Saving Lives in Your Community Association: Defibrillators (AEDs), Bleeding Control Kits (BCKs), and CERTs with Dr. Jason Mansour

Does your community association have an Automated External Defibrillator (AED) or a Bleeding Control Kit (BCK) on hand in the worst-case scenario and do you have trained people on hand to use these devices? Do you have a gym, pickleball/tennis courts, and other recreational amenities where a cardiac event may be more likely? Are you familiar with the responsibilities and value of a volunteer Certified Emergency Response Team (CERT)? Join Donna DiMaggio Berger and guest Dr. Jason Mansour, Chair of Emergency Medicine at Broward Health, as they dive into the details of these vital life-saving tools. Learn about local ordinances that require these devices in multi-story residential buildings, how they operate, and the essential training needed for their use.

In times of emergency, the choice between CPR and AED can be pivotal. Accompany Donna and Dr. Mansour on a journey into the depths of cardiopulmonary resuscitation (CPR). Explore the impact of chest compressions on the heart and brain and the American Heart Association's endorsement of hands-only CPR. Dr. Mansour guides you through the differences between CPR and the use of AEDs, highlighting how a split-second decision can drastically enhance survival rates.

Donna and Dr. Mansour reflect on the importance of being a good neighbor and the role of life-saving equipment in our communities, emphasizing the significance of AEDs, BCKs, and CERTs in multi-family buildings and HOAs particularly those with gyms and recreational amenities where a cardiac event becomes more likely. We guarantee you will leave with a newfound appreciation for these vital resources and their roles in our daily lives.

Conversation highlights include:

•  Necessary training for safe Defibrillator. (AED) usage
• Risks associated with improper AED usage
• Where associations can find AED training for their employees
• The differences between using a defibrillator and performing CPR
• What a Bleeding Control Kit (BCK) is composed of, and how it functions
• Advice for CERT members to triage injuries in mass casualty situations
• Other life-saving devices community association boards should consider for common areas

Transcript

Speaker 1: 0:02

Hi everyone, I'm attorney Donna DiMaggio-Burger and this is Take it to the Board where we speak Kondo and HOA. A few weeks ago, dr Jason Mansour joined us to discuss how to spot heat stroke and heat exhaustion and what to do during extreme heat events. Dr Mansour is the chair of emergency medicine at Broward Health. I've asked him to join us again today to discuss automated external defibrillators, or AEDs, bleeding control kits, or BCKs, and certified emergency response teams, or CERTS, so we're going to be discussing a lot of acronyms today. Broward County, florida, recently adopted new requirements related to life preservation equipment. That ordinance requires multi-story residential buildings with five or more floors to have AEDs and BCKs no later than October 24, 2023. I imagine there are countless ordinances like this around the country, so we wanted to have a medical perspective of how and when to use these devices. So with that, dr Mansour, welcome back to Take it to the Board.

Speaker 2: 1:06

Well, thank you for having me. I'm happy to be back.

Speaker 1: 1:08

Well, thank you so much for agreeing to join us again. Your other episode was extremely popular, and so today we're going to be talking about all the things I mentioned in the introduction. Let's start with the AEDs. What is an AED and how does it work?

Speaker 2: 1:23

So an AED is an automatic external defibrillator. So your heart, in order to squeeze, needs electrical conduction, and sometimes that electrical conduction becomes disorganized. So instead of things, let's just for lack of a better word like instead of things being linear, they kind of get chaotic or a short circuit, and a defibrillator is a jolt of electricity that essentially will act on your heart's conduction system, almost like control-alt-delete works on your computer. It sort of just resets everything and starts things back at point A, and in doing so the goal is to take disorganized electricity in the heart and restore it back to organized activity within the heart and in doing so restore someone's pulse.

Speaker 1: 2:04

Is there a time threshold within which the device must be used, or is it just any time before, obviously, somebody has died? I mean, is there an optimum time period to use this device?

Speaker 2: 2:15

The sooner the better and, just to give you some idea, they've actually studied this and the safest place to have a cardiac arrest in the entire United States believe it or not is in a Las Vegas casino, because there's a camera on you at all times and within one minute you hit the ground there's an AED on you able to shock you and so getting returned to spontaneous circulation. Back in a place like that where they can apply an AED and apply a shock really quickly, the survival rates are tremendously higher than anywhere else in the community, because anywhere else, even if you call 911, getting that AED to the person, there's inevitably some delay. Even if it's under 10 minutes, which is a good time, it's not what you would get when there's the eye in the sky taking a look at you. So obviously the sooner the better. If it's within minutes, the survival rates are very high. When you get out beyond 10, 15 minutes, then the prognosis is pretty poor. So you want to apply a shock as early as humanly possible.

Speaker 1: 3:15

In some of our communities the residents actually resist the cameras being placed in the gyms, the other common areas, out by the pool. But to your point, if somebody does have a cardiac arrest in the gym and there's a camera there and somebody's watching it, you can get to them much more quickly than if they're in there working out alone. As a matter of fact, I think that's what happened to Sheryl Sandberg's husband, who passed away. He had been on vacation. They were on vacation. He was working out in the gym. He had a heart attack and expired.

Speaker 2: 3:46

Yeah, it's all about time to first shock. So in any way, in any system, when patients come to our emergency department, the question is always was this witnessed or unwitnessed? If the person's cardiac arrest was unwitnessed, there's an unknown downtime before that person was even discovered, which potentially means they could have been down for a really long time. Those unwitnessed arrests the prognosis is really poor. If it is witnessed arrest, we're somewhere. I looked over. I saw him collapse. You start the clock at that point. That's the moment that it happened and you have the AED on the way. They do much better. So any method, any technology we can use in order to deliver a shock quicker is better.

Speaker 1: 4:24

What powers the device? Is it battery, electricity, a combination of the two?

Speaker 2: 4:29

Yeah, it has a power source, which is typically a battery that delivers the shock. What kind of training do you need? Surprisingly, very little. Obviously, healthcare providers are well-trained in an advanced way, but even a layman who has no training whatsoever, if you open it up, the manufacturers of these devices design them in such a way to make them overly simplified, because they know that every time this thing is being opened it's a stressful situation and quite often someone who doesn't have medical training.

Speaker 2: 4:59

They'll place this pad here, place this, and it'll be a picture right on there where to put the pads.

Speaker 2: 5:04

They're adhesive and you stick that on your chest and stick that over here in your abdomen and then it'll automatically go into a face called analyzing, where it's going to analyze the heart rhythm. If it's finding that disorganized heart rhythm, like what we're talking about, it usually talks to you and it'll say shock is advised. Then it'll tell you what to do hands off and everyone's hands off, and then it could deliver the shock and say resume CPR. It almost acts like an automated coach that's built into the device, even if you have little to no training, you have no experience with it, you being able to just open it up and just see what's there and try to figure it out with the simple instructions that's giving you Now. Keep in mind always, when you first see a situation like that, you always call for help. Typically, 911 will be on the phone and they'll coach you too. If you have somebody, a 911 dispatcher will coach you if you're having any trouble with it.

Speaker 1: 5:56

That's an important point.

Speaker 2: 5:57

The shock is so critical.

Speaker 1: 5:59

The Broward County Ordinance I mentioned in the introduction does require associations to have employees and perhaps other people trained on this device. Does Broward Health offer in-person training on the use of defibrillators?

Speaker 2: 6:13

I think what you're asking about is BLS, basic life support class. This is a course that lifeguards take and people that are going to be around something like this that aren't necessarily doctors or nurses or people working in a hospital. Bls courses typically are offered by training facilities. They offer BLS, acls, which is advanced cardiac life support, pediatric advanced life support. These are all credentials that you can get. There are many training centers Broward Health we occasionally do offer certain training courses. We don't regularly offer BLS courses here, but if you just go to the American Heart Associations website, it'll give you a list of places where you can get training.

Speaker 1: 6:52

Is there normally a cost associated with training for those centers?

Speaker 2: 6:56

Probably yes. If you go to a commercial center, Keep in mind that fire rescue and EMS units sometimes have outreach programs where they offer training to the general public as just a public outreach. I would just say reach out to your local EMS and see if those are ever available.

Speaker 1: 7:16

This happens frequently. Where the legislature has a good idea In this case it's local government has a good idea on an ordinance, but then it's not really fleshed out. Who gets the training? Where do they go for the training? Does the training cost anything? Those are still some questions that we need to have answered. I did want to ask you is there any way to use the AED improperly? Pull it out? You don't follow any direct. What are the risks associated with doing that?

Speaker 2: 7:43

Yeah, there's not a ton of risk. The risk really is, by using it improperly, you're not delivering what the patient needs. If the pads are not applied appropriately and the shock is not being delivered where it needs to go, then it's not doing anything. The risk to you as the rescuer is very minimal. In fact there are some rescuers that will continue compressions throughout the shock and you feel a little bit, but it's not like something like a lightning bolt that kind of blows your way there. The risk really is to the patient.

Speaker 1: 8:12

I wanted to ask you what's the difference in terms of you've got somebody who's had a cardiac event. They're on the floor, they're unconscious. What's the difference between applying CPR versus using the defibrillator? I know one's providing an electric shock. Is there a difference in terms of outcome?

Speaker 2: 8:30

They're trying to accomplish two different things. If my heart stopped right this moment, my brain would be dead somewhere around a 10-minute mark. With no flow to the brain. I would be, essentially, from that point, a vegetable If I do CPR. So I'm doing chest compressions, I'm trying to substitute for a pump that's not working. By pushing on the chest I'm forcing blood out of the heart up the carotid arteries into the brain, trying to refuse the brain. By coming off of the chest I allow the heart to refill with blood and pushing down again I'm pushing that blood forward. So essentially, I'm trying to do the function of the heart until I have the ability to get the heart to resume pump function.

Speaker 2: 9:11

Now the goal of CPR is to refuse the brain. It is not necessarily to restore the rhythm. That's what the electric shock is doing. I'm just trying to wake the pump up. Once the pump wakes up, I don't need CPR anymore because the pump is working. So CPR is a temporizing and it buys time. It buys time for EMS to arrive, for you to get to a hospital and some other trained medical personnel who have more equipment to try to get your heart going again. So it's just to keep your brain alive longer. Essentially, think of CPR as something you're doing, even though you're doing it on the chest. Really, it's benefiting the brain and the coronary arteries, for that matter.

Speaker 1: 9:46

Can chest compression ever result in the heart starting again, starting to beat on its own again?

Speaker 2: 9:52

Yeah, it could. It could, but that's not the said intention of it. Sometimes just that stimulation that you're doing to the heart I suppose it could restore cardiac function. But ultimately that AED and trying to reverse the underlying process is really the best chance that patient has to get pump function back. So if it's a heart attack, that caused their heart to stop getting them to a hospital that has the ability to open up that clogged artery is really what's going to get them back.

Speaker 2: 10:23

If it's critical hypothermia or critical electrolyte problem that caused their heart to stop us. Reversing that process is really the best thing they have. So the CPR is buying us time to get to that moment.

Speaker 1: 10:35

What about mouth-to-mouth resuscitation and I apologize if my questions as an attorney sound outlandish in terms of medical questions, but if somebody's here working on the defibrillator, should somebody else be providing mouth-to-mouth resuscitation to start giving oxygen?

Speaker 2: 10:51

So there's good studies on this that show that adding mouth to mouth resuscitation to chest compressions adds very little. And what we found when it was being studied was bystanders were reluctant to do any CPR whatsoever because bystanders were reluctant to put their mouth on a stranger. So too many bystanders were keeping their hands in their pocket. So what they found was that there was this kind of a public campaign to push what we call hands-only CPR. Look, just through the chest compressions, we're not adding a ton more value by adding any rescue breaths. That's if EMS is going to arrive in a timely manner. Now, if you're somewhere on a mountain or somewhere where it's going to take a long time for any rescuer to get there, then mouth-to-mouth adds some benefit. But in most places, in most US cities, ems is going to arrive in a timely manner. If you could just get those chest compressions going, hands-only CPR is completely acceptable, in fact encouraged by the American Heart Association.

Speaker 1: 11:48

When you're using an AED, different size pads for a child, a minor with an incident, as opposed to an adult. Dr Mansour.

Speaker 2: 11:56

Yeah, there are pediatric pads. So when you open it up it'll be very clearly labeled, and when they use these versus those. So it should be pretty obvious when you open the NAD.

Speaker 1: 12:08

So let's move to bleeding control kits, because that's one of the things the ordinance requires as well and, like I said in the introduction, I'm sure there's ordinances around the country that are similar in terms of requiring these items in multi-family buildings. So my basic understanding is it contains tourniquets, gloves, scissors, gauze rolls and gauze pads Basically, anything to stop bleeding. Is that it? Is that how it was? Is it that simplistic?

Speaker 2: 12:35

Pretty much. I mean, essentially these bleeding control kits are usually from penetrating trauma and somebody who's hemorrhaging out and we're trying to control the hemorrhage. So gloves are your personal protective equipment, the scissors involved there. Sometimes you need to cut someone's genes to get to the wound so you can address the wound. The gauze is to apply direct pressure and a lot of these kits have these hemostatic gauzes that are embedded with material that helps blood to clot and so by applying pressure with something like that there's kind of two ways that it's going to stop bleeding there. And if you can't control bleeding with direct pressure, that's when tourniquet comes into play, where you're going to try to stop blood flow to that extremity.

Speaker 1: 13:18

You know, this is, I think, to all the movies I've ever watched, where somebody gets shot or gets stabbed and they take out the belt, or somebody rips off their shirt and they tie it up, but you just mentioned that the gauze actually would have. Because I'm wondering what's the difference between this and what we see in movies or on TV, where somebody uses a belt as a tourniquet or uses a shirt If you don't have a commercially available tourniquet, then any of those would be fine.

Speaker 2: 13:48

The commercially available ones kind of works like winding a watch and so you can apply the pressure and release the pressure pretty easily and you don't have to necessarily take away 100% of the compression where you know, with a belt it's a little harder to do that, but if that's what you have, that's fine. Now, most bleeding can be controlled with direct pressure, so nobody should go directly to a tourniquet. So even if you see somebody bleeding pretty briskly from a limb or something like that, if you can put gauze on it and just put a lot of pressure on it, usually you can control it that way. Now if, whatever the penetrating injury is hit an artery, it'll be difficult to control with direct pressure, especially a major artery. So in that case you'll still see quite a bit of bleeding. That's when the turnip comes into play.

Speaker 1: 14:32

I was going to ask you how successful are these bleeding control kits that save lives?

Speaker 2: 14:57

Dr David L.

Speaker 1: 15:12

You mentioned with the AEDs that the kits themselves have instructions. Is it the same with these BCKs, the bleeding control kits? Dr David L.

Speaker 2: 15:21

Yeah, the boxes should have big, bold letters of what they are. The thing is, there's so many different types of manufacturers and there's basic kits and more advanced kits that have more things in them. It's tough for me to answer that with some sort of blanket statement. Of all of them, I've only seen a couple. To be honest, it's not something I routinely open, because we don't really use those in the AED. Those are pre-hospital medical care, essentially, I would imagine, with the caveat that I haven't opened up every manufacturer, but I would imagine that they're pretty self-explanatory, dr David.

Speaker 1: 15:53

L. I would hope there's not a lot of reading, because when you're confronted with somebody bleeding in front of you, hopefully you don't have a large number of instructional pages to go through. Is there any risk, dr, of a blood-borne infection for the person using the BCK, the rescuer? I know there's gloves, but sometimes gloves typically end here. Is there any risk of a blood-borne infection, dr?

Speaker 2: 16:17

David L, your best protection against a blood-borne infection is your body's own skin. Dr David L, using gloves is similar to the PPE that we use in the hospital Of course, somebody's exsanguinating out. We have more than that. Your body's defense really is your skin and the gloves that you're wearing. If you had an open wound and someone else's blood that has a blood-borne pathogen in it was on the open wound, yes, there's a theoretic risk. This has been studied and the risk is extremely low for blood-borne pathogens like HIV. Well, less than 1%, that's. If the patient had that and you had an open wound or a needle stick or something like that, the risk is extremely low, dr L.

Speaker 1: 17:00

Let's turn to our last acronym, the CERT team, the Certified Emergency Response Team. I do have a lot of communities that are looking into this. Some have already set up these volunteers in the community. Others are considering doing it. Normally it's done because when we have a mass casualty or a very large event, like right now we're taping this on August 30th and Idalia has already made landfall and created not a little bit of destruction the volunteers, the first responders, may not be able to get everywhere all at once. You've got these volunteers to perhaps do their part until the first responders can get there. What advice would you have for CERT members in terms of triaging at victims, Dr Okay?

Speaker 2: 17:49

that's a good question. So triage comes into play when the demand exceeds the capability of taking care of them. If you have five CERT providers and 10 victims, then we need a triage. So you're hoping that in these situations it's not a mass casualty type event. But if it is, what we generally recommend is a quick assessment of each victim. We triage them in sort of tiers or we sort of label them. Sometimes we use colors or numbers or what have you? Most commonly ones use our colors. Black is what we call expecting, which the other person is deceased.

Speaker 2: 18:28

Regardless of what you're going to do, you can't really spend resources there because the odds of them coming back are very, very low. There's red, which is these immediate address. They need to immediately be addressed. So those patients are in respiratory distress or in clear danger or some airway issue, or they're choking or something like that. Those are the highest triage level. There's like a yellow, which we call the late, which they have some injuries, but they're able to talk, they're able to wave at you, they're able to follow a command.

Speaker 2: 18:58

Those patients you have a little more time to address. You go to immediate first and you go to yellow. Then there's green, which is minimal. I broke my leg, maybe the bone sticking out of the leg. Well, that's a terrible injury, but that's not necessarily life-threatening. In this type of scenario considered a minimal injury and we have time there. Every patient in a situation like that you'd have to label them one or another. Sometimes people will use something to label them with in order to keep everything organized, because what you don't want is a provider spending an exorbitant amount of time with someone that has a low, a very poor prognosis. If you come upon someone who's collapsed, you're trying to assess whether or not they're responsive, whether they have a pulse and whether they're breathing. If there's someone who's not showing those signs of life and not something immediately reversible like something blocking their airway that you can take out or something like that then that really is a patient you need to move on from and go to the next patient and figure out what category they're in.

Speaker 1: 20:03

Do you know where these CERT teams, where people can find out more information about creating these CERT teams for their community?

Speaker 2: 20:12

Certainly, I think that your local fire department spearheads the CERT teams and they do outreach and training and things like that. I believe on the FEMA website there may be information there. Don't quote me on that, but I think they may have some information there as well.

Speaker 1: 20:31

I just have to ask you what device do you give your interns so you oversee the emergency department? I'm sure the first week for the new interns coming in the emergency department, just tell us what you tell them.

Speaker 2: 20:43

I tell them that the emergency department is like an all you can eat buffet and you want to leave this buffet very well fed. There's so much medicine happening and our department is very busy. We see so many patients and we've been serving this community for decades and decades and we see from the sickest of the sick to the most minor injury and there's learning to be done on every single case and I ask our interns to stay proactive in their learning. So don't allow learning opportunity to walk by you. If you have the opportunity to learn how to do a procedure, learn it. If you have an opportunity to learn something from the most mundane case, take that opportunity. And you want to leave your training in our hospital. Ability to tackle anything, to handle the world.

Speaker 2: 21:30

Not every emergency department is like ours. We're a level one trauma center, we're a cardiac center, we're a stroke center of excellence, so we see everything and we're the receiving facility from not only here in Broward County but the Caribbean, and we get life flight patients from cruise ships and from all over the place. So, being in a receiving facility, we really get to see it all. So you have the opportunity to be able to handle it all, and you may, in the future, be working in a rural place and there is not so much backup and so many specialists all around you and you are gonna have to be able to manage somebody's eye emergency or airway emergency, or maybe you have to manage somebody's orthopedic injury or something that you have the opportunity to learn here and you get to apply in a place like that.

Speaker 1: 22:15

So even the kid who sticks a marble up his nose, you can learn something from that right.

Speaker 2: 22:21

Certainly, there's definitely deans and bones when it comes to almost everything.

Speaker 1: 22:24

So we've talked about AEDs, we've talked about BCKs. Are there other certain life saving devices that our community associations should consider having in their communities in the event of an emergency?

Speaker 2: 22:39

Yeah, I mean the things that you probably already have the fire extinguishers and flotation devices close to the pool. One thing that I think is a good idea to have available is something to check someone's sugar. Sometimes it's something very simple like a glass of orange juice can fix somebody, but you don't necessarily know unless you know that their sugar is low. So those are just simple things that can really save lives, and most of the people that are probably listening to this are in a city or somewhere where EMS is close by and they're always very helpful and they can quickly come to you and be available to you. So they're always there if you need them.

Speaker 1: 23:21

And for our listeners. As the attorney on the episode, I would say reach out to council. There are good Samaritan laws, but you're certainly going to want to know what the legal parameters are when you're trying to assist somebody in the midst of a medical emergency. You've been great with your time once again. I want to ask one final question. We've talked before you, so you do attend medical conferences. Is there any new technology on the horizon for any of these life-saving devices?

Speaker 2: 23:49

There is always innovation in medicine and new medical devices, whether it be devices to achieve better airway visualization of the airway. We now rely on more automation with CPR. So we have a device called a Lucas device which acts like a wrap around the chest and attaches to the backboard. It actually does the chest compressions for you and because it's automated, you don't have to rely on human error and human fatigue or have those as pitfalls. So the machine will just keep the chest compressions at the exact depth and the exact rate that it's supposed to and never tire. So it just keeps going until that battery dies. So a device like that was really a game changer when it came to resuscitation and CPR, and new devices like that are coming out all the time.

Speaker 1: 24:37

Well, september 28th is National Good Neighbor Day. This episode is going to come out after that, but there's no better demonstration of being a good neighbor than helping save your neighbor's life. So with that, I want to thank you for coming on again and all good things, and thank you for doing what you do in the community.

Speaker 2: 24:55

Thank you so much. I appreciate it and thank you for having me on.

Speaker 1: 24:59

Thank you for joining us today. Don't forget to follow and rate us on your favorite podcast platform, or visit TicketToTheBoardcom for more ways to connect.