December 9, 1998
From:Commissioner, Works and Emergency Services
Purpose:
Funding Sources, Financial Implications and Impact Statement:
There are no financial implications associated with this report.
Recommendations:
"It is recommended that:
the report be received for information of members of Council." Council
Reference/Background/History:
Survival from out-of-hospital cardiac arrest has been shown to be dependent on rapid access
to cardiac defibrillation, followed by advanced life support ambulance care. The introduction
of simple, safe, computer-controlled technology has made defibrillation a skill which can be
performed by non-medical staff such as security personnel, lifeguards, and fire fighters.
Immediate intervention is therefore possible in high risk locations such as the city's
workplaces, recreation facilities and other public buildings. At its meeting of October 2, 1998,
Council endorsed the principal of public access cardiac defibrillation and approved a pilot
installation of such a program as part of the renovations to Toronto City Hall.
Toronto Ambulance will be responsible for effectively integrating lay defibrillation into the
system of emergency cardiac care available in Toronto.
Comments and/or Discussion and/or Justification:
The introduction of public access defibrillation can provide the final link in the chain of
survival for people who suffer a cardiac arrest in a public facility in Toronto. It is now
increasingly clear that any organization which trains its employees in cardio-pulmonary
resuscitation (CPR) needs to consider providing automated external defibrillators (AEDs) if
more victims are to survive. Today, even some airlines provide on-board AEDs for the use of
flight attendants.
First responder defibrillation is, in fact, only one piece of a total emergency medical system.
In fact, this system, such as the EMS system operated for the city by Toronto Ambulance,
provides intervention to a very wide range of other medical conditions other than cardiac
arrest. In this system, a patient may be treated in succession by several levels of providers
before arriving at hospital. In an optimal system, these include:
Citizen Intervention:
First Responders:
Ambulance Paramedics:
Co-workers, family members, passer-by
Security staff, on-site response teams, fire fighters
Any or all of Level 1, 2 or 3, or Critical Care Providers
| Level 3 Ambulance |
Level 2+ Level 3
Paramedic Team |
All of the above skills PLUS:
Provincially certified ALS paramedic
Intravenous therapy
Manual defibrillation
Synchronised Cardioversion
Forceps to remove airway obstructions
Transtracheal jet ventilation
Intermittent oxygen-powered ventilator
Needle cricothyrotomy
Needle thoracostomy
Medical Anti~Shock Trousers (MAST)
Intra~osseous W therapy
(infants/children)
External cardiac pacing
Vaso-vagal manoeuvres
Additional drug administration:
Adenosine
Amiodarone
Atropine
Diazapam
Dopamine
Lidocaine
Morphine sulphate
Naloxone
Sodium Bicarbonate
|
Ambulance paramedics work under the medical licence of the Medical Director of the
Sunnybrook Hospital Base Hospital Program, and have 24-hour-a-day access to medical
advice and instruction from Sunnybrook physicians by radio and cellular telephone. During
the first nine months of 1998, our paramedics initiated 94,325 advanced care procedures for
patients under their care, mostly for cardiac and respiratory illnesses.
Conclusions:
The addition of public access defibrillation in City Hall will act as a demonstration project to
show how workplaces across the city can increase the level of life safety present in their
buildings. Automated defibrillation is the final link in the "Cardiac-Safe City" concept which
require rapid intervention and relies on the skills of various levels of providers in an organized
system co-ordinated by Toronto Ambulance.
Contact Name:Ron Kelusky, General Manager,
Toronto Ambulance
Phone: 392-2200
Fax: 392-2115
Ron Kelusky,Barry Gutteridge
General Manager,Commissioner,
Toronto AmbulanceWorks & Emergency Services
