New CPR Guidelines Recommend Using Social Media and Mobile Technology to Speed Bystander CPR in Sudden Cardiac Arrests

PulsePoint CPR Response App Already Downloaded More than 505,000 Times – More than 16,500 Cardiac Arrest Responders Alerted to Date

(16 October 2015 – Redmond, WA) – For the first time, CPR guidelines issued by the American Heart Association (AHA) recommend that communities consider using social media and mobile app technology to alert CPR responders when someone nearby suffers sudden cardiac arrest. The new guidelines cite studies that show emerging mobile technologies can result in a “higher rate of bystander-initiated CPR.”

The leading bystander response mobile application, PulsePoint Respond, alerts users when a sudden cardiac arrest occurs in a nearby public place, directs them to the patient location and provides CPR guidance while paramedic units are en route to the call. The app also notifies users of the closest available Automated External Defibrillator (AED).

To date, the PulsePoint app has been downloaded more than 505,000 times and has alerted more than 16,000 responders to the need for CPR in more than 6,500 suspected sudden cardiac arrest incidents. PulsePoint is now active in more than 1,200 communities in 24 U.S. states and Canadian provinces.

The PulsePoint app has played a key role in saving several lives. The first documented PulsePoint save involved a 57-year old truck driver near Portland, Oregon, who suffered sudden cardiac arrest outside his gym and received CPR from a PulsePoint responder. In Spokane, Washington a five-week old infant received CPR from a nearby off-duty EMS volunteer working at his job as a mechanic. In Sunnyvale, California, a 63-year old father of two collapsed on a soccer field and received CPR from a college student living nearby who received a PulsePoint alert on his mobile phone.

“PulsePoint-connected communities don’t need to rely on the luck of having a CPR-trained citizen witness a cardiac arrest,” said Richard Price, President of the PulsePoint Foundation. “By directly notifying those who are qualified and nearby, PulsePoint helps put the right people in the right place at the right time. PulsePoint builds on the good work that a community has done with CPR training and AED placement and improves the efficiency and use of these resources. Two-thirds of our 24-hour healthcare professionals - firefighters, paramedics, police officers, nurses, doctors - are off-duty at any one time. With PulsePoint, responders like these are available to assist if they are made aware of an urgent need nearby.”

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The PulsePoint apps were created by and are a product of the PulsePoint Foundation. Physio-Control is the foundation’s implementation partner and provides services to integrate PulsePoint with public safety agency dispatch and communication systems.

“Apps like PulsePoint can help save lives,” said Brian Webster, President and CEO of Physio-Control. “This new AHA guidance is a strong call to action. Quick bystander response to sudden cardiac arrests – performing early CPR and finding and using an AED – is a vital part of an effective system of care. Mobile devices are already in millions of hands – PulsePoint Respond puts lifesaving skills and awareness into those hands.”

“The PulsePoint mobile device system, for the first time, changes the old paradigm of waiting for trained EMS responders to arrive on scene,” said Dr. Bentley Bobrow, Medical Director, Bureau of Emergency Medicine and Trauma Services, Arizona Department of Health and past Chair of the American Heart Association Basic Life Support Subcommittee. “PulsePoint allows communities to harness the enormous life-saving potential of their citizens, many of whom are ready and willing to perform CPR and use an AED in the most critical minutes before trained EMS providers can arrive.”

Information on how to download the free PulsePoint app is available at this site. Public safety agencies interested in becoming PulsePoint-connected can learn more here.

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About Sudden Cardiac Arrest (SCA) Sudden Cardiac Arrest is the abrupt loss of heart function in a person who may or may not have diagnosed heart disease. Death can occur shortly after symptoms appear without rapid intervention and treatment. Each year, more than 420,000 emergency medical services-assessed out-of-hospital cardiac arrests occur in the United States. The American Heart Association states that “there is clear and consistent evidence of improved survival from sudden cardiac arrest when a bystander performs CPR and rapidly uses an AED.”

About the PulsePoint Foundation PulsePoint is a 501(c)(3) non-profit foundation based in the San Francisco Bay Area. Through the use of location-aware mobile devices PulsePoint is building applications that work with local public safety agencies to improve communications with citizens, empowering them to help reduce the millions of annual deaths from sudden cardiac arrest (SCA). Deployment of the PulsePoint app can significantly strengthen the “chain of survival” by improving bystander response to cardiac arrest victims and increasing the chance that lifesaving steps will be taken prior to the arrival of emergency medical services (EMS). PulsePoint is supported by the Wireless Foundation, built and maintained by volunteer engineers at Workday and distributed by our marketing and implementation partner Physio-Control, Inc. Learn more at www.pulsepoint.org or join the conversation at Facebook and Twitter. The free app is available for download on iTunes and Google Play.

About Physio-Control Physio-Control, Inc. is headquartered in Redmond, Washington. The company was founded in 1955 and is the world’s leading provider of professional emergency medical response solutions that predict or intervene in life-threatening emergencies. The company’s products include LIFEPAK® monitor/defibrillators and automated external defibrillators, the LIFENET® System, HealthEMS® electronic patient care reporting (ePCR) software, LUCAS® 2 Chest Compression System, TrueCPR™ coaching device, McGrath® MAC EMS video laryngoscope and implementation for PulsePoint mobile bystander response applications. Learn more at www.physio-control.com, or connect on Facebook, LinkedIn orTwitter.

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Media Contacts: Matt Fikse, Physio-Control, +1 425-867-4208, [email protected] Shannon Smith, PulsePoint Foundation, +1 773-339-7513, [email protected]

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(Caption) This map shows PulsePoint mobile app CPR responder coverage across Los Angeles, California. More than 26,000 people have opted-in to receive CPR alerts from the PulsePoint Respond mobile app. Los Angeles county went live with PulsePoint in August, 2014 and the City of Los Angeles went live with PulsePoint in March, 2015. (Data: PulsePoint; Map: Google.com)

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(Caption) This PulsePoint mobile app alerts users when a sudden cardiac arrest occurs in a nearby public place, directs them to the patient location and provides CPR guidance while paramedic units are en route to the call. The app also notifies users of the closest available Automated External Defibrillator (AED). (Image: PulsePoint)

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Clinical Summary - PulsePoint

Bystander Response to Cardiac Arrest is Critical to Improve Rates of Effective Resuscitation

Introduction

Utilizing laypeople as CPR/AED responders for out-of-hospital cardiac arrest has been occurring to some extent over the last decade. Advances in cellular technology are enhancing the ability to notify and direct laypersons trained in CPR/AED to the scene of a cardiac arrest. The key take- aways from the summaries of the four references in this paper are:

A layperson alerting system increases bystander CPR rates (Ringh)

CPR prior to EMS arrival more than doubles 30-day survival in a European urban setting (Hasselqvist-Ax)

Similar results were seen in urban, suburban and rural communities in North Carolina (Hansen).

The Institute of Medicine in Washington, DC released a report on strategies to improve cardiac arrest survival in July 2015. One of the eight recommendations discussed was that bystanders need to be prepared and willing to deliver basic life support before professional responders arrive. Additionally, it calls out the PulsePoint mobile app as an example of ways to empower bystanders to act quickly in emergency situations.

1. Ringh M, Rosenqvist M, Hollenberg J, et al. Mobile-Phone Conclusions Dispatch of Laypersons for CPR in Out-of-Hospital Cardiac A mobile-phone positioning system to dispatch lay volunteers who Arrest. New England Journal of Medicine. 2015;372:2316-2325. were trained in CPR was associated with significantly increased rates of bystander-initiated CPR among persons with out-of-hospital Background cardiac arrest. Study investigated whether rates of bystander-initiated CPR could be increased with the use of a mobile-phone positioning system that Physio-Control Discussion Points could instantly locate mobile-phone users and dispatch lay volunteers who were trained in CPR to a patient nearby with out-of-hospital The notification system in the study is a more basic version of cardiac arrest. The primary endpoint was number of patients receiving PulsePoint but comparable in its intention. bystander-initiated CPR. Calls requiring dispatcher-assisted CPR were excluded. PulsePoint may have similar and improved results due to:

Registration is via free mobile app. Methods Activation occurs instantly without any additional workflow from This blinded, randomized, controlled trial took place in Stockholm the dispatcher. from April 2012 through December 2013. A mobile-phone positioning system was developed specifically for use in this study. Once The PulsePoint app shows an interactive map of the incident, user and emergency services were dispatched for a cardiac arrest call, the nearby AEDs. The study used a web link in a standard text message; a system located and notified trained volunteers who were within 0.3 better user Interface is likely to drive better compliance and response. miles (500 m) of the patients. This study only looked at arrest occurring during the daytime. PulsePoint is active 24/7. Results While this study did not include children under 8 years old, A total of 5,989 lay volunteers who were trained in CPR were recruited the PulsePoint app has already played a part in the successful initially, and overall 9,828 were recruited during the study. The rate resuscitation of a 1-month old in Washington State. of bystander-initiated CPR was 62% (188 of 305 patients) in the intervention group and 48% (172 of 360 patients) in the control group. The conclusion states: “Future integration of mobile-phone No major adverse events were reported. positioning systems with AED registries may facilitate lay responders in locating the nearest AED and thereby increase efficacy in public-access defibrillation programs.” PulsePoint already does this. 2. Hasselqvist-Ax I, Riva G, Herlitz J, et al. Early Purpose Cardiopulmonary Resuscitation in Out-of-Hospital To observe changes over time in bystander/first-responder Cardiac Arrest. New England Journal of Medicine. resuscitation efforts prior to arrival of the emergency medical 2015;372:2307-2315. services (EMS).

Background To examine the association between bystander/first-responder resuscitation efforts to survival and neurological outcome. Three million people in Sweden are trained in cardiopulmonary resuscitation (CPR). But whether this training has an impact has Methods been questioned. This study looked at whether bystander CPR was associated with 30-day survival of out-of-hospital cardiac 4,961 out-of-hospital cardiac arrest patients with attempted arrest victims. resuscitation who were identified through the Cardiac Arrest Registry to Enhance Survival (CARES) were included in the study.

Methods First responders included: dispatched police officers, firefighters, The study analyzed a total of 30,381 out-of-hospital cardiac arrests rescue squad or lifesaving crew trained to perform basic life support witnessed in Sweden from January 1, 1990, through December 31, until arrival of EMS. 2011, to determine whether CPR was performed before the arrival of emergency medical services (EMS) and whether early CPR was Results correlated with survival. The combination of bystander CPR and first-responder defibrillation increased from 14.1% in 2010 to 23.1% in 2013 (P < .01). Results Survival with favorable neurological outcome increased from CPR was performed before the arrival of EMS in 15,512 cases 7.1 in 2010 to 9.7% in 2013 (P = .02) and was associated with (51.1%) and was not performed before the arrival of EMS in 14,869 bystander-initiated CPR. cases (48.9%). Adjusting for age and sex, bystander and first-responder interventions The 30-day survival rate was 10.5% when CPR was performed were associated with higher survival to hospital discharge. before EMS arrival versus 4.0% when CPR was not performed before EMS arrival (P<0.001). Survival: -- EMS-initiated CPR and defibrillation was 15.2% compared Conclusion with 33.6% following bystander-initiated CPR and defibrillation.

CPR performed before EMS arrival was associated with a 30-day -- 24.2% following bystander CPR and first-responder defibrillation. survival rate after an out-of-hospital cardiac arrest that was more than -- 25.2% following first-responder CPR and defibrillation. twice as high as that associated with no CPR before EMS arrival.

Conclusions Physio-Control Discussion Points The proportion of patients receiving bystander-initiated CPR and PulsePoint activates trained bystander during the crucial minutes defibrillation by first responders increased and was associated with before on-duty professionals arrive on scene. greater likelihood of survival. The Ringh study showed a 30% increase of bystander CPR in the Bystander-initiated CPR was associated with greater likelihood of group notified by the mobile system over the control group. This survival with favorable neurological outcome. study showed that bystander CPR provided prior to EMS arrival improves 30 day survival more than 2 fold. Physio-Control Discussion Points Utilization of a system like PulsePoint has the potential to achieve survival rates similar to those in these studies. Initiatives such as the one in North Carolina that improve bystander CPR initiation have clinical impact on the survival of patients who experience out-of-hospital cardiac arrest, leading to statistically 3. Hansen C, Kragholm K, Pearson D, et al. Association of significant increase in survival with favorable neurological outcomes. bystander and first-responder intervention with survival after out-of-hospital cardiac arrest in North Carolina, 2010- PulsePoint is a tool for engaging CPR-trained bystanders, 2013. JAMA. 2015;314:255-264. removing the reliance on chance and using technology to get bystanders to those that require CPR as quickly as possible to drive positive clinical outcomes. Background

In 2010, the HeartRescue Project in North Carolina introduced a statewide initiative to improve bystander and first-responder efforts. The initiative involved urban, suburban and rural communities. 4. IOM (Institute of Medicine). 2015. Strategies to improve “Bystander CPR is also associated with improved health outcomes cardiac arrest survival: A time to act. Washington, DC: The for individuals who survive cardiac arrest. A number of studies National Academies Press. have also found increased quality of life following cardiac arrest for individuals who receive bystander CPR compared to individuals who This report outlined a total of eight recommendations designed to do not receive bystander CPR.” p.104 improve low survival rates from cardiac arrest. One of these are highlighted below: “Bystander CPR makes the next link in the chain of survival, early defibrillation, more effective by increasing the proportion of Recommendation #2: Foster a Culture of Action Through Public individuals who are found with a shockable rhythm.” p.105 Awareness and Training “Many national and international registry studies indicate that State and local departments of health should promote public awareness bystander CPR can increase survival rates for OHCA between 50 creating a culture of action that prepares and motivates bystanders to and 500 percent.” p.106 respond immediately upon witnessing a cardiac arrest, p.12. “Other efforts—such as the PulsePoint Foundation in San Ramon, California—have focused on using smartphones to alert Chapter 3: The Public Experience with Cardiac Arrest potential bystanders to cardiac arrest and AED locations in actual emergencies (PulsePoint Foundation, 2014)”. p.141 “The immediate, hands-on response of bystanders to cardiac arrest is critical to improve rates of effective resuscitation and, thereby, “PulsePoint mobile apps share information about cardiac arrests increase the likelihood of survival and positive neurologic outcomes for in public locations with nearby bystanders. Occurring in real time, out-of-hospital cardiac arrest (OHCA) across the United States.” p.103 the alert system allows nearby participants to respond to the scene and use CPR and/or an AED for resuscitation. This program also “For example, a definitive body of literature demonstrates statistically uses crowdsourcing to empower bystanders to act quickly and significant improvements to cardiac arrest survival rates when responsibly in emergency situations.” p.142 bystander CPR is performed. By preventing the degradation of ventricular fibrillation (VF)—a shockable cardiac arrest rhythm— to a nonshockable cardiac arrest rhythm, CPR increases the number of patients who can be successfully resuscitated through defibrillation.” p.103

In summary, this body of literature indicates bystander-initiated CPR for out-of-hospital cardiac arrest patients has enormous implications that address the strategy for improving outcomes. Activation of trained bystanders in cardiac arrest situations can be greatly enhanced in communities that invest in a mobile system like PulsePoint. For further information, please contact Physio-Control at 800.442.1142 (U.S.), 800.895.5896 (Canada) or visit our website at www.physio-control.com.

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