Melissa Olen MSN, FPN-C, CCRN: Sudden Cardiac Arrest Training in Schools (Project ADAM) 4/25/25

So, good morning, everyone. Welcome to the Florida NAMSP webinar. Today we're going to be talking about shoring up the chain of survival for pediatric cardiac arrest patients by both placing AEDs in schools and also creating emergency response plans to facilitate utilization of that resource. Our guest of honor today is Melissa Olin with Project adam, who will be discussing her important work with this initiative in South Florida and elsewhere. So, Melissa, floor is yours.

All right, well, thank you all for logging in today. And thank you to Dr. Antevi for the great honor to be among this captive audience. It really is exciting. I have spent over 20 years taking care of kids with heart disease, primarily the subspecialty of kids with heart rhythm disorders. And so that is really what has driven this mission and this program that is so near and dear to my heart. South Florida Project Adam. And so over the next 15 minutes, we will be talking about sudden cardiac arrest in the young, a community approach. The objectives for today is we're going to discuss the incidence of sudden cardiac arrest in the young and why conditions can go undetected. How can cardiac emergency response training prevent sudden cardiac death? What implementing cardiac emergency response drills are like the recognition, communication and team response. The near future of cardiac emergency response training and how can public policy help us? And last, we will wrap up by putting it all together on how can we cover more ground by partnering with fire, rescue and ems.

Now, this slide is probably not that surprising to many of you on on this call today. Sudden cardiac arrest across all ages is the leading cause of death in the United States. And the young are certainly not excluded from this. Fortunately, it is rare, but when it does occur, it is devastating and shatters families and communities. So one thing that can be done to ASSIST this is EKG screening. And EKGs can reliably identify conditions like Long QT Syndrome, Wolff Parkinson white syndrome, hypertrophic cardiomyopathy. But as for all of these other conditions, the only it would not be uncommon for the first presenting symptom to be a cardiac arrest. And so therefore, the only reliable way that these lives would be saved is through the chain of command of survival. And this is actually how Project Adam began almost 25 years ago after a tragic event while he was playing basketball at his high school. His family's mission to ensure that schools were equipped and trained to respond if cardiac arrest would occur has since saved hundreds of lives nationwide.

And really a lot of work has been done in this space. It was really ignited after the death of Hank Gathers, a really great basketball player died on his basketball court. In the early 90s, this ignited many medical experts throughout the world to really answer the question. At this time, it was so shocking that athletes could die of cardiac arrest. And so since this time they've been able to move the needle into treatments and procedures and best practices and all of these sorts of things. But yet all the medicine and all the procedures and the devices and still to this day, on April 25, 2025, if you don't have bystander CPR, the chance of survival is 10%.

So this is our why these are some of the terrible cases in our own backyard. And not completely fair. I wasn't an eyewitness, clearly, but willing to bet that if an efficient chain of survival was performed, at least half of these victims would still be here today. Superintendent tells television station this was a cardiac arrest that happened early this school year in the fall. Tells television station that the player did not have a pulse when rescue for workers first got to him. What can we do to bridge this gap so that when fire rescue arrives, you still have a beating heart to attempt to work with.

And are we doing our best? Well, here's our bar and I do think that we can only improve from here. And here's how. This is a two year perspective study that was performed nationwide. It looked at over 2,000 schools. Half of them had a cardiac emergency response team, the other half did not. In the schools that did not have cardiac emergency response training, the Highest survival was 24% versus the schools that did have formal training where 85% of the students survived.

Now here's our own work. In just a little less than two years, we were able to launch this program in Miami Dade county public schools schools. It, it took a lot of energy, but we did ultimately get a hundred percent of all of the Miami Dade county public schools heart safe recognized. In that time frame, there was nine cardiac arrests.

And in, in that 18 months to two years before EMS arrived, we had eight out of nine survival with a fully intact neurological outcome.

And here's our Palm beach work. We really just started this program in Palm beach county and it's been really exciting. We're at two and a half months and we're about two thirds of the way through getting all of the school's cardiac emergency response trained and heart safe recognized. And in that time frame there was one cardiac arrest. There was an acute survival of that cardiac arrest. And although this didn't end with a happy ending that everyone would have hoped for, this team of school faculty did make a difference. This Teenager did not die on the floor at school, but rather in a hospital bed with her mom by her side. And I have no doubt that the Palm beach county is going to have their happy story if and when tragedy strikes again.

And now, on a happier note, these are the four kids that are still here today because the school faculty was trained to respond on how to save these lives.

All right, so let's get to the business end of this. I'm sure many of you are curious. Okay, so what goes into this and how is it done? Well, the first step is that the team of all school faculty needs to know that there is a how to recognize what cpr. So it's an all staff awareness video.

Hi, everyone.

John.

I'm John Dresner, director of the UW Medicine center for Sports Cardiology. And in the next hundred seconds, I want to show you how to recognize sudden cardiac arrest in an athlete.

He can be seen coming out of a timeout huddle, his head dropping. He stumbles. Then alarmingly, he falls face first.

Here you see Keonte head drop, stumble, sudden collapse. This is what sudden cardiac arrest in an athlete looks like.

And collapses. Just like Hamlin did in sports from football.

Lacrosse to baseball.

Mark Vivian Foe shows all the signs of sudden cardiac arrest. Continued breathing after collapse, eyes open and rolled back. The face of sudden cardiac arrest.

For Demar, after his arrest, his arms go up with seizure like activity.

And for Christian Erickson, a sudden collapse, also unresponsive, eyes open, brief seizure activity in his leg. This is sudden cardiac arrest, isn't it? But that's, that's not a good look at all. With Claire, traumatic episode, collapse with seizure like activity in the arms. An amazing emergency response. Call for help. Someone go get the aed.

Remember, in a class athlete that is unresponsive to verbal stimuli. In a shoulder tap, you must assume it's sudden cardiac arrest. Call for help. Start chest compressions. Get the add. Anyone stable?

All right, so what are the five steps? So we've kind of broken this down to as basic as possible, and this has worked very efficiently. So the first thing is that all staff awareness video. That's step one. If school faculty that are not part of the cardiac emergency response team can't recognize what it looks like, then that's not really helpful to be able to alert the team. Step two is building their internal cardiac emergency response team. So we provide this, you know, kind of layout that would be good potential candidates to be on the team of 10 or so school faculty to be trained. Step three is an 11 minute skills training video that we created. And I'll show you just a very brief clip of that and the steps that it goes through. And then step four, they perform their own internal practice cardiac drill with their team so that they're ready for Project ADAM drill day. So that's step five. This date is provided by the district directly to the principal. We ask that they set aside 45 minutes for drill day. Our Project Adam coordinator, along with sometimes EMS who joins in, and when they do it takes it to the next level. And it is so nice. We visit the school and we watch the cardiac emergency response team perform their drill. Now, in order for them to be heart safe recognized, they have to first obviously be able to recognize what cardiac arrest looks like, alert their team, respond with compressions, and be able to deliver the first shock off in less than three minutes. Immediately following this drill, we go through a debriefing with them. What we look at all of the times, if there was anything that they could have done to improve their time efficiency as well as all of the little things that are left out, clues, and just really lessons learned by going through all of the schools and things that we have seen to really help and improve things. Now right here, I would ask all of you guys to just sort of create a mental post it on. The fact that a lot of work goes into the initial step of getting the school's cardiac emergency response ready. But. But in order for them to maintain these skills, obviously consistency and practice is really. And so we ask that they do a minimum of one practice drill per year with their school team, and every two years they are recertified if this is completed correctly. Now, what we've learned in our experience with Dade county is, you know, going back to some of these schools, I don't feel that they're as strong as they were in their initial training. And so I really think that these. This continuing practice is so important and should really just be as easy as their fire drills and just as routine as the fire drills that are performed. So this is the step three. This is the video that we created that they watch.

Okay. Are you okay?

Sudden cardiac arrest can happen to anyone at any aid.

All right, we'll stop there.

Okay, so here we have the near future of cardiac emergency response training. And how can public policy help us? Well, in December 2024, the Harts act was passed into federal law. And I do think that that thanks to some of the fabulous people on this call, so truly a huge hats off to all the work that went into Getting a job well done. But rolling this out to the state level should be in the hands of a team that is equipped to handle this responsibility so that it is done systematically. And so what exactly is the law enforcing? Well, it's enforcing exactly what Project Adam has been doing for 25 years and is still doing, requiring precisely the work that we, we have now done in the third largest school district and will complete in the tenth largest school district in the country. And so it is looking at developing and providing comprehensive materials to establish AED and CPR programs in public elementary schools and beyond. It's providing support for CPR and AED training programs for students and staff. It's providing support for developing a cardiac emergency response plan within such schools. And then of course, if we can get state funding dollars to this, it will help go to support any deficiencies that we identify or any needs for to keep up with the equipment and the supplies. And sometimes this is identified at the school when you run the drill, that the school campus may just be too large and they may need more AEDs, things like that.

And so I know it's easy for us to sit on a call and make demands on tasks for school faculty. And they do. Teachers and faculty have a tough job. They have a large responsibility. And a few facts here. 20% of the US population is within the school walls at any given day. Many of our children spend more awake hours in the school walls than they do at home. And so it highlights the importance of why schools need to be the safest place for our children. So that if a tragedy like this happens, somebody knows what to do to be efficiently activating the chain of survival during these critical seconds to minutes so that when you arrive, you can be the heroes that you need to be and you can bring them to hospital care so that we can do all that needs to be done to ensure that lightning does not strike twice for this family.

All right, so now let's wrap all this up. We're going to put it all together. How can we cover more ground by partnering with fire rescue and ems? Well, here we have our great state of Florida and how can we bridge this gap statewide? So these are the two affiliates for Project Adam in South Florida. And remember that mental post it that I asked you guys to hold on to regarding the continued practice drills, the annual practice drills that are so valuable now, if these numbers are slightly off that I'm going to quote you here, this is based on Google, so we will just blame Google and I'm sure it'll all Be okay. So I want to break this down and I think many of you might know where I'm heading with this. Now the average schools to fire station throughout statewide is about two to three schools per fire station. I took our most populated county with Miami Dade county and the average schools is somewhere between five to six schools per fire station. Now our friends in Palm beach, the average schools to fire station would be about three to four schools per fire station. Palm Beach Gardens helped participate in all of our practice drills that we performed, all of our initial drills that we performed in that region. And it really has been a true collaboration. And so when we wrap this up, I'm going to pitch the ball to their court to elaborate on their experience and things that they learned and to kind of just give everybody a feel for firsthand. And then I just randomly picked a rural county and what would that ratio look like? And it was one to one. And so what I'm proposing here is a missing piece to this really rewarding puzzle that once a year the team at the fire station visit the schools in their fire stations backyards and perform a 10 to 15 minute practice drill to ensure that school faculty is confident and can maintain these skills.

And I know that this was very Floridian driven and Florida heavy. But if there are anybody, if there is anybody else on this call that is outside of Florida or will, you know, relocating or whatever. This is the Project Atom website where you can locate a local affiliate at these. The states that are burgundy color all have a Project Atom affiliate located in them. And for the ones that don't have a Project Atom affiliate, something that maybe you could contribute to and help and I will plug this article, this manuscript that's about to be pumped published shamelessly. It is basically a blueprint of exactly the work that we did in a very large county to be able to get our schools 100% heart safe recognized to be able to save those lives. And it basically rolls out exactly the work that we did in all of the lessons learned. And from here I thank you guys so much for your time and I welcome any questions.

And Melissa, at this time did you want the the fire department to to make their comments before we move on to the question and answer?

Yeah, sure, if Palm Beach Gardens can chime in, that would be fabulous.

Yes, yes. Good morning everybody. Thank you for the opportunity to talk with all of you today. It's been a real honor for us for Palm Beach Garden Fire Rescue. This started back in 2022 when we received our Hearts Safe designation. We ended up attending the cardiac arrest summit in 2023, where we met Dr. Dresner and learned of Project Adam, it seemed like a natural fit to grow our program even further. As a data driven fire department, we see the importance of bystander CPR and how it is the missing link in survivability. Pairing with the schools in our district and forming these relationships, being a part of their drills, it seemed like a real pivotal piece of their training. Being on site, giving the crews and faculty opportunity to familiarize themselves with each other and giving vital information that can mitigate emergencies more efficiently. Having faculty be a part of the transition of patient care and the turnover seems so important. We were able to expose different logistical problems and just form that. That relationship and have the crews do area familiarization. Excuse me. And just be a part of that. Talking with Melissa and seeing how this program will be sustainable in the future, like she said, I can see how well they're doing because it's initially the start of this, so they're doing great. But moving forward in years to come, for them to be able to receive this designation again, it's really formed that relationship to where we are even reaching out to these schools and being a part of their training and offering them assistance on a more, you know, new basis where we're there often and we've developed these relationships. So the idea of us being there, it seemed like that last missing length of this drill and getting other fire departments to buy into this was. Is super important.

It's a great program.

Yeah. Thank you. The next. You know, a couple times throughout this presentation, we've talked about the chain of survival. And so next I'd like to bring in Dr. Paul Pepe, who was the senior author on one of the first papers that characterized the chain of survival and who has also worked on CPR training plans in a number of jurisdictions in relation to schools specifically. So, Paul.

Okay, am I here? Am I on? I know you're not. Okay, got it. All right, so first of all, thank you for doing this. It is so important and critical. And we recognize that really early on in Seattle because one of the first things we did was put it in the school systems. And I want to tell you it made a difference. After about seven or eight years, I would be going to a scene, and 50% of the time there would be someone, some buddies, plural, doing cpr. That was a large part of it. Now, here's the irony about the school system issue is actually placing, you know, the AEDs and whatever institute said the PO we saved the most. I mean, yes, we had some young athletes that out in the field, we made sure there was, there was an AED out there on the field, et cetera, during practice. But the OR in the gymnasium was where it was more common. So the interesting thing is that we actually saved more teachers, which is an incentive to get them involved and all that. When you present cases that that's who you're more apt to save. So I'm going to make five bullet points that I've learned over the years and as I've got about 20 of them. But I just thought would be kind of fun to, to just mention because these are ways that inspire people to do this besides saying, hey, we have, you know, we don't lose kids, etc. And make it really tangible for them. But one of the things is to make the training, you know, who's going to do the training. You got to make it, you know, is it always going to be the fire department or we have an internal agent there. In other words, the train the trainer approach is what I'm recommending. But you shouldn't just say it's the biology teacher or the whatever. They may not be really caring. You first go for volunteers who might want to do this and have motivation and you find a good core people that can continue to do this. Then you make the training simpler, which is like there's only one thing you need to know about choking and pop the cork. You know, it's much better than a lot of the stuff we train. I mean, making this really to the point where the two things you need to know about AEDs know where it is, go get it and turn it on, you know, that kind of thing. And just as you go through this, make it very simpler. And your concept of using the videos are fantastic. That's it, make it short, make it to the point and stimulate them. And I think that's fantastic that everybody gets to see that. The third thing that I think is that is, is important is the standardized placements as part of the job. So that sometimes if you have a large school system like the ones I've worked in, whether it was in Seattle or Dallas or Houston, we have multiple schools throughout the system and then, and we think county wise, statewide, whatever, but sometimes the teachers move from one place to the next. And so what you do is you try to standardize it, you know, in terms of like, it's always in the gym, it's always under the flag, the AED is always there or in the pool. It's really under the office, underneath the clock there, whatever it may be, you have everything standardized where you always know where to get it. Because that's the biggest problem is people don't know where to get it. Someone says, go get an aed. Well, everybody in the room has to know where it is, et cetera, and that. So that's part of it. If you standardize it throughout the whole system to do that. And then the last thing is that what I found was really interesting. For example, in the state of Pennsylvania, when I was the Commonwealth medical director.

The. I was having a hard time getting it past all the bureaucracy of the school system, you know, and all that. Initially enough, I happened to run into the bishop or archbishop for the area of the Catholic Church at some meeting with the mayor and so introduced the concept. And then he said, oh, let's just do it. And he ordered it. And once that just happened, when you had this person just saying, it will be done right, There will be blood or whatever it might be, it got done. And so then all of a sudden, boom, Everybody else had to play catch up, you know, that kind of thing. And it helped us on the other side. We did things across the state very similarly. So. But anyways, I. I could go on, but I didn't mean to take up all the time. But I think this is fantastic work. And there's the. What you'll learn is how to fine tune it a little more. And what you brought up, I think was really important, namely that you start losing kind of interest and it backs off. So you got to make it sustainable. You got to have it change. And the partnership with the fire department sites, we just heard from Palm Beach County. I mean, Palm Tree Gardens is fantastic. And you need to continue to do that. So make sure you keep this sustainable. Okay? All right. I'm Paul Pepe and I approve this message. Thank you.

To speak to that sustainable piece. I do have many thoughts and I was hoping, you know, maybe doctor And Heavy and the hand tevy team who's so efficient with their apps and the work that they do is creating a link once the fire station has completed their drill that would quickly be able to document that the drill is completed and completed successfully so that you could easily track that and you would be able to know if there is compliance. Just I think that there's a lot of ways that this can be done and they're not that difficult.

And by the way, one of the interesting things is just as a sidebar too, is what you just remind me about about the sustainability is like when I work, for example, when I'll go into a city, I'll teach the city council how to do it and go, this is easy, you know, and then they go and they have every city employee train. Well, we already have at the fire department. So you can get it done, but then you got to make it sustainable. So one of the things I did, and you could do it in the school system, is that you make training part of the teacher's orientation. So let's say the city, if I have a 10% over, you know, attrition rate every year of employees, when those new 10% come in every year, then we basically just make it part of their training right up front with videos and, you know, little mannequins or whatever, you know, little cereal box size, you know, training devices that we have. And so just another thought to add to your armamentarium there, your portfolio. Okay.

Yeah. I also love that in this discussion, we're also talking about legislation to require not only teachers get trained, but also the training of students in school systems. There's a lot of positive externalities to that. Right. In the United States, we lag behind a lot of other countries, and our bystander CPR rates and our survival rates reflect that. Right. And I think an easy way to do that is to legislate that you have to spend, you know, 45 minutes a year in a classroom, you know, that you're already going to be in learning cpr. Right. That's something you can carry with you for the rest of your life.

Right.

With you forward, you know, and so, you know, aside from. From having these emergency response plans and teaching all these teachers in the schools right now, now you just have more people in your community that are able to do pr. And I think that's a really important point.

No, Tanner, it's interesting you should say that because one of the things we found that was really useful, you know, back in the, I think in the 80s and early 90s, was that there were kids that wanted to go to college. Their cvs, they could put that. They were CPR trainers. So what we usually did, we would take seniors and had them be trainers for the, like the ninth graders or something. So then it's like, cool. It's a cool thing to do. Right. And they were teachers. So there's. There's that peer. That I used to call that peer training or whatever, but it really isn't. It just was good, you know, it was good. What sort? Modeling, you know, that kind of thing. Right. And there was a motivation. So always find those inspirational things, as I just mentioned, to make it happen. Okay.

Yeah.

Yeah. I think there are very few things, you know, thinking back to my, you know, middle and high school days, there's few things that, that I learned back then that could be useful today and used to do something as important as saving someone's life. So I think it's a, you know, a chunk of the curriculum that would be well spent on, on cpr.

Yeah. So all I can say is I'm gonna have to go off to the other meeting, of course. But I just wanted to thank you very much for this fantastic job you guys are doing. So really appreciate such an important task. So thank you so much. And if I could help in any me a shout. Okay, there go. So thank you so much. Take care.

And the link to join the the Eagles webinar with Dr. Pepe is in the, in the chat now. So, so typically on the, on the webinar, we're coming up to, to 11:30 now, so we'll give the, the speakers the last word. So any, any final words of, of wisdom. If you have to give us one maybe takeaway from your presentation. What's, what's the message you want us to walk away from this with?

I mean, you guys all, well know that anyone can save a life. You just have to act and you have to have a very basic training. I, I'm extremely appreciative that all of you guys are here today. And I do hope that there are some next steps that come from sharing with your community where we can really link ourselves and, and work collaboratively to make this as fluid and systematic as possible, because it will, it is going to be rolling out statewide. And I just, I think that this is the, the best link of us making this sustainable, consistent, and as powerful as we can be. And if we were able to accomplish this in the large counties that we were, it does not seem like a big undertaking to be able to really, truly make this statewide. And I say that with obviously knowing trying to eat an elephant and you do this one bite at a time, but I do think that it, it truly is accomplishable.

I'm, I'm super thankful. Thank you guys for your time this morning.

Oh, thank you. It was an excellent presentation. A lot of discussion. I see there's a bunch of people in the chat asking where they can find the, the videos that you were showing.

Oh, wonderful. I can share them with you guys afterwards through your email and you can distribute.

Yeah, I think somebody was Kind enough to. Casey sent the link, looks like in the chat.

Okay, Tanner, if one quick thing, I would add that Dr. Pepe already sort of mentioned one thing. We. We see when we're out doing these trainings for those that do this every day, it's just a way of life responding to an emergency and some sort of medical crisis. But so often what we see when we provide training to people is it removes a little bit of that fear factor. And it really is not rocket science what we're teaching. And when we show people, they often respond with, oh, man, I would feel much more comfortable intervening or getting involved in an emergency because this is not. It's not as scary or as intimidating as I originally thought. So.

That there's just so much value in that. Just connecting, keeping it simple, like he said, I think is really, really valuable. And it sort of removes a little bit of those barriers that people often have to being willing to get involved and intervene in an emergency.

Yeah.

And I'll add one other thing. It's so important. It gives fire departments and EMS agencies such a wonderful opportunity to get out in their community and be a part of that training and form these relationships like that and offer that type of assistance like that. It's been monumental from our side of it, and I highly suggest any other fire departments and EMS agencies getting involved with this initiative. It's been great.

And I think there certainly is something to having the fire department participate in the training in that. You guys have all worked cardiac arrest before, right? You've done CPR before probably a lot. Right. And so, you know, I sometimes I think that, you know, having somebody there that's saying, hey, like, you know, when you're doing cpr, you're going to hear crunching of cartilage in the chest. Right. That. That's. That's not a bad thing. That probably means you're going deep enough like. Like bringing some of the. The realism in your experience in the real world into that training. I think, you know, helps would help somebody. You're giving them advance warning if they've never done it before. About. About, you know, some of the.

You know, aspects of resuscitation that aren't necessarily apparent from the very sterile aha. Videos that are sometimes. Sometimes shown.

So.

All right, unless anybody has anything else, I think that's it for us. I'll hang on here for. For a couple minutes. But again, Melissa, thank you very much for. For coming and sharing this wonderful presentation.

Thank you.

We've taken a lot away from it.

Yes, thank you. All so much.