Frequently Asked Questions
What the heck is HEARTSafe?
HEARTSafe is a public health initiative intended to help more people survive after sudden out-of-hospital cardiac arrest. When someone’s heart suddenly stops, they will generally not survive unless a number of interventions take place immediately, including CPR and defibrillation. In order to facilitate this process, a strong system must be established to ensure the rapid execution of each step.
The HEARTSafe Community concept works by creating criteria that support this “cardiac chain of survival” and encouraging communities to work toward them. For more information, read the general description here.
HEARTSafe Communities is unrelated to the Heartsafe patient portal or the HeartSafe America, Inc. medical supply company. Although it recognizes similar goals, it is not affiliated with the Heart Safe Community Award offered annually by the International Association of Fire Chiefs (IAFC) and Physio-Control, or the paid Heart Safe Solution service from Physio.
What service, business, or organization runs HEARTSafe?
The HEARTSafe concept was originally developed by David Hiltz and Michael Aries in Massachusetts. It has spread and grown organically, and is now considered open-source “freeware”; it’s available to anyone with no permission needed.
This website is maintained on a volunteer, unaffiliated basis by David Hiltz and Brandon Oto.
Each state or regional program is managed independently, designates its own criteria, and answers to no external arbiter. For assistance and advice, there is a strong community of peer support provided by existing program directors and advocates, but there is no central authority that certifies or coordinates all HEARTSafe communities; in any given area, the certifying authority is merely whichever regional agency that has been chosen to administer the program.
What are common elements of a program?
Depending on scale, various criteria can be used, with the broad goal of supporting the chain of survival. These typically involve bystander recognition, response, CPR and AED use; first responder care; and hospital involvement. In some cases, other public health measures have also been incorporated, such as regional heart attack (STEMI) and stroke systems of care. Most programs designate a community as HEARTSafe for a period of 2-3 years before reapplication is required.
Requirements can be minimum standards (i.e. all first responders must carry AEDs) or population-linked criteria (i.e. one public AED per 1,000 residents), but many programs have used score-based systems, with points (dubbed “Heartbeats”) earned by enacting various measures—for example, each public CPR course or AED installed is worth 10 points—and a certain number of minimum points needed according to community size. Some common goals are:
- General: Is there an organization tasked with pursuing improved cardiac arrest survival? Is a system of data collection, feedback, and quality assurance in place to measure the results?
- Early recognition and activation: Is there a campaign to increase public awareness of sudden cardiac arrest and encourage bystander intervention (e.g. “push hard and fast, call 911”)? Is an E911 system in place? Do dispatchers provide EMD (emergency medical dispatch) with pre-arrival CPR instructions?
- Early CPR: Is a certain portion of the population certified in CPR, or are a certain number of CPR classes being regularly held? Are there requirements that certain persons, such as teachers, sport or fitness instructors, applicants for a driver’s license, etc. must be trained in CPR? Are first responders and EMS trained to perform high-quality resuscitation that emphasizes chest compressions and defibrillation?
- Early defibrillation: Are AEDs available in certain public areas, such as malls, sporting arenas, schools, municipal buildings, and airports? Are all public safety and first responder units—including police, fire, and EMS—equipped with defibrillators, and encouraged to provide early intervention?
- Advanced life support: What is the availability of advanced life support (ALS) in the EMS system? Are they trained and equipped to provide cutting-edge cardiac arrest care? Are they capable of recording 12-lead ECGs, diverting patients to PCI-capable hospitals based on their findings, and activating the cardiac catheterization laboratory?
- Post-arrest care: Do area hospitals have equipment and protocols for post-arrest therapeutic hypothermia? Can they provide emergency percutaneous coronary intervention (PCI), and if so, do they routinely perform it on appropriate candidates after cardiac arrest? Will they consider PCI on intra-arrest patients? If no PCI centers are locally available, is there a system in place for transferring patients to the nearest STEMI center, and/or for administering timely thrombolytic therapy?
- Supportive cardiac preventive care: Will your program involve secondary public health measures supporting cardiovascular wellness, such as education, prevention, and systems of care for stroke or myocardial infarction?
Is the HEARTSafe concept evidence-based?
No studies have specifically attempted to demonstrate improved survival after instituting an explicit HEARTSafe program in a community. However, when considering criteria for a new program, we do recommend that requirements should be based on scientifically-supported measures, such as increased bystander CPR, early access to defibrillators, and post-ROSC hypothermia. In addition, the general model of community-level efforts to strengthen the chain of survival has been successful (e.g. in Arizona and Wake County, NC) and is supported by expert recommendations.
How do I set up a new program in my region?
See Setting up a Program.
How do I make my community HEARTSafe if my region already has a program?
Consult the requirements established by your central office and follow the procedures they lay out to apply for HEARTSafe designation in your community. See here for some ideas on identifying weaknesses and building local support.
How can I find out more?
Who runs this site?
This website is a free, public resource managed by Brandon Oto, an EMT from the New England area, with the help of David Hiltz, who helped create the initial HEARTSafe concept.