Setting Up a HEARTSafe Program
If you’re in a region that already has a HEARTSafe program in place (for example, at your statewide or county level), then turning your community into a HEARTSafe community is simple: review your local criteria, determine what needs to be done in order to meet requirements, collect documentation demonstrating you’ve done so, and follow the process for submitting your request and receiving designation. Some ideas for mustering the needed requirements are below.
If you live in a region that hasn’t established a HEARTSafe program, then start one! Although every situation is different, here are some general tips for navigating the process.
The Resuscitation Academy and Dr. Mickey Eisenberg have also released a wonderful booklet based on their experiences in Seattle/King County, which gives clear, proven, step-by-step recommendations for working toward the incredible survival rates they’ve earned in their community. It can be downloaded from their website.
Decide where to aim
Under whose auspices will your new HEARTSafe program be administered? Most commonly in the US, this is organized at the state level (through the Department of Public Health or similar bureau with the appropriate authority). County-based programs also exist, and a few national programs have been instituted in Ireland, New Zealand, and Taiwan.
In general, it’s wise to aim as large as you think you can succeed with. If a county program is the best that seems feasible, then create a county program, but if you can found a new statewide program, go big! It’ll mean the system is available to more people in more areas.
Most regional governments have the stated goal of improving public health among their constituents, and have an infrastructure in place for facilitating this. Programs like HEARTSafe probably already exist—just not for sudden cardiac arrest. You merely need to convince the powers-that-be that SCA is a real concern (statistics can support you here) which is worth their time and money to address. Fortunately, establishing a HEARTSafe template and accreditation system typically requires almost no money spent by the central office, just a bit of time to write down the rules and determine which existing staff will manage the process. Any financial outlay generally comes from the community itself, such as the businesses who need to purchase AEDs or host CPR classes.
Analyze your situation
Every community is different, and the obstacles to a strong chain of survival are unique everywhere. Consider the common elements of a program, then look at your existing community. What are you currently working with, and what needs to be changed or added to strengthen your system?
Consider factors like:
- What are your major public gathering places, such as malls, schools, municipal buildings, sport or recreation centers, or transit hubs? What about areas with large populations of the elderly or sick? Do they have staff trained in CPR and available AEDs?
- What is the availability of EMS around your community? Are there areas in which response times are frequently prolonged?
- How many hospitals do you have available to you, and how distant are they? Can they provide therapeutic hypothermia and emergency PCI?
- Do you want your program to include support for supplemental stand-alone public health measures such as stroke and STEMI care, or to exclusively focus on cardiac arrest?
If your community collects statistics on sudden cardiac arrest, perusing them can help you to understand where you’re coming from. Is your survival rate already fairly good, and you’re simply trying to polish it a bit and fill a few gaps? Is it quite poor, in which case many elements of your chain of survival may need substantial overhaul? Can you pin down specific neighborhoods or areas that experience unusually high numbers of arrests, or whose proportional survival from arrest is particularly poor? How often is bystander CPR or defibrillation performed? What are typical response times for EMS? (Depending on the quality of your statistics, you may be able to answer all or none of these questions, and that will reinforce the importance of gathering this type of data in the future!)
Improving systems for cardiac arrest care requires widespread change, and this isn’t possible without many parties committing to the cause.
Two overlapping groups will need to be courted: individuals in positions of power, and the general public. Although it may be possible to make progress with buy-in from only one of these parties, movers and shakers are more likely to listen when there’s a groundswell of support behind you, and likewise the public can only accomplish so much without the implementation of top-down initiatives. In some cases, it may be effective to approach the decision-makers early, establish the HEARTSafe criteria and accreditation process, and then seek out local support once you can point to a concrete incentive. But more often, SCA system improvement begins at the grass-roots level, with at least partial community buy-in—when one community or a portion of a community has made good progress, and local champions want to expand this progress across the map.
Public support can be effected through media campaigns, and many areas have had success using low-budget guerilla methods, such as social media (Facebook groups, Twitter accounts, and so forth). Local newspapers and television stations are often interested in reporting on large-scale CPR classes (for instance, 20-minute CPR Anytime courses for entire gymnasiums or stadiums full of people at a time), or human interest stories about recent cardiac arrest “saves”; this type of coverage can serve as free publicity and help spread your message. As budget allows, paid public service announcements can also be run in local TV, newspapers, billboards, or other venues.
Buy-in from the decision-makers is more complex. In the end, the decision to create a HEARTSafe program typically lies with the Department of Public Health (or similar agency), and at some point they’ll need to become involved. No matter where you begin, however, the process won’t find legs unless you can get buy-in from numerous groups at all levels. If you can approach the decision-makers saying, “Everybody wants this,” you’re much more likely to get a positive response—and many of these voices are the same troops who will be running classes, instituting agency protocols, and installing AEDs anyway, so you’ll need them on board at some point.
Valuable partners include:
- EMS, fire, and police: Department chiefs or operations directors from local first responder agencies should be recruited. Not only are they perceived as an authority on matters of public safety, their cooperation will be essential to actually implement any HEARTSafe scheme.
- Hospitals: Representatives from your area’s medical professionals should be at the table, including emergency physicians, cardiologists, and other hospital staff. They’ll lend authority and professional legitimacy to the problem and provide an essential link in the chain.
- Community leaders: Leaders from your towns and cities will serve as representatives of the public interest. Community groups like the Rotary or Lions Club, neighborhood coalitions, and any other prominent voices should be recruited, particularly municipal government (e.g. city council members or other politicians and administrators) if they’re supportive. After all, it’s the public that will benefit from these efforts, and their position should be heard. In particular, once a few communities in your area have become HEARTSafe, there’s an increasing incentive for others to follow suit, since nobody wants to be perceived as less safe than their neighbors.
- Local businesses: Representatives from business groups, malls or complexes, and individual businesses are valuable partners. Ensuring the safety of their patrons is good for business. Real estate agents in particular often appreciate the ability to reassure potential home buyers that they’ll be living in the safest possible neighborhood.
- Survivors: There is no better way to illustrate the problem of sudden cardiac arrest and “bring to life” its importance than by telling real stories. Seek out people in your area who suffered SCA and were successfully revived. Many of them are passionate about the systems that saved their life, and will jump at the chance to go before decision-makers or the public and tell their tale. If survival rates are very low in your area, it may be tough to find these people, but there are often a few and you may be able to borrow examples from other regions (using well-reported stories in the media, for instance).
Implement and track changes
Once there’s a system in place, and you understand the criteria you’ll need to fulfill, just do it! If you’ve already sought out the support of the relevant parties, such as public safety agencies and community leaders, then there’s little to do except get your designation.
One of the key pieces of any HEARTSafe program is to collect data and track progress. This is typically done with cooperation from the local EMS agency and their destination hospitals. When an effective system for gathering statistics is in place, it allows you to track the results of your changes. You can determine what’s working, what isn’t, where you need to focus further efforts—and when it all goes well, it provides motivation by revealing the improving numbers resulting from your hard work. Nearly every existing HEARTSafe system includes a requirement that communities establish a system of data-collection, feedback, and mechanisms for ongoing change.
Promote and support the cause
The first thought after achieving HEARTSafe status for your community is usually elation that you’ve guaranteed yourself and your loved ones the best chance of surviving SCA. But the second thought is often the realization that, if you drive into the next town over, you may lose that safety net completely. The answer? Push for HEARTSafe Communities everywhere!
Remember, this concept spreads by word-of-mouth and grass-roots promotion. There’s no big corporation advertising it, there’s no money to be made, and no bigwig is going to force anyone to pursue it. You probably heard about it because somebody told you, or perhaps you saw a sign. Now it’s your responsibility to keep spreading the word so that eventually, it won’t matter where you are when you collapse.
Your experience with establishing a HEARTSafe community is also a valuable resources for others. The obstacles or challenges you addressed won’t be unique, and the support and guidance you provide can make the difference for other burgeoning systems. HEARTSafe champions everywhere have formed into a loose peer “help desk” which provides mutual assistance, shares ideas, and promotes the cause. Try creating a Facebook page for your program and linking up with the countless others out there via our hub.