Aurora Health Care Foundation
Aurora Medical Center in Grafton
Optimizing the Chain of Survival
Executive Summary
Traditionally, an emergency patient’s medical team would consist of pre-hospital support (basic
or advanced), emergency department personnel and in-hospital personnel. This only allows the
patient access to care beginning with the first responder. With average response times in
Ozaukee County at eight to ten minutes, this could mean the difference between life and death
for some.
The pre-hospital medical staff of Aurora Medical Center in Grafton (AMCG) proposes to
optimize the chain of survival so that an emergency patient can receive earlier access to care,
prior to professional medical help arriving through emergency medical dispatch (EMD). We will
also strengthen the chain of survival by providing Ozaukee County emergency medical system
(EMS) responders with additional training and support, specialized advanced care, and quality
assurance through an EMS support vehicle and simulation. Finally, it is our goal to empower
community members to activate the chain by calling 911 and providing zero-minute response
care.
Background
The “Chain of Survival” is a metaphor that was first used in 1988 in reference to by-stander
cardiopulmonary resuscitation (CPR). The concept was later adopted by the American Heart
Association in the early 1990s, as the Association developed their guidelines for sudden cardiac
arrest. They have recently updated their guidelines to include five core links: immediate
recognition and activation of the emergency response system, early CPR, rapid defibrillation,
effective advanced life support, and integrated post-cardiac arrest care. Although some links are
very specific to cardiac arrest, the metaphor could hold true for any medical emergency: heart
attack, stroke, trauma, and the like. (Chain of Survival, American Heart Association)
During this campaign, we will reference the chain of survival and how it relates to all medical
emergencies. We will address activation and early access through EMD; early CPR and rapid
defibrillation through community CPR training and automated external defibrillator (AED)
placement; and effective advance life support through an EMS support vehicle and simulation
training.
Although integrated post-emergency care is important and serves as the fifth link in the chain of
survival, we will only be address the pre-hospital links in our proposal.
Activation and Early Access: Emergency Medical Dispatch
Nearly 100% of Ozaukee County’s EMS responders are volunteers or paid-on-call, and a vast
majority of the county is rural. Because of these two reasons, the average response time is eight
to ten minutes, double the national average. EMD will be able to provide the zero-minute
response that emergency patients need.
EMD is a systematic approach for an emergency dispatcher to narrow in on a 911 caller’s
emergency, dispatch appropriate resources and provide quality instructions until medical help
arrives. It is based on question and answer logic trees, guided by computer software, as well as a
manual system likened to recipe or flash cards.
Early CPR and Rapid Defibrillation: Community CPR and AED placement
According to the American Heart Association, effective bystander CPR provided immediately
after sudden cardiac arrest can double or triple an out-of-hospital victim’s chance of
survival. (CPR Statistics. American Heart Association) It has proven to be the best treatment
until a defibrillator arrives. In addition, those that are trained in CPR are also trained to
recognize the gravity of the situation, and are able to activate the chain of survival by calling 911
or instructing someone else to do so.
AMCG currently trains freshmen and junior high school students in CPR. In addition, we will
strive to offer a free community-wide CPR training, open to the public. The course will not
certify individuals however it will provide the hands-on instruction and take-home materials
which will ensure they have the ability to provide CPR if needed, as well as the knowledge of
how to use an automated external defibrillator, if available.
The American Heart Association also recommends that AEDs be placed in public places where
large numbers of people gather or where people at high risk for heart attacks live. AMCG plans
to place a minimum of five AEDS in Ozaukee County over the next 3 years that fit these
parameters. (CPR Statistics. American Heart Association)
Effective Advanced Life Support: Simulation
The use of high-fidelity simulation training is becoming more and more prevalent in the field of
medicine. Simulation increases safety, decreases errors, allows deliberate practice, and has
proven to build competence and confidence, which ultimately leads to better pre-hospital care for
the patient.
Given the volunteer nature of EMS responders in Ozaukee County, there is a need to maintain
their skill set and competency level. Ozaukee County EMS responders need training that consists
of both quality and quantity of cases in an estimated shorter time period. AMCG already
provides high-fidelity simulation trainings to EMS agencies related to adult patients. We would
like to expand those trainings to include a baby simulator that would meet those needs, too.
Effective Advanced Life Support: EMS Support Vehicle
Although EMS responders provide direct patient care on-scene, it is the medical director that
approves their medical actions and provides medical oversight, and assistance if needed. (Cone
et al. 2009) An EMS support vehicle would give that medical director the ability to do so onscene.
With an EMS support vehicle, AMCG’s out-of-hospital medical team would be able to: provide
immediate physician-led, on-scene responses to high-acuity/specialized advanced care for the
most severely injured/ill cases; allow for real-time education; and provide quality assurance.
Aurora Medical Center in Grafton: Uniquely qualified to lead
Dr. Steven Zils, Out of Hospital Medical Director, and Rick Boeshaar, EMS Coordinator, will
manage the implementation of EMD, the EMS support vehicle, simulation, community CPR, and
community AED placement.
Dr. Zils has unique specialty training in Emergency Medicine coupled with a fellowship in
Emergency Medical Services; there are less than ten physicians in the state of Wisconsin with
this elite background. In addition, as the Out of Hospital Medical Director, fifty percent of Dr.
Zils’ time is spent in the community with EMS agencies and peers to enhance and improve
Ozaukee County’s EMS system overall.
Mr. Boeshaar is a Registered Nurse and Certified Critical Care Paramedic with extensive
experience in Emergency Medicine and Critical Care. As the EMS Coordinator for AMCG, he is
dedicated full-time to the enhancement and training of EMS, Fire, and Law Enforcement
providers in Ozaukee, Sheboygan, Washington, and northern Milwaukee Counties. In addition,
Mr. Boeshaar has significant experience in the use of high fidelity simulation and training aids.
Fundraising Effort
The total cost of this three-year campaign is $464,500 as outlined below:
EMD (4 PSAPs)
EMS Support Vehicle
Community CPR (per 100 ppl)
Community AED Placement (5)
SimBaby
Physician and Caregiver Training
Campaign Total
$205,000
$175,000
$ 5,000
$ 25,000
$ 40,000
$ 27,500
$464,500
After the initial capital purchases are made, maintenance for each piece is minimal and will be
absorbed into appropriate operating budgets, with the exception of training. This is not
operationalized; however, the donors will still have the option to give in this area of need.
Demonstrating success during the project may allow us an opportunity to expand our
geographical reach to surrounding counties. An assessment to expand will be made on an annual
basis during the campaign.
A Commitment to Community
At Aurora Health Care, we are committed to progress, to creating better care models, and
bringing them to the forefront of our practices. We want to empower our patients, our
communities, to live full lives. We want to address gaps in healthcare in our communities, and
we want to ensure that everyone has access to the best care possible.
This includes our work in pre-hospital care. By implementing EMD, by providing support to
EMS on-scene, by training EMS through simulation, by training the community in CPR, and by
strategically placing AEDs in the community – we will be optimizing the chain of survival.
AMCG is committed to working in our community and with our community to help change lives
and save lives.
References
“Chain of Survival.” American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231,
[Sept 3, 2014]. Viewed Sept. 21, 2014.
http://www.heart.org/HEARTORG/CPRAndECC/WhatisCPR/AboutEmergencyCardiova
scularCareECC/Chain-of-Survival_UCM_307516_Article.jsp
Cone, David C., O’Connor, Robert E., Fowler, Raymond L. Medical Oversight of EMS.
Emergency Medical Services: Clinical Practice and Systems Oversight, 37-44.
Dubuque, Iowa: Kendall/Hunt Publishing Company, 2009.
“CPR Statistics”. American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231,
[Sept. 3, 2014]. Viewed Sept. 21, 2014.
http://www.heart.org/HEARTORG/CPRAndECC/WhatisCPR/CPRFactsandStats/CPRStatistics_UCM_307542_Article.jsp
“What is an Automated External Defibrillator?” American Heart Association, 7272 Greenville
Avenue, Dallas, TX 75231, [2012]. Viewed Sept. 30, 2014,
http://www.heart.org/idc/groups/heartpublic/@wcm/@hcm/documents/downloadable/ucm_300340.pdf