Thank you all for listening today to this presentation on PulsePoint in Cape Girardeau, Missouri, a community collaborative project to enhance early heart attack care. My name is Monica Kleffner-Fau, and I am the Chest Pain Center Coordinator at St. Francis Healthcare System in Cape Girardeau, Missouri. I have no disclosures. Objective today is to discuss the process and the barriers in engaging the local community in improving healthcare outcomes. The outline of what we're covering today, we will define the project, talk about how we got involved in this project, that if you go out and look at the PulsePoint website, this is pretty much an EMS-based project. We'll look at the implementation, figuring out how to tackle the different parts of this project, explore the main challenges we had in implementing this, look at what we were able to accomplish in our first year of this project, and where are we going next to help keep this work going. So PulsePoint was first introduced to myself and St. Francis Healthcare System in 2017. The Cape Girardeau Fire Department, who I've been working with with other projects, approached us with a proposition to fund this project that they were very enthusiastic about starting in our community. The purpose of PulsePoint is to engage the community in providing early hands-only CPR and defibrillation to a victim before EMS arrives. This early effective intervention can decrease mortality and morbidity from out-of-hospital cardiac arrest. So if you go out and you do a lit search on what's the latest research on out-of-hospital cardiac arrest, you see that survivability is only 10%, so 90% mortality rate. We were encouraged by data on the PulsePoint websites showing that in some PulsePoint communities, they had survivability of up to 30%. So that was very encouraging and made us eager to participate in this project. PulsePoint alerts CPR-trained responders in the community that someone close by is in need of CPR. The responders receive an alert on their phone to the PulsePoint app if they are within walking distance of the victim. So we have our radius set at a quarter mile and the alert on their phone sounds something like an amber alert. So something they are definitely gonna be able to pay attention to. Responders can choose whether or not to respond to the alert that they receive. They may be in a situation where they cannot respond. They may be out around town alone with young children and you just can't abandon the children to go run to respond to an event. So they would choose, no, I cannot respond at this time. If they choose to respond, they're given a walking map to the victim and the location of the nearest AED. Alerts are sent out via the 911 dispatch system to the PulsePoint app. Alerts for citizen responders are only for incidents in public areas. There is a version of PulsePoint that sends trained responders into private residences. These are generally like off-duty police and fire and healthcare workers, but these are carefully vetted. You only participate this in by invitation basically. And there's a training that goes with that on situational awareness and scene safety so we wanna make sure our responders are safe. And this is not something we offer to the general public. For implementation of this project, one of the first things that needs to happen is to upload the web-based program into the computer-aided dispatch system, so the CAD system. Uploading, one line on the slide here, sounds like it would be simple, but there's a lot of behind the scenes that happens with this part of the project. And this was all done by the fire department. There's a lot of interfaces, there's a lot of testing that needs to go on, and that took quite a bit of time. The other big part of just starting up is to map all the existing AEDs so that they can be loaded up into the system and appear on the maps in the proper places at the times that they are available so that the system works for the responders, that they can see the AEDs. In early 2019, we became aware of and applied for a grant, and were awarded a grant through the American College of Cardiology Accreditation Foundation Board. This grant provided us a way to help expand the original scope of the project and facilitated placement of additional AEDs into the community. The ACC grant funding was used to place an additional 30 AEDs into the community. It helped provide free CPR classes. These were full CPR classes, so they got the whole day-long program with the card and all the education materials. These were in addition to the free CPR, hands-only CPR classes that we provided. It also funded the extra work hours needed by the fire department to get the PulsePoint program installed and all the AED locations logged into the system. This is a very time-consuming project, and we all know most of our fire departments are not extremely well-funded, so this was able to help them out. It also helped us acquire educational and promotional items for the education of the community. As the computer-aided dispatch system of the CAT system was being set up, we engaged in the large project of mapping the existing AEDs in the city of Cape Girardeau. We recruited Greek organizations on the campus of the local university to approach local businesses within the city to determine the presence of existing AEDs and to distribute information on PulsePoint. Several sororities responded to our request for assistance as part of their community service outreach. We had packets with maps focusing on just one section of the city, letters of introduction, and instructions on how to load any AEDs they found into the PulsePoint AED app. The fire department produced maps for me with the city broken down into manageable sections. We asked that the sorority members, whether official sorority shirts looked professional when they went out. If an AED was present at a business, we had them ask permission to make it publicly available to be part of the PulsePoint system. And all of this was in the letter that we provided for them. They could then take that picture of that AED, load it up into the system. The fire department would see that AED, which would just be up as conditional. And then they would go look at that AED, make sure it was still functional, that it was a good picture, all the information needed was there for them to be able to make it part of the program. And then they would confirm that AED location. If no AED was present, they asked if they would like to participate in PulsePoint. They would give them the letter that we provided. It had information and it also had our contact information so they could get ahold of us about the project. Only one sorority actually fulfilled the project. And this still left a lot of the city still to be mapped. So the fire department utilized their inspection teams to locate existing AEDs and load them into the system. And this actually worked quite well because of COVID and things locked down and especially going into schools with school security, the fire department can go someplace that volunteers cannot. After the AEDs were located, another map of the city was produced by the fire department showing the existing AEDs. As you can see on this map, there's areas where there's a lot of lack in coverage. And some of these are residential areas that there's not a lot of public buildings available to put an AED in. Although we were able to find, like there's a gas station that's kind of on the outskirts of town in the middle of a residential area that accepted AEDs, we were able to penetrate some of these residential areas. The gray area around each of the black dots is a 500 foot radius around each existing AED. When we placed our new AEDs, we wanted to try not to overlap the coverage too much so we could get the best utilization out of the extra AEDs that we have to put into the city. Through dialogue with the fire department, locations were identified where it would be beneficial to place an additional AED. So these areas were identified based on where do large number of people gather on a routine basis, places where they had frequent medical calls, and then of course, just gas in our AED service areas. I contacted entities in those locations to have some discussions about PulsePoint, ask if they would be willing to acquire an AED and be part of this project. In making these calls, I also found AEDs that we were not aware of that were already in service. So I would ask those people, would you be willing to make your AED public available and be part of this project? If they were, I would give them information about how to upload their AED into the system. I would also ask them about education on PulsePoint that they could share with their church members or their business group, wherever that location happened to be. To help keep me on task and keep my time the most efficient, I created a spreadsheet to track all of this. Who had been contacted? Who needed to be followed up with? Who said yes? Who didn't want to participate? I used the spreadsheet to show contact information which then I could share with the fire department and to track other parts of the AED placement process. I used it to track vendor notification, make sure I made the vendor aware. He was very responsive, usually got the AED delivered within a week. And he is also a great resource for me to share information with. I also used the spreadsheet to show contact information which then I could share with the fire department and he is also a great resource. He was very familiar with PulsePoint and AED programs and made me aware of some things that I really hadn't thought about before. One of those was making sure that our AEDs got put up in wall cabinets, make them extremely visible, easy to find. Otherwise they get put on shelves, they get put in closets, things get shuffled around, things get put in front of them. Then you have an emergency and no one can find the AED. And then the vendor was also very good about making sure we got the best product and everything we needed and was well within our budget. So that was very nice. Once an AED was delivered, I would give it a week or so and I would go into the PulsePoint app and see whether or not that AED was actually uploaded into the system. If it wasn't, I would reconnect with my contact, ask them, have you tried uploading it yet? If they were having problems, I would actually go out and upload it for them. So we get it into the system so the fire department could go back and then confirm that AED. Also follow up after delivery to answer any questions and set up training, making sure wherever we had an AED that the people were actually trained in CPR and how to use an AED. Because we all know that an AED alone out in the community is not really gonna save lives. It's all about getting people trained how to do the CPR and how to use that AED that's gonna make a difference. While I was making the effort to place AEDs out in the community, the fire department was making preparations for the go live of the PulsePoint system. This involved lots of testing. There was a first, a soft launch, which was where alerts went only to the fire department, the police department, myself, a few other vested individuals to make sure that the alerts were going out properly, that if you responded, that was going well, that the AEDs appeared on the mass like they were supposed to. So that took a lot of time. Then once that was all good, we went live. And in the weeks following our go live, we did a lot of public events that were held at farmers markets. This introduced the public to PulsePoint and they were able to train them right there with hands-only CPR and AED use. As an ACC accredited chest pain center, our facility was already teaching early heart attack care or EHAC in our community and internal CPR classes. So we have all this educational material already available to us. So this information was also provided at our community CPR events, at our farmers markets and to the classes taught to individual groups. EHAC is important for early recognition of signs and symptoms. We can get people to recognize their signs and symptoms early. Hopefully we can prevent an acute MI or an auto hospital cardiac arrest from even occurring. The marketing department here at St. Francis Healthcare System worked to provide materials for public events. We had banners, we had some small business card size information handouts, as well as flyers. And the business card handouts really worked well for outdoor events. So at the farmers markets, so that flyers weren't blowing all over the place with the slightest breeze and it's something they could stick into their pocket or it was easy to carry. And so that really worked well for that event. Also did vinyl window decals for our business and churches that participate in the project that says that they are PulsePoint connected and invites their members and the people visiting the business to download the app. It also had our St. Francis Health System name on it. So if they have questions about PulsePoint, they knew who to contact, get in touch with for more information. And then also had an informational PowerPoint that we use to educate community groups. So several times I and the fire department went out together to groups that were interested, that wanted more information. And we would talk to them about PulsePoint and those groups then would end up turning around and accepting an AED and be willing to participate into the PulsePoint system. Okay, so now we're gonna talk about some of the challenges that we face with implementing this project. One significant issue with the starting of this program was inability of the city's computer-aided dispatcher, CAD system to handle the program. Initially it was thought that it could handle the software, but as the project started, it was found that it could not. So then there was a process of finding a new system, something that would work for the whole city, funding, waiting for new fiscal year to get into the budget. And then there was installation of the new system. So this caused significant delays to our initial projected start. As a result of needing a new CAD system to support PulsePoint, the project really did not get started until 2019, which is a two-year delay from the initial proposal. We did end up going county-wide with the PulsePoint system, which is a good thing. That was one of our initial stretch goals with this project that we hoped we could do, but it also presents some challenges. This is a very rural area. There's a whole county is kind of a fragmented 911 system as well as really Southeast Missouri and the whole state is kind of a fragmented 911 system, something we're really trying to work on. And also the volunteer fire departments out in the rest of the county, most of them are volunteer, has varying capabilities for EMS response. This hinders a dispatch from the system because PulsePoint wants to dispatch to an EMS entity. And not all of the volunteer fire departments have an EMS capability within their volunteer department. Also being a rural area, cell coverage is also an issue. Not all of these areas have really good cell coverage. Engaging the public was my favorite part of this project. I like to get out, I like to teach, but it also has obstacles that need to be overcome. People have a fear of doing CPR. They're afraid they're gonna hurt somebody. So you have to be really kind of blunt with them going, well, they're already dead, so you're not gonna make them more dead, but you could give them the chance to help them live again. And that's something that's a viewpoint they don't necessarily have if they're not in healthcare. Also, we know as healthcare providers that trying to get our individual patients to have responsibility for their healthcare outcomes is difficult. So trying to engage the public and get people to want to have responsibility towards healthcare outcomes of the entire community is difficult and something that needs to be overcome with a lot of education. There's also fear out there of getting sued. So you have to talk to them about the Good Samaritan Law, that that is not gonna happen. Time constraints was a large challenge. Fire department has other responsibilities outside of PulsePoint. I have other job responsibilities besides PulsePoint. It's very time-consuming to make calls. There's a lot of follow-up, verifying uploads, setting up training, doing the training. There's a lot of emails and voicemails that go back and forth to get someone even to accept an AED, much less all of the follow-up. COVID-19, of course, a restraint on our time because we're going out and doing extra staffing, doing extra jobs, dealing with short staff and high census. So that had an impact. It also had an impact on our rollout because we could not roll out and go live like we had wanted to. We did do outside events at the farmer's markets, in our masks, in the August heat, but that's what we had to do to get it out there during COVID. Also, collecting data on outcomes. We are not the only medical center in the area, so we don't get all the out-of-hospital cardiac arrests. And the data within the system, the PulsePoint system, there's a lot of good data there, but it doesn't, as a nurse, tell me everything that I wanted to know, such as how many people actually responded that got an alert. Because if you, to find out the information that people have to fill out a survey post. So if they don't do that, then we don't know if they actually accepted and responded to the person, unless that is in an EMS report that I get on that patient. I am working with PulsePoint, though, to help pull some extra data out and to maybe find some other reports that I can use to get me all of the specifics that I would like. So what have we been able to accomplish since we started this project a little over a year ago? We have placed 30 new AEDs out in Cape Girardeau County. Our initial efforts were within the city limits, so you can see 23 within the city limits. That's that cluster down in the lower right-hand corner. And then once we knew that we were able to expand this project out to the rest of the county, I put my efforts in getting AEDs outside of the city limits. So I was able to put seven AEDs out into the county. But as you can see, there's a lot of places that do not have AEDs. Part of this is we have not mapped the entire county for who has AEDs. So there may be AEDs out there that we don't know of, but these are only the ones that I had actually put out. So I have a lot of areas that I would like to explore and try to get AEDs into. One year post-project, we have 803 followers, but only 516 have enabled the CPR notifications. I feel this is probably partially an educational gap. I try to let people know when I educate them on how to set up the PulsePoint app, how to get into the system, that they not only need to follow the fire department, but they need to go a couple layers deeper into the app and actually enable CPR notifications. I think some people have followed the fire department, but have not gone to the next layer in the app and actually turned on the notifications. A portion of the calls that have in the past year have had no responders within a quarter mile of the event. And this is something to decrease this number. We just need to get more people trained and more people to be responders within the system. To date, we have trained 263 people on PulsePoint, eHack, CPR, and AED use. And while this is a good start, not all these people necessarily live within city limits or live within a PulsePoint area. They could be out of the county. There are people who have come into the county, moved out of the county. So that number is always varying. So we need to make sure we keep up the effort to keep educating everyone. So where do we go from here? Because this is truly a never-ending project. First, we need to keep PulsePoint in front of our community. We need to keep people aware, keep people engaged, encourage people to participate. This is going to take continued education, having more responders out there, making sure that no one who goes down in an out-of-hospital cardiac arrest does so without someone within the vicinity to be able to help them. That is a big goal of this project. Also finding ways to increase AED access needs to continue. We need to find alternate funding to help put more AEDs, not just out in the city, but out in the entire county. And also continue to work on getting our county-wide access into the PulsePoint system, working on resolving those communication issues so that we can have true coverage in the entire county. This also takes individual effort. People involved in the project need to be engaging on a personal level with people within their community, within your church groups, within your social life, within your work group. New people who are new to the area may not have heard about PulsePoint. Engaging everyone on a personal level to get them to respond, become part of the project. That's going to be key to increasing our number of responders. Thank you for listening to my presentation. If you would like more information about my experience or any more details about different parts of this project that I wasn't able to delve into in this presentation, feel free to email me. And I hope you all have a blessed rest of your day. Thank you. Thank you.

PulsePoint project

early heart attack care

CPR-trained responders

automated external defibrillator

AED location

community collaborative project