study and in those in those types of television shows. Upwards of eighty percent of the people who have CPR done on them survive, which is completely flip of the outcomes in real life. It's only about fifteen percent of people. That do survive. For all comers, and so there's this expectation that CPR is always going to work and that's not. The reality, you know, TV sets us up for failure in so many ways. And that's one of them. Is that when you watch those shows and they people survive at a much higher rate than in real life? And so that's that's really unfortunate. That we create that expectation. The other big myth is that you're always going to break ribs. That's not true.
Speaker 1
You get the.
Speaker 2
Anatomy ribs are attached to the sternum by cartilage. And so when you start doing CPR, it. It's just like popping your knuckles. You actually start separating those ribs from the. If that break, they're not broken, they're just. They're what we call separated. If you've ever had a wrestler in your house, they've had separated ribs because that's just really, really common. When people 's ribs break because the rib is like au shape, they actually break under the armpits as you squish them down. Where they break along the armpit. But as. Do CPR that popping sensation you feel is just the rib separating from the cartilage. And you know, I know a lot of people that wake up that are really sore, but they are really, really happy to be alive. And so don't stop just because you you think you broke your ribs. Make sure your hands are right over the sternum and just keep right on going.
Speaker 1
And with that, is there anything else that we haven't talked about that you want to make sure our listeners know about seven thirty eight? And what they can do in their communities.
Speaker 2
Bird Rescue Foundation is a national program that we partner with and it helps communities using documentation. To improve survival for cardiac arrest and the way they do it is they look at you know, how many people that train in CPR, where are your AE, DS. Kind of. Training. Does your ambulance service have all of those things? And it's a step by step process that you can go through and when you're done, you can go through this whole process. You can submit your project. To heart rescue and they will actually go through the documentation and everything and then you can become a heart safe community. And so the heart safe community project is really a cool thing. Actually will help. They'll set up zoom calls with the coordinators to help give them ideas and encouragement, and. Things like that, and it's a really, really cool program that. Helps communities improve their outcomes from from seven cardiac arrest. We have had one community in the state of Montana that's done that. Glasgow has gone through the process and was awarded a heart Safe Community award and so. It's kind of cool to know that this little Pike town up in northeast Montana was able to pull it together and do that. Lots of communities in Montana have parts and pieces of it. They just haven't gone through the formal process of pulling it all together and having that for their community. But they've done pieces and parts of it. I think that's, you know, if if people are interested in that, they can reach out to me and I can do it connected with the heart safe communities project. Another cool thing that we have here in Montana that anybody can use and anybody can do is call pulse point AED and it's an app that you download on your phone. A yellow. It looks like a little yellow heart. And if you are in a situation, then where you need an AED, you pull up. App and it will show you all of the Aeds within a quarter mile radius of where you are. You can also. Hit my husband laughs at me because I do this all the time. We're on vacation and we're wandered around and I see an AED and I pull out my phone. You. A picture up to the AED with the app. And it geolocates that AED on the app. It's a crowd sourcing way to add locations of Aeds through this whole point AED app. And so it's a nice way for people to be able to find an AB in their communities. And it's also a way to add more. DS to the app. We use it as part of our registration process. When you register your AED, we ask that you go on to the pulse point, AED app and pin your AED. And then that way you can also add things like. This is in a business that's open from eight until five. And so in the evening, the AED isn't available because you can't get into the business or if it's a mobile, AED. Like the railroad and lots of construction companies, they have ads in their vehicles. And so it's mobile. And so it doesn't get pinned on the map. Just we know that they have them in their vehicle. Really cool. You know, the city of Bozeman has been very, very proactive with their AED program and all of the city vehicles, not just law enforcement vehicles, but the water truck guys. The park correct guys, everybody has an ad on their vehicle in the city of Bozeman, so. Anytime you're in Bozeman and you see a city vehicle, you know that there's an AED on that vehicle and that's a really neat service that that the community provides. But that pulse point AED app. Those Aeds and all you do. Go to your App Store. Pulse point. Like I said, it's a really cool app that people can use. I've had communities where the four H kids or the Boy Scout, they do it as a scavenger hunt and they'll run around and take pictures of all the. In their community and Geo rotate them all make. Kind of. Contest to see who can get it both. It's a really neat. Feature, especially if you're traveling, they'll tell you where the AED is in the hotel you're staying in, things like that 'cause. You never know when an emergency. Going to happen.
Speaker 1
Thanks for listening to talking health in the four oh six, where we are one community under the Big Sky. I'm your host, Maureen Ward. Our guest today was Janet Trethewey. The time sensitive illness and injury program manager at Montana Dphhs and member of the first responder community for over four decades. If you'd like more information on what we discussed today, you can head on over to talking health in the four O six dot Mt dot Gov. Don't forget to rate, review and subscribe and until next time take care and stay healthy.