Are you a Good Samaritan?

I am sure everyone is familiar with the parable of the ‘Good Samaritan’. But consider this scenario :

It’s been a busy day. On the way home you notice a small knot of people gathered around a middle-aged person, prostrate on the pavement. The bystanders look uncertain of what to do.

Do you stop and help? 

Lay public are often uncertain what to do in an emergency - if you were nearby, wouldn't you want to help?
Lay public are often uncertain what to do in an emergency – if you were nearby, wouldn’t you want to help?

As clinicians we are trained in basic and advanced life support. Indeed for GPs, BLS is a mandatory component of triennial accreditation in Australia. Whilst there is as yet no legal duty to render assistance, I think there is a professional and ethical duty to assist, notwithstanding considerations of one’s own safety and training. Indeed Minh le Cong has blogged about some of the legal and professional obligations to render assistance over at the PHARM website. We know that early bystander BLS makes a difference, hence the successful campaigns to encourage lay public to ‘push hard, push fast’ (see videos at the bottom of this blogpost). But supposing this incident happened in the next street and was not witnessed by you. Wouldn’t it be great if there was a way to alert ‘good samaritan’ clinicians to such events?

Enter the GoodSAM App for smartphone

A group of smart clinicians are launching the GoodSAM app (SAM for Smartphone Activated Medics). The premise is simple – using the GPS-technology embedded in every smartphone and tablet, to create a network of credentialled BLS providers who can be activated to an incident and ‘crowdsource’ BLS before the arrival of statutory providers. If there is an out-of-hospital emergency, nearby registered GoodSAM responders are alerted via push notifications to smartphone. They can then elect to attend or not. The app is only active when turned on, so there is no onus to be ‘on call’ 24:7. Rather it plays to the inherent altruism in us all – after all, who would NOT assist if you were aware of an emergency in the immediate vicinity? The app is available as an ‘alerter’ and ‘responder’ version – only credentialled clinicians can activate as ‘responders’ – basically anyone with a BLS or clinical qualification can register (by showing proof of clinical registration or BLS/ALS credentialling)

GoodSAM app - goodsamapp.org
GoodSAM app – goodsamapp.org

But what’s the point? Aren’t the ambos supposed to do this?

Well yes – the last thing we want in the prehospital environment is a mob of “enthusiastic amateurs”. But the reality is that from activation to arrival of a paramedic response may take minutes – and if a cardiac arrest happened in a coffee shop next door, wouldn’t you feel guilty knowing that you had the skills to provide BLS but were unaware? If you are a paramedic, nurse or doctor it would be tragic to be sat next door, unaware of the crisis until you heard the sirens as paramedics arrive… There is a short (2 mins 30 secs) video from the developers of GoodSAM here https://vimeo.com/84266406 as well as FAQs from their UK and International websites below: http://goodsam.co.uk http://goodsamapp.org

Sneak Peek of GoodSAM at #smaccGOLD

"Neurosurgery for Everyone" from London HEMS Open Day
“Neurosurgery for Everyone” from London HEMS Open Day

I caught up with Dr Mark Wilson at the #smaccGOLD conference last month. Mark and I were in medical school together & podcasted last year on “Burr Holes in the Bush”. He has published a useful guide on “Emergency Burr Holes – How to Do It“. https://vimeo.com/64985630 Mark ran a slimmed down version of his ‘neurosurgery for everyone’ on stage at #smaccGOLD (I was the muppet doing the Burr holes). It’d be good to entice him to smaccCHICAGO – who knows, #simwars might include some more hands-on skills next year… Whilst Mark spent his medical school elective with NASA, is part of the Centre for Altitude, Space & Extreme Environment Medicine (CASE), conducted research on everest (Xtreme Everest) and carved out a postgraduate career in neurosurgery and as a HEMS doctor, I became a rural doctor on Kangaroo Island. Quite how his career derailed so badly I can’t say, but nevertheless Mark was gracious enough to show off the GoodSam app both in his excellent smacctalks and over breakfast. I reckon it took less than 30 seconds to get up and running; register on the website, punch in your AHPRA details and download the GoodSAM app – wham, you are good to go. GPS technology will alert you if there is a GoodSAM alert and guide you to the location. You can opt in/out according to availability.

GoodSAM pushes alerts to your smartphone, then guides you via maps
GoodSAM pushes alerts to your smartphone, then guides you via maps

Impact Brain Apnoea

Of course the GoodSam app is not just confined to cardiac arrest; Mark spoke about the phenomenon of traumatic impact brain apnoea – put simply, if sufficient force is delivered to the skull, then apnoea will be induced for a period of time, during which critical hypoxia will cause irreversible damage. The delivery of basic measures, such as jaw thrust and assisted ventilation by a BLS-accredited GoodSam responder, can bridge this gap and help ensure more favourable outcomes for neurotrauma.

Where to get it?

The App can be downloaded from the App Store and is available for iOS platforms – an Android version is expected soon. I should stress that the App is in soft launch phase currently – I would expect that avid users of #FOAMed and #smacc aficionados would be early adopters, with more mainstream uptake in months to come. When browsing the App store, just search for “GoodSam” responder app – be sure to look under the ‘iPhone’ tab (iTunes App store tends to classify by apps available either for iPad or iPhone – it will work on either, but is optimised for iPhone)

 Screen Shot 2014-04-05 at 10.01.47 am

Other applications

Smartphone technology is changing the way we work as clinicians. Most users of #FOAMed resources are using their smartphone or tablet to pull up clinical guidelines, useful websites, videos, podcasts and so on on a daily basis. I use my iPad in theatre and ED most days, showing short videos to stimulate discussion, running sims, accessing clinical resources or just keeping up to date. But the embedded GPS-capabilities allow extra function – Many retrieval services are on board with regularly updated SOPs, drug doses and location of landing sites for their retrieval practitioners. The Scottish EMRS service is a good example. It is also gratifying to see the more enlightened retrieval services placing their SOPs online for dissemination – this is invaluable for us rural clinicians who wish to meet the same standard of care for our patients as delivered by dedicated critical care services. HEMS SOPs from London GSA-HEMS SOPs (see under Resources tab) I was speaking last week with David Hogg, a remote area doctor on the Isle of Arran in Scotland about the UK BASICS scheme – smartphone location and activation of BASICS responders offers significant advantages over bulky pagers or expensive vehicle-location systems. However such applications are limited by mobile reception – this is a real issue in rural areas.  See the NO BARS initiative from ruralGP.com to improve the issue of limited mobile coverage. I think we will see more and more use of the embedded technology within our smartphones to deliver better patient care. GoodSAM is an interesting app – it would be wonderful to have good uptake of this by willing clinicians in both metro and rural areas, reducing time to BLS. Extension of the concept could allow much faster mobilisation of expertise in other scenarios, for example – smartphone location and activation of RSI-positive, equipped & trained RERN members to prehospital incidents (equivalent to BASICS UK) – smartphone activation of emergency responders for mass casualty or other incidents (bushfire, earthquake, tsunami etc) etc

My recommendation?

Download the GoodSAM responder app and have a talk to colleagues and lay public – they may wish to use the GoodSAM alert app for their friends & family. Through connectivity, we grow… GoodSAM website – International Contact via Twitter The developers seem very open to feedback. In Australia there is a slight hiccup, in that registration of doctors, nurses & paramedics requires supply of AHPRA registration – yet paramedics are not (yet) registered with AHPRA. Don’t worry – just register online and email GoodSAM who will authenticate by other means. As far as I know, registration is also available to other BLS providers eg: students, community first aiders etc on production of valid BLS credentialling. The potential to crowdsource BLS is huge. What a great idea!

Disclaimer

I am not an employee nor a beneficiary of GoodSAM.  There are other similar crowdsourcing BLS apps available – the PulsePoint Foundation app is a similar concept, costing between $5K-$25K depending on population covered. As far as I am aware, GoodSAM is free and as such should appeal to users of #FOAMed ! Other apps exist to guide the lay public through the process of BLS eg: the AHA first aid & CPR smartphone app or this from Ambulance Victoria

Ambulance Victoria App for lay public - learn CPR
Ambulance Victoria App for lay public – learn CPR

GoodSAM does not teach you how to do CPR – it is an app to deliver trained responders to the scene, not to assist novices.

CPR videos for the Public

There is concerted effort by National bodies to educate the lay public in hands only CPR. I see GoodSAM as complementary to this, adding trained responders to lay responders. After all, BLS – even hands only – is what matters.

There is no point in pre-hospital ECMO for OOHCA if the brain is dead through lack of early CPR!

American Heart Association – Ken Jeong “Hands Only CPR”

UK  British Heart Foundation – Vinnie Jones “Hard & Fast”

..and of course the “Mini-Vinnie’ spoof

Australian Resus Council – ‘Hands Only CPR – It’s Not Aeroscience