What cops need to know about cardiocerebral resuscitation
Despite being positioned to make an impact on emergency cardiac survival rates, LE remains an under-utilized component of the chain of survival
First implemented in Arizona in 2003, cardiocerebral resuscitation (CCR) is continuous chest compressions (also known as CPR) without “mouth to mouth” ventilation for EMS, first responders and bystanders in incidents of witnessed cardiac arrest.
CCR provides high-quality continuous compressions with limited interruption and rapid defibrillation. Previously, compressions were interrupted to deliver mouth-to-mouth ventilation, but continuous chest compressions have been shown to not only triple the chances of survival but also provide better brain outcomes at a rate of 250%-300% over CPR with mouth-to-mouth ventilation.
Cardiocerebral resuscitation is ideal for law enforcement. No longer providing “mouth to mouth” ventilations mitigates the chances of disease transmittal or getting vomit and bodily fluids in an officer's mouths. Officers using CCR can still observe the scene during compressions ensuring officer safety instead of diverting their eyes to give breaths.
Heart disease is a global leading cause of death taking the lives of approximately 17 million people each year. Cardiac arrest with its sudden onset and limited window for emergency medical intervention is particularly deadly with only 1 out of 9 people surviving an out-of-hospital sudden cardiac arrest. Not to be confused with a “heart attack,” cardiac arrest is an electrical malfunction that disrupts blood flow to the brain and vital organs. Emergency responders have little time to provide CCR (commonly known as “hands-only CPR” or “compression-only CPR”) and shock therapy from a defibrillator before a patient has irreversible brain damage or is unable to be resuscitated.
Despite being positioned to make an impact on emergency cardiac survival rates, law enforcement remains an under-utilized component of the chain of survival. Police officers trained to deliver high-quality cardiocerebral resuscitation can not only be the difference between life and death but also determine good brain outcomes post-incident.
How difficult is it to train police officers to do cardiocerebral resuscitation?
It is easy to train officers how to do cardiocerebral resuscitation. Officers should be trained to focus on reaching optimal compression rates, depth and allow the heart to fully recoil with limited interruptions. The earlier defibrillation can be provided via an automated external defibrillator (AED), the better. Agencies should talk with their local medical directors and EMS trainers about how to train their officers to increase sudden cardiac arrest survival rates in their communities.
Feedback training manikins can be an extremely valuable training tool. Agencies should talk to their trainers about using feedback manikins in their officer’s recertification courses to improve police compression quality.
How important is it for police departments to carry AEDs in their patrol vehicles?
Police are on patrol 24/7 throughout their jurisdictions. Being decentralized when dispatched allows officers to often respond to calls for service faster than fire and EMS. Unlike fire/EMS crews, police officers can leave non-priority calls (for example civil matters or barking dog calls) to respond to more urgent emergencies. Defibrillation from an AED within the first 3-5 minutes (the electrical phase) can increase survival by 70%-80%.
Adding AEDs to your agency
We wouldn’t send officers to an active shooter without the proper training and equipment, so why are we sending them to the number one cause of death without the life-saving tools they need?
Selecting an AED that matches your agency’s needs is vital to program success. There are multiple factors to consider when selecting the right AED for your agency.
FDA-approved AEDs: When selecting devices, agencies are recommended to look at the FDA-approved devices list. Also, consider speaking with your EMS agencies and medical directors about the devices they recommend for your agency.
Cost-effectiveness: Prior to purchasing AEDs ensure your agency does a detailed cost analysis of AEDs and how your agency will continue to fund the program long-term. Failing to conduct in-depth cost considerations prior to implementing AEDs in the field, could cause budget complications down the road making the program unsustainable. If an agency selects AEDs that are too costly to maintain, the program could fail and cost the lives of the people you serve.
Battery/pad/electrode considerations: Battery/pads should be cleared by the FDA for usage in the device. Consider FDA-approved AEDs with batteries and pads/electrodes with longer shelf lives. Some AEDs have batteries and pads/electrodes that last up to five years. That means except for replacing used pads/electrodes and batteries, an agency will only have to replace expired batteries and pads one time to sustain the program over a 10-year period.
Consider AED pads with CPR feedback to set your officers up for success. According to a study conducted in Mesa, Arizona, CPR feedback pads can increase survival chances by 55.6%. Using AEDs with CPR feedback can assist officers to achieve proper depth compression, targeted compression rates, allow the heart to fully refill with blood and limit compression interruptions.
Fire/EMS cohesiveness: Police agencies should talk with their fire/EMS providers about what cardiac equipment they use. Your agency could purchase AEDs for your officers that can plug directly into fire/EMS devices for cohesive cardiac care. Your fire/EMS partners may be able to assist you with battery and pad/electrode replacements at cheaper costs or free to your agency. Your fire/EMS agencies may even be able to assist your agency with reporting/tracking AED usages to your physician oversight depending on local legislation/policies.
Durability: Police are not known for being delicate with our issued field equipment. Durability is a factor to consider when selecting the right AEDs for your agency. How well do the AEDs hold up being thrashed around in the trunk or toolbox of a police vehicle? Do the AEDs come with carrying cases or protective cases?
Environment: Temperatures should also be a factor when selecting an AED. Does your department work in extreme cold or hot weather? Some AEDs work in temperatures down to -40 degrees Fahrenheit and up to 140 degrees Fahrenheit. Most police officers have their patrol vehicles on the entire shift going call to call with either the air conditioning or heating on. During shifts, your officers will most likely not have to worry about temperature considerations. However, if your patrol vehicles are not shared and remain parked in extreme weather, your agency may have to develop an AED check-out program at the beginning and end of officers’ shifts.
Warranties: Look at AED warranties and how long they will cover your agency's devices. Look into AED companies' recall protocols and ensure they will assist you in keeping your AEDs field ready. Find out how easy it is to troubleshoot issues and how quickly the AED manufacturer will resolve issues as they arise to get your AEDs back in the field.
Inspections: How often do the AEDs you select for your agency need to be inspected? Do the devices do self-checks or alert your officers/AED coordinators to issues? Agencies should look at AEDs with maintenance indicators or units that do self-assessments. The last thing you want is to have one of your officers go use an AED in a life and death emergency and not have it work because of a maintenance issue.
Law enforcement specials/packages: Agencies looking to implement an AED program should investigate special law enforcement pricing and packages. Often AED manufacturers will have special bulk order prices when you order larger volumes of AEDs. Look at what is available to benefit your agency at the time of purchasing.
I write this article not only as a certified police officer but as an out-of-hospital sudden cardiac arrest survivor. In my mid-twenties, I collapsed to my death from an electrical malfunction in my heart. This was in front of my wife in our home. She heroically called 9-1-1 and began compressing away on my chest until a fellow police officer was the first to respond and take over medical care. The officer did outstanding cardiocerebral resuscitation on me until fire/EMS later arrived and successfully brought me back with advanced life support. I was medically dead for approximately 16 minutes. Now I do my best to earn each day I am given and prepare, train, and equip law enforcement for cardiac emergencies.
Until police departments can outfit their officers with AEDs, it is paramount they are provided cardiocerebral resuscitation training. High-quality compressions with limited interruptions are the best chance a cardiac arrest patient has until defibrillation and advanced medical care can be provided. If officers cannot provide defibrillation with a department-issued or public access defibrillator, they can at least give the brain and vital organs the best chances of resuscitation and favorable brain outcomes with high-quality cardiocerebral resuscitation.
Bobrow BJ, Clark LL, Ewy GA, et al. Minimally interrupted cardiac resuscitation by emergency medical services providers for out‐of‐hospital cardiac arrest. JAMA, 2008, 229:1158–65.
Bobrow BJ, Spaite DW, Berg RA, et al, Chest compression‐only CPR by lay rescuers and survival from out‐of‐hospital cardiac arrest. JAMA, 2010, 304:1447–54.
Ewy G. Cardiocerebral and cardiopulmonary resuscitation – 2017 update. Acute Med Surg, 2017, Jul, 4(3): 227–234.
Ewy GA, Bobrow BJ. Cardiocerebral resuscitation: an approach to improving survival of patients with primary cardiac arrest. J. Intensive Care Med, 2016, 31:24–33.
Kellum MJ, Kennedy KV, Barney R, et al. Cardiocerebral resuscitation improves neurologically intact survival of patients with out-of-hospital cardiac arrest. Ann Emerg Med, 2008.
Mehra R. Global public health problem of sudden cardiac death. J Electrocardiol, 2007, 40(6 Suppl):S118-S122.
NFPA 1710 Standard for the Organization and Deployment of Fire Suppression Operations, Emergency Medical Operations, and Special Operations to the Public by Career Fire Departments, 2010 edition.
Panchal AR, Stolz U, Spaite D, et al. The impact of hands‐only (compression‐only) CPR by bystanders on survival in adult victims of out‐of‐hospital arrest caused by non‐cardiac etiologies. Circulation 2010, 122: A86.