 MISSION: Our vision is for Arizona to have the best survival rate in the world for out-of-hospital cardiac arrest.
BACKGROUND: The SHARE Program is developed by the Arizona Department of Health Services, Bureau of Emergency Medical Services (BEMS). The SHARE initiative promotes public awareness, public education, data collection, and research of cardiac arrest. Most of all, SHARE is designed to advance research in OHCA and seek new strategies to save lives.
The SHARE Program will develop and maintain statewide registries for automated external defibrillators (AEDs) and cardiac arrest victims (CA). The registries are designed for quality improvement. The goal is to improve cardiac arrest survival through implementing scientifically proven strategies for EMS and non-EMS personnel.
Sudden cardiac arrest (SCA) is one of the leading causes of death in the United States, claiming approximately 400,000 lives each year. In fact, SCA is truly a public health crisis. The average survival from an out of hospital cardiac arrest is less than five percent. However, through mass public education in the signs and symptoms of cardiac arrest, along with cardiopulmonary resuscitation, and creative early defibrillation strategies, some communities' survival rates approach forty percent.
Automated external defibrillators (AEDs) are designed for use by medically trained and by non-medically trained people who witness an individual collapse from a sudden cardiac arrest. AEDs have been safely and successfully used by a variety of non-medically trained individuals including: flight attendants, security officers, police officers, manufacturing plant employees, cruise line employees, bailiffs, restaurant and golf course employees and government workers to name just a few. The American Heart Association and experts in the field of cardiac arrest research recommend the placement of AEDs in appropriate communities to provide rapid defibrillation to those cardiac arrest victims who may benefit. Most fire departments and emergency medical service providers have defibrillation capability; however, due to the location of the victim and factors such as traffic congestion, precious minutes may pass before they can respond with this life-saving technology. Layperson defibrillation can occur within minutes of a witnessed out-of-hospital cardiac arrest. Every minute that passes before a cardiac arrest is treated decreases the chance of survival by 10%. For many, quicker access to an AED represents their only chance to survive.
Although science and industry have developed a safe and effective cure that works, few victims of sudden cardiac arrest have quick access to this treatment. Why? Because many communities have not yet developed strategies to ensure that a defibrillator reaches every victim of sudden cardiac arrest within five minutes of collapse.
As a result, in most communities, fewer than five percent of victims survive. In contrast, some communities with strong response systems have achieved much better survival rates. It really doesn't matter who brings the defibrillator to the victim's side. The important thing is to make sure a working defibrillator is readily available and there is an action plan to ensure the device and trained rescuers reach the victim in time. To be effective, defibrillation needs to be within the first five minutes of cardiac arrest. To improve survival of patients who do not have defibrillation this early, chest compression by bystanders is critical.
The BEMS has teamed up with Dr. Gordon Ewy, Dr. Karl Kern, and Lani Clark, of Sarver Heart Center at the University of Arizona. Dr. Ewy and his colleagues have conducted cardiac arrest research for more than 20 years. Another colleague, Dr. Terrence Valenzuela, reported in the landmark study of AED use by security officers in Hotel/Casinos, published in the New England Journal of Medicine in 2002, the highest survival rate for cardiac arrest victims reported to date. Of equal importance, the study demonstrated the safety factor of AED use by non-medically trained individuals. Over more than three years and 200 uses, no patient was inappropriately treated and no provider was injured. Lani Clark worked with Dr. Valenzuela on this noteworthy project.
A physician’s prescription is required for purchase of an AED. This requirement discourages businesses that wish to purchase AEDs and develop a Public Access Defibrillation (PAD) program but find it difficult to obtain physician oversight. In many cases, the unavailability of physician medical oversight and experienced QI personnel forces many to regrettably give up on the idea altogether. The SHARE Program encourages AED placement and use by providing these services to groups and individuals in Arizona who wish to provide this aid to their fellow citizens. More rapid defibrillation by laypersons will save lives that otherwise would be lost.
The SHARE Program will provide, free of charge, Medical Oversight through the BEMS Medical Director Dr. Bentley J. Bobrow. The program will also assist in implementation and follow-up quality improvement for non-medical individuals and businesses in Arizona purchasing automated external defibrillators (AEDs).
If alternative medical direction is selected, registration of your AEDs with the SHARE program will guarantee you all other benefits of participation and any assistance you or your medical director may request or require.
The SHARE Program also works with government agencies seeking grant moneys to begin or augment their Early Defibrillation Program.
PROGRAM PLAN: The Bureau of EMS (BEMS) will coordinate a centralized program to provide medical oversight and follow up for qualified individuals and businesses in Arizona who purchase automated external defibrillators. The coordinator of the AED program is Lani Clark, Prehospital Research and QA Director and Dr. Bentley J. Bobrow.
SHARE will provide:
- A prescription for AED purchase when necessary;
- Training resource recommendations;
- Event review for each AED use and a file copy to participant;
- Guidance and assistance with implementation and maintenance of your AED project;
- Documentation for participant files verifying the BEMS as providing required medical direction;
- Availability for questions or concerns about participant's AED project;
- Guaranteed confidentiality of all individuals, participants and patients.
Participant will agree to:
- Provide documentation of training on request;
- Maintain names of all individuals trained in AED use on request;
- Provide manufacturer of all AEDs purchased;
- Provide information and event data from device for all AED uses; and
- Provide name and contact information for medical director if other than BEMS is selected.
PROGRAM QUALITY IMPROVEMENT PROCESS: Lani Clark has reviewed more than 8000 out-of-hospital cardiac arrest incidents. She assisted with the design and implementation of AED programs for the Tucson Fire Department, the Las Vegas Hotel/Casino Project, Miami-Dade Police Department, University of Arizona campus, Maricopa Community College District and many others. The Bureau of Emergency Medical Services (BEMS) will maintain complete records of all participants, review each AED use, maintain a database of all out-of-hospital cardiac arrest AED uses by participants. SHARE will provide the BEMS the following on a quarterly basis:
- Current list of participants;
- Any uses of the AED with review report including waveforms and patient/incident information if needed; and
- Any recommendations for improvement or change.
NOTE: There will be immediate notification of issues that require physician input or intervention
Click here to become a SHARE Program Participant.
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