Community Chain-of-Survival Taiwan Perspective
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1 Community Chain-of-Survival Taiwan Perspective Matthew Huei-Ming Ma, MD, PhD Department of Emergency Medicine National Taiwan University, Taipei, Taiwan
2 COI Disclosure Matthew Huei-Ming Ma National Taiwan University, Taipei, Taiwan Research grants from National Science Council and Ministry of Health and Welfare, Taiwan
3 Taiwan at a glance In this talk Taiwan EMSS and Chain of Survival Recent development of Taiwan Public Access Defibrillation (PAD) program Future directions
4 Taiwan at a Glance 23 million population Area: 36,188 km 2 Population: 23,315,822 Life Expectance: years Male: years Female: years Rates of Birth: 9.86 Rates of Death: 6.63 National Health Insurance since 1995
5 Cause of death in Asian country Korea Singapore Taiwan Japan Thailand Malaysia Australia Turkey UAE 1 Cancer Cancer Cancer Cancer Cerebrovasc ular disease Ischemic heart disease Ischemic heart disease Ischemic heart disease Ischemic heart disease 2 CVD Ischemic Heart disease Heart disease Heart disease Malignant neoplasm Pneumonia Stroke Malignant neoplasm Road traffic accidents 3 Heart disease (IHD + etc.) 4 Suicide Cerebrovasc ular disease Pneumonia CVD CVD Ischemic heart disease Pneumonia Pneumonia Diabetes mellitus CVD Dementia and Alzheimer disease Septicaemia Trachea and lung cancer CVD Chronic obstructive pulmonary disease Maligna nt neoplas m CVD 5 Diabete s Mellitus Accident, Poisoning & Violence Diabetes Mellitus Senility Chronic obstructive pulmonary disease Transport accident Chronic lower respiratory diseases Lower respiratory infections Hyperten sive heart disease
6 TAIWAN EMSS AND CHAIN OF SURVIVAL
7 EMSS Development Milestone 1990 Fire dept ambulance service st EMT training 1995 the EMS Act 1998 EM as specialist 2000 Fire Dept AED legalized st EMT-P training 2003 Fire-based ALS 2007 Medical Direction Legislature 2008 Hospital Categorization (AMI, Trauma, CVA) / Regionalized 2012 PAD and Good Samaritan Law
8 Momentum of EMSS Chi Chi Earthquake 1999 EMSS, DMAT, UR&R
9 Momentum of EMSS SARS Epidemics 2003 Emergency Coordination Ctr & Regionalization
10 Sources & Types of Providers Provider Training (hours) Training Scope of Practice EMT-1 40 Fire Dept Fire Academy EMT-II 280 Fire Dept Fire Academy First responder, BLS-D BLS-D, LMA, Fluids EMTparamedic 1280 Tertiary Medical Centers Advanced life support (intubation, Rx) Dispatcher 40 Fire Dept Priority Dispatch
11 EMT-1:28 EMT-2:168 EMT-P:3 EMT-1:341 EMT-2:1039 EMT-P:96 EMT-1:42 EMT-2:1665 EMT-P:267 EMT-1:23 EMT-2:165 EMT-P:6 EMT-1:11 EMT-2:175 EMT-P:12 EMT-1:8 EMT-2:256 EMT-P:12 EMT-1:92 EMT-2:787 EMT-P:76 EMT-1:32 EMT-2:259 EMT-P:12 EMT-1:16 EMT-2:171 EMT-P:18 EMT-1:18 EMT-2:300 EMT-P:7 EMT-1:162 EMT-2:891 EMT-P:35 EMT-1:46 EMT-2:392 EMT-P:16 EMT-1:9 EMT-2:316 EMT-P:17 EMT-1:46 EMT-2:465 EMT-P:13 EMT-1:82 EMT-2:1249 EMT-P:84 EMT-1:131 EMT-2:724 EMT-P:33 EMT-1:25 EMT-2:300 EMT-P:12 EMT-1:11 EMT-2:149 EMT-P:18 EMT-1:19 EMT-2:304 EMT-P:20 EMT-1:0 EMT-2:20 EMT-P:0 EMT-1:25 EMT-2:117 EMT-P:6 EMT-1:9 EMT-2:48 EMT-P:3 EMT-1:1165 (9.8%) EMT-2:9953 (83.8% EMT-P:766 (6.4%) (2013/06/30)
12 119 Access to EMSS Universal number of 119 (Fire & EMS) Central and vertical dispatch Location identification capability Dipatch CPR provided but suboptimal
13 Early CPR CPR education partners National Resuscitation Council of Taiwan (NRCT) Taiwan Red Cross Medical Societies Health care facilities Schools Military Low bystander CPR rate (15-20+%)
14 Single Tiered All BLS-D since Fire BLS Ambu Fire BLS Ambu
15 Two Tiered BLS-D / ALS since 2003 Fire ALS 119 Fire BLS Fire ALS Fire BLS
16 Regionalized EMSS since 2008 Prehospital Inhospital Public Health Hospital Categorization 191 EMSS Hospitals Emergency Care Needs (Critical 26,Acute 76,General 89) Stroke Center, Trauma Center, PCI Patient Center Care Triage Criteria Diversion / Bypass Policy Costs
17 Survival for Cardiac Arrests Published Data City / Hosp Year N ROSC Survival to Hosp Discharge OHCA Taipei % 1.4% OHCA Kaohsiung % 1.4% OHCA Taipei % OHCA Taipei % 5.6% OHCA (ALS only) Taipei % (>2hr) 9.3%
18 Leadership
19 Dedicated Professionals & Providers
20 Community Support
21 Low bystander CPR (20%) Low incidence of VF (10%) No PAD / Good Samaritan Law Long CPR+AED training hr (4-8hr) No TOR ALS varies Hypothermia, PCI, ECPR varies Call to arrive at patient: min Dispatch to arrive at scene: min
22 PAD in Taiwan Filling the gaps in chain of survival
23 The PAD Taskforce MOHW EMSS Committee Multidisciplinary - EM - Critical Care - Education - Cardiology - Law Legal - Good Samaritan - PAD Law Education - CPR+AED guideline - Hours - Materials Implementation - Feasibility - Roadmap
24 PAD Legislation Public Hearing Nov 21, 2011
25 PAD Int l Symposium, Dec 1, 2011
26 Seven Pillars for Taiwan PAD Guided by National and Local Health Authority Overseen by the Academia Regulated and Protected by Law Linked to the EMSS Evidence-based and Strategic Device Deployment Disseminated by streamlined and effective Training Supported by Community and Stakeholders
27 Regulated and Protected by Law EMS Act 2013 Jan Article 14-1 PAD Site Designation Compulsory Registration and Linkage to EMSS Article 14-2 Good Samaritan law
28 Transportation Hubs Long Distance Vehicles (airplane, vessel, High-speed train) National Parks / Amusement Parks School (high school and university), Public Arena Recreation > 3000 ppl Shopping > 3000 ppl Hotel > 250 ppl Bath/Hotspring > 100 ppl
29 Streamlined, Effective & Effective Training CPR+AED Training Pyramid Time Audience Qualification 240 mins CPR+AED +AED adm PAD program managers O (completion card) 180 mins CPR+AED Responders O (completion card) 90 mins Compressiononly CPR+AED General Public X (participation card ) Approved by MOHW
30 PAD Infrastructure PAD Codes & Regulations Streamlined and Effective training PAD Toolkit Registry & Post-event Notification Certification & Q/A
31
32 AED vendor upload S/N into system Site designated manager register device Local Health Department Approval Registration Information go public and transfer to fire department
33 > 70% Registration Rate in 2 months
34 Public AED from A-Z PAD Tool Box Site Manager Machine & Site Choice Device Registration Education & Management Emergency Responses & SOP Post-Event Notification & Device Maintenance Site manager qualification and training Standardized Contract Public AED Registration Staff Education, Maintenance, Heart Safe Spot Certification Site Emergency Response SOP, PAD-EMS Integration Post-event notification and data transfer
35 Post-Event Notification & Data Transfer < 7 days
36 Momentum of Progress Government Community Industry Academia
37 2013 Taiwan AED Survey Which City Best Implement PAD? Mass media can be very helpful
38 Offering AED is like offering the Blessing Light
39 PAD in Taiwan It is okay legal protection It is easy simplified education It is everywhere strategic deployment
40 Streamlined strategy to increase bystander CPR Evidence-based, cost-effective strategy to deploy public AED and other interventions Practice and policies tailored to population epidemiology and system configurations Concerted efforts in research, education and implementation key to successful community Chain of Survival
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