VPSI: Stroke, and Heart Attack Prevention Workshop Curriculum

Allison Binkley, Wilson Ta, Kylee-Ann Tawara & Lauren Witty

Time Topic Presenters

5 minutes Introductions: Lauren

- Name, pronouns Allison
Have one person say we are all students at the School of Public Wilson
Health at the University of Washington working with VPSI Kylee
VPSI- what the acronym stands for and the work they’re doing

5 minutes Intro of the problem Lauren

- Ask if they know anyone who’s had a stroke or heart attack Allison
(Raise hands) Wilson
- Heart attack/ stroke prevalence, specifically within KC Kylee
- Disparities within KC
- Because this prevalence and burden is so high, we wanted to
discuss how to lower it/what to do in these emergency
situations

8 minutes EMS Services Allison

- What happens when you call
- What your emergency is
- Are they conscious?
- Address, approx. location, landmarks
- Name
- Age
- Stay on the line, do what the operator tells you to
- Interpretation services are available
- All you have to do is say “This is an emergency
(fire/medical) and I speak [language]” in English and
they will connect you with someone as fast as they can
- It usually takes about 8 minutes for responders to show up
- Payment
- Free to call
- Free for EMS services to show up
- If you need to be transported to the hospital,
transportation is free in KC thanks to an EMS levy
that was passed
- Fire dept. Will take you if you have a stroke
- Private ambulances may cost you
- Actual treatment cost will depend on your medical
insurance
- If you’re not 100% sure if you should call, it’s better to
call and be safe than to wait and have symptoms get
worse to ensure the best outcomes
 - What to do if you accidentally call
- Stay on the line, tell them it was an accident
- Otherwise they will call you back
- File of life
- Collection of important info including your name,
DOB, emergency contacts, medical conditions and any
medication you are taking, allergies
- Keep it accessible in case of emergency
- Handing out at the end
- COVID- you should still call
- More important to get someone potentially life-saving
help than to worry about the virus at that moment
- Most healthcare workers are vaccinated and
wearing PPE
https://kingcounty.gov/depts/it/e-911-program/911-basics.aspx

2 minutes Question break

8 minutes Stroke Lauren

- Brief, what is a stroke?
- When part of the brain does not get the necessary
blood/oxygen that it needs to function
- Two types:
- Ischemic Stroke, most common (80% of cases),
happens when artery is blocked by a blood clot,
prevents blood flow to brain
- Hemorrhagic Stroke, happens when an artery
ruptures and there is bleeding in the brain
- Info to know for questions (not necessarily
say): same symptoms between the two,
however hemorrhagic stroke sometimes has a
more severe headache as a symptom
- TIAs (transient ischemic attacks), “mini-stroke”
- Temporary blockage of artery -> results in
some experienced stroke symptoms, but only
for a short amount of time
- Does not cause permanent damage
- Clarify that TIAs are not full strokes, but are
still dangerous as they are risk factors for
future strokes and a full stroke is likely to come
soon
- Reaffirm that you should call 911 for these
events as well
- You do not know if you will have a
stroke following a TIA, so it is best to
seek medical attention before anything
 happens
- Who Can Have a Stroke/Risk Factors for Stroke
- Mention a few that are relevant to the population we
are working with:
- High BP, high cholesterol, diabetes, heart
disease, physical inactivity, unhealthy diet,
obesity, smoking, etc…
- Timing! Talk about how it is important to act as fast as
possible to save brain cells from dying
- Stroke is treatable, and the faster the patient’s access to
treatment, the better the chances of a full recovery
- Goal: less than 120 minutes between stroke symptoms
onset and treatment (best chance at full recovery)
- Therefore, you need to call 911 as soon as
possible!
- When to call 911
- Signs, symptoms
- List a few: focus on the ones that will be
addressed in the FAST exam (repeating will
reaffirm what to look for)
- Sudden severe headache with no known cause
- Loss of balance/coordination
- Sudden confusion, inability to speak
- Introduce FAST exam
- F-face drooping
- Action Item: Ask patient to smile
- What to look for: paralysis on one side
of their face
- A - arm weakness
- Action Item: Ask patient to lift their
arms above their head
- What to look for: Does one arm drift
downward?
- S - speech difficulty
- Action Item: Ask the patient to repeat a
simple sentence. For example, “the sky
is blue.”
- What to look for: if the sentence was
repeated correctly/clearly
- T - time to call 911
- When in doubt, call 911

5 minutes Interactive FAST Exam Lauren

- Find a partner, have 1 person pretend to be the stroke victim,
and the other pretend to be a bystander.
 - The bystander will be tasked with asking the stroke victim
questions/conducting the FAST exam.
- Have partners switch roles, allowing both to be the
bystander/ask questions

2 minutes Question Break Lauren

5 minutes Cardiac Arrest Kylee and

- When to call 911 Wilson
- Importance of bystander intervention (segue into CPR)
- Cardiac arrest vs. heart attack
- Symptoms of cardiac arrest
- Sudden collapse
- Abnormal or no breathing
- Loss of responsiveness

15 CPR/AED: Virtual presentation (with video Kylee and

minutes https://www.youtube.com/watch?v=M4ACYp75mjU) Wilson
- Why know CPR?
- Disclaimer
- Chain of survival: Early CPR → Early defibrillation
→ Early post-resuscitation care → increased survival
- Four out of five cardiac arrests happen at home
- Without CPR a person will not live. You cannot make
it worse.
- Cardiac arrest survival in Washington state one
of the best in the country because of bystander
intervention
- Good Samaritan law
- You will not be punished/sued for performing CPR;
protected by the Good Samaritan law
- Cardiac arrest situation response steps: 2 steps to save a life
(call 911 and hands only CPR)
- Make sure scene is safe
- Shake & shout
- Check if person is not responsive, abnormal breathing
(look at stomach and chest area, listen for any gasping,
snorting or snoring sounds that are not normal)
- If yes to either, call 911 then begin hands only CPR.
- Perform CPR
- Ensure the patient is on a flat surface. If the
person is on a bed or sofa, roll them to the floor
or pull the sheet off the bed until they are on
the ground
- High quality compressions
- Place hands in the center of the chest,
 between the nipples. Position yourself
directly over the person's chest, lock
your arms straight and shoulders
aligned over the chest. Lace fingers
together & use only the heel of your
hand to push. Lock elbow. Use entire
body not just hands
- Push DOWN hard into the center of
the chest 2 inches deep (the height of
the driver's license or width of soda
can). Then let all your weight off the
chest allowing the chest to rise back up
to its neutral position
- Between the nipple line; in the
past people may have been
taught below the ribcage
- Push FAST: push 100-120
compressions per minute. It is helpful
to think of the rhythm of a song to help
pace your compressions (ex: Staying
Alive, Baby Shark)
- Songs to perform CPR:
https://open.spotify.com/playlist
/7oJx24EcRU7fIVoTdqKscK
- Repeat nonstop until EMS/help arrives
or the person wakes up
- Don’t stop compressions, if you get tired, take
turns with someone else. Doing compressions
keeps the blood pressure up and delivers blood
to the brain. If you stop, blood pressure will
drop. Don’t stop compressions for more than
10 seconds
- CPR is going to be very intensive. It is
normal to get tired.
- Notes: While performing CPR, you may hear
or feel changes in chest walls (cracking), which
is normal and means that you are pushing hard
enough. You are NOT hurting the person.
- Breaths are NOT NECESSARY. Survival rates are
better if you stick to hands only CPR. 1 victim not 2
(only perform breaths if you are comfortable). Don’t
attempt unless you practice. Breaths can be a
distraction. Main priority is the compressions.
- AED (automated external defibrillator)
- AED analyzes the heart’s rhythm of a cardiac arrest
patient. It detects abnormal heart rhythm and responds.
 It will only give a shock if the person’s heart has a
specific type of abnormal rhythm that can only be
helped with a shock. Otherwise it will not shock.
(safety-proof)
- You can ask if there is an AED in the area. While
people look for an AED, still continue CPR.
- If AED is available, use it. If no AED nearby, just
continue compressions. Compressions are
IMPORTANT to do, don’t worry if you don’t have an
AED.
- Turn on the AED, expose the patient's bare chest, and
apply pads according to the pictures on the pads
(below right collar bone and left rib). Follow the
AED’s instructions. It will alert you when it will
administer the shock (make sure the patient is clear
and stop compressions) and when to resume
compressions.
- Be careful to not be touching the patient when
the AED is administering the shock
- Note: AED will tell you to check the pads if they are
not sticking to the bare chest of the patient. If the
patient has a hairy chest and the pads won’t stick,
check if the AED comes with a razor and quickly
shave an area for the pads to stick.
- https://kingcounty.gov/depts/health/emergency-medica
l-services/vulnerable-populations/resources/~/media/d
epts/health/emergency-medical-services/documents/vu
lnerable-populations/AED.ashx
- Note: Public AEDs are register with King County. The
911 dispatcher will provide the nearest location of the
AED if it is available.
- (mention locations at specific site, who to ask)
- Pulse Point app
- Alerts nearby vicinity for bystanders who know CPR
and locates nearby AEDs
- No need for extensive CPR or AED certification
- Demonstration on manikins
- Manikins will display green light if compressions are
deep enough and fast enough and red light if these are
not properly followed
- Give handout after:
https://kingcounty.gov/depts/health/emergency-medica
l-services/vulnerable-populations/resources/~/media/d
epts/health/emergency-medical-services/documents/vu
lnerable-populations/hands-only-CPR-handout.ashx
- Observe participants on CPR Skills on manikins and provide
 feedback
https://kingcounty.gov/depts/health/emergency-medical-services/vuln
erable-populations/resources/~/media/depts/health/emergency-medica
l-services/documents/vulnerable-populations/adult-hands-only-cpr.as
hx

5 minutes Closing and Final Questions, hand out file of life, hand out other
resources

*Will modify some of the information/presentation depending on the population we are working
with (i.e. senior adults vs. college students at the UW)...

After Workshop Handout Information

1. File of Life - they can fill it out on their own time
2. Handout Summarizing Important Info
a. Brief summary of topics
i. Stroke
ii. Cardiac Arrest -> CPR
b. Flowchart of what happens when you call 911
i. Includes info about how to ask for translation services during a call
c. FAST Exam Review
i. F-face drooping
1. Action Item: Ask patient to smile
2. What to look for: paralysis on one side of their face
ii. A - arm weakness
1. Action Item: Ask patient to lift their arms above their head
2. What to look for: Does one arm drift downward?
iii. S - speech difficulty
1. Action Item: Ask patient to repeat a simple sentence, for example,
“the sky is blue.”
2. What to look for: if the sentence was repeated correctly/clearly
iv. T - time to call 911
d. Important Resources:
i. PulsePoint App
ii. Put links to future CPR certification workshops within KC/close time
range
iii. Short guide on CPR:
https://kingcounty.gov/depts/health/emergency-medical-services/vulnerabl
e-populations/resources/~/media/depts/health/emergency-medical-services
/documents/vulnerable-populations/hands-only-CPR-handout.ashx
 iv. International songs in 100 bpm:
https://www.youtube.com/playlist?list=PL7FxfhVvQtdjzYTVj9ozyNPPpq
yjN08Bm
e. QR code for translated materials
i. Link:
https://kingcounty.gov/depts/health/emergency-medical-services/vulnerabl
e-populations/resources.aspx

Questions about the Workshop:

- Will we also be able to share a follow up email with the community we are working with
if we want to share links to resources? Or should we just stick with the handout
- Should we make a disclaimer that we are just sharing information about CPR, you will
not actually be certified after this workshop?
- For the Good Samaritan law, do you ask consent to do CPR if the patient is conscious but
having trouble breathing?

Resources for Us
- FAQs for facilitators to review:
https://kingcounty.gov/depts/health/emergency-medical-services/vulnerable-populations/r
esources/~/media/depts/health/emergency-medical-services/documents/vulnerable-popula
tions/lesson-plan-FAQ.ashx
- Stroke Resources:
- https://kingcounty.gov/depts/health/emergency-medical-services/vulnerable-popul
ations/resources/~/media/depts/health/emergency-medical-services/documents/vul
nerable-populations/stroke.ashx
- https://www.heart.org/idc/groups/heart-public/@wcm/@fdr/documents/download
able/ucm_467905.pdf

Abdominal Thrust when someone is choking

Why not just drive myself to the hospital?
6 certified stroke centers but just go to the nearest one
3-4 EMT, 7-9 Medics
Tailor language for population
- Older population: talk loud and slowly, repeat questions
- Self fast exam if live alone. Look in the mirror
If someone has a pacemaker, you can still put on AED? Follow the picture
HRC 434 (http://depts.washington.edu/hserv/faculty/Meischke_Hendrika): Black vest, manikin?
Kids: 1 hand, Infants: 2 fingers

Last year’s video:

https://drive.google.com/drive/u/0/folders/1gC224YpnQKpkrMjC9LFP_GZQTCGd6DVS

Practice Presentation Audiences:

Tour guides
Jumpstart