In April, 2016, Richmond became the first city in Virginia to partner with the CPR crowdsourcing app PulsePoint, bringing their technology to our city. Across the US the incidence of sudden cardiac arrest is over 300,000/year, and survival rates are generally less than 10%. Early CPR and defibrillation can triple that number. Other municipalities have had success with the technology, with early data showing it to be an effective way to get a bystander’s hands on the chest prior to the arrival of EMS units.

While neither Steph nor I have been alerted by the app yet, one of our interns has had it go off not once but twice in just three months. I spent a while picking his brain about it last night so we could share his experience.

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Amir: Ok Mike, you were telling me a couple of weeks ago that your PulsePoint actually went off. Could you just explain to anyone who maybe hasn’t heard of PulsePoint exactly what it is and why you have it?

Mike: Sure, PulsePoint is an app that’s tied with the local EMS dispatch. Whenever there’s someone nearby who needs CPR, people with the app get a notification and can respond to help.  Essentially trying to do for CPR what tinder has done for online dating.

Amir: Perfect. Except preferable not to wait for the other person to swipe right as they have only moments to live. Got it.  So it’s on your phone, just monitoring the EMS dispatch, waiting for some unsuspecting person to drop – and that’s where your story starts. Lay it on me and the rest of the English speaking world.

Mike: When the alert went off I was enjoying my day off watching Game of Thrones. I had received one alert previously that I didn’t respond to (that one was while I was in the hospital), so I recognized the alert. It was a nearby address, and “CPR Needed,” no other information. I threw a shirt on (always don appropriate PPE first) and ran out the door. When I got there, I identified myself as a doctor (liability much?) and was let in. The victim in question didn’t actually require CPR; I did a jaw thrust to keep the airway open, and literally 45 seconds later an EMS crew made their way in. And from there, EMS basically was running the show.

Amir: Ok so most importantly, have you seen this season’s finale?  It was amazing.

Mike: I can’t believe they killed off [insert character you’ve only just finally felt an emotional connection to]. So unexpected.

Amir: Speaking of killing off, back to this maybe-dying person.  How did you even know where to go?

Mike: Pulse Point has a pretty clean interface. When the alert came up it has a Google Maps type street grid.

Amir: How far away was the spot?

Mike: Just a block or so, looking into it the app will typically alert a provider within 1/4 of a mile, depending on the agency.

Amir: So pants on, shirt on, out the door – leisurely stroll down the block? Or were you hoofing it?

Mike: I think I had a decent clip going. Not a full on sprint.

Amir: You live about 1/4 mile from us. If that app ever puts a pin on our house I expect you to transform into Usain Bolt.

But ok so you’re keeping it cool, it’s their emergency not yours after all, and you show up. What kind of place? Apartment? House?

Mike: House; one I had biked past many times around the neighborhood.

Amir: What’s the etiquette here? Politely knock on the door or charge in like Superman? I imagine the latter comes with the risk of being, you know, shot to death. But for all you know it’s an innocent baby dying in there, and you’re literally the only person who can save her, right?

Mike: Yeah, the thought crossed my mind. There’s definitely a can of worms to be opened here: how do Good Samaritan laws apply to physicians, was the correct address sent through the app, the list probably goes on.  But I knocked and was let in, so cross at least one of those concerns off the list.

Amir: Did they ask who you were or how you knew what was going on or what you were doing there?  I mean no uniform, badge – you’re Joe Schmo for all they know.

Mike: It was pretty hectic and everybody just seemed to accept that I was there to help. No other questions asked.

Amir: What did you find in there?

Mike: Respiratory distress, cause unknown. As somebody who doesn’t have a background in EMS, approaching this in the field is definitely a different thought process than undifferentiated respiratory distress rolling into the ED. Differential diagnosis isn’t too important when your treatment options are limited to what you bring with you, which in this case was nothing.

Amir: Great point. Something more docs should keep in mind when EMS rolls in with a hot mess.  So not breathing, could be overdose but could also be massive head bleed, who knows? You don’t even have gloves. So you jaw thrust, trying to avoid any and all fluid leakage, and just hope the cavalry arrives soon. You weren’t up for mouth to mouth?

Mike: In retrospect, I did have my Red Cross pocket mask in the depths of my closet. Now it’s been moved to the shelf in my kitchen.

Amir: That’s a great tip. If you’re going to use this app and respond to god-knows what, be as prepared as possible. Maybe a little kit for the car and home with some basic stuff – gloves and a barrier mask.

Mike: But that does lead into another thing I’ve been considering about PulsePoint. The cavalry in this case was less than a minute away. From their website, PulsePoint costs over $10,000 to implement, and another $10k to $28k a year to maintain. So the agencies most likely to be able to afford an extra service like PulsePoint are also the agencies that are well funded, and most likely to have an EMS crew right around the corner.

Amir: Ah so you think maybe we need to see some pre/post implementation outcome data.  I’d say if that guy had been in cardiac arrest though, those 45 seconds could make a significant difference.

Mike: Oh sure, it’s definitely a good idea. Especially considering that you don’t need to be a doctor to get the app. Anybody who’s BLS certified or better can join up. And unless there are some hidden costs involved, it’s still less expensive than a lot of the other “bells and whistles” that EMS agencies can add to their toolkit.

Amir: {{*cough* ACLS drugs *cough*}}  Any other tips for potential heroes out there?

Mike: Just the usual things that I’m sure are second nature to EMS providers. Expect the unexpected, prepare for as much as you can, and the number one rule, first do no harm to yourself. “Survey the scene, don’t expose yourself to harm” doesn’t get drilled into us a ton as docs, but there’s a reason it’s the first step in BLS training.

Amir: Perfect. So to sum up:

1. Get Dressed.
2. Don’t show up empty handed.
3. Watch your back. And your front.
4. Have a good lawyer, just incase.

Mike: Couldn’t put it better myself.

Amir: I love it. Thanks for sharing the story. I can’t believe it’s gone off not once but TWICE for you.  I’ll let you have the last word to your now adoring public.

Mike: Flarhgunnstow.

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I had to look up that last word. Apparently it’s this:

If you know CPR and are willing to help someone whose life depends on it, go to PulsePoint.org and see if your city has partnered.  If you don’t know CPR yet, the American Heart Association website can help you find a CPR course.

~Amir

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Michael Billet, MD is now a PGY-2 in Emergency Medicine at VCU Medical Center in Richmond, VA. He attended the University of Virginia for both his undergraduate and medical school training. He likes long walks on the beach, Settlers of Catan, and is definitely the guy you want on your trivia team.