Report of Richard O. Cummins And Curriculum irae The Estate of Andrew James Westling (deceased) RE PORT SEPTEMBER 20, 2016 Richard 0. Cummins, MD, MPH, Professor of Medicine Attending Physician, Emergency Medical Services University of Washington Medical Center Westling, Andrew: Cummins Report Page 1 QUALIFICATIONS AND EXPERIENCE 1, Richard Cummins, M.D., M.P.H., provide this report in the matter of the Estate of Andrew James Westling. I am a physician licensed to practice medicine in the State of Washington. I attended the University of North Carolina in Chapel Hill, as a John Motley Morehead Scholar, graduating Phi Beta Kappa, in [968. I attended medical school at Case Western Reserve in Cleveland, Ohio, graduating Alpha Omega Alpha, in 1972. I received three years of post-graduate training in Medicine and Pediatrics at the University of Virginia in Charlottesville, Virginia. For two years I served in the US. Public Health Service in a medically indigent community in rural Virginia. In 1977 I was awarded a Robert Wood Johnson Fellowship to the University of Washington School of Public Health where I obtained graduate training in Epidemiology, and a Master?s in Public Health Degree. In 1979, was awarded a Milbank Memorial Fund Fellowship to study for two years at the University of London in England (obtaining a Master?s of Science degree) and one year doing research at the Royal Free Hospital in London. In 1981, I joined the faculty of the Department of Medicine at the University of Washington. I was promoted to the rank of full Professor in 1993. I am double-board certified in both Intemal Medicine and in Emergency Medicine. A copy of my curriculum vitae detailing my professional quali?cations and experience is attached hereto as ?Exhibit I have served as the co?director of the Center for Evaluation of Emergency Medical Services, and as the Medical Director of the Early Delibrillation Programs in the Seattle?King County EMS Division. My research activities have been in epidemiology and the treatment of sudden cardiac death, including long?term survival, automatic external defibrillation, transcutaneous pacing, and the pharmacology of resuscitation. I have written and published more than 150 peer? reviewed articles, scienti?c publications, editorials, and book chapters about emergency cardiac care and related topics. have served as the Chair ofthe American Heart Association?s National ACLS Subcommittee, the National ECC Committee, and co?founder and co-chair of the lntemational Liaison Committee on Resuscitation (ILCOR). For five years I served as one of two Senior Science Editors with the ECC programs. In this position I helped develop ACLS guidelines, instructor manuals, provider manuals, handbooks and textbooks. I have been the co-editor for 3 editions of the ACLS Textbook, 2 editions of the ACLS Instructors Manual, and 6 editions of the ECC Handbook. I co-originated the ACLS for Experienced Providers Course and co-authored the Instructors Manual and Toolkit. In 2005 I was one of ?ve individuals awarded the Giants of Resuscitation award given every ?ve years by the American Heart Association and the ILCOR. As an active member ofthe Division of Emergency Medicine at the University ofWashington, I have worked continuously as an attending physician in the UWMC Emergency Department since 1981, more than 35 years. There I have provided direct patient care, and supervised and taught hundreds of residents and medical students in training. I have seen and evaluated many Westling, Andrew: Cummins Report Page 2 patients presenting with cardiac and supra-ventricular tachycardias such as that experienced by Andrew Westling at Nisqually Correctional Facility on April 1 1-12, 2016. SUMMARY: THE CASE OF ANDREW WESTLING Andrew Westling was an 19-year-old man who died April 12, 2016 while incarcerated at the Nisqually Corrections Center [4w iI'-iL? ~..1\i1y Ico pawl.- ai. v1~ He had a history ofa familiar, readily recognized, and easily treatable heart condition called Paroxysmal Supraventricular Tachycardia or PSVT. During his approximately 24-hour confinement at the Nisqually Corrections Center he began to experience from this condition. When he ?rst reported his heart condition and his to correctional officers they simply transferred him to a different cell for supposed better "observation." He reported his increasing distress a second time, approximately I and V2 hours later. However, no physical assessment, vital sign review, or even a pulse check was performed by a CO. No assessment was performed locally by the Correctional Center?s nursing, or on-call medical staff. No request was made for an evaluation by Emergency Medical Services personnel, such as EMTs or paramedics. And no decision was made to have him evaluated and treated at a local hospital?s emergency department. In fact, no medical provider of any kind was contacted by the COs and Andrew never received any kind of medical evaluation or treatment. After suffering for more than six hours from his PSVT, this 19 year-old man died, alone in his cell.This young man?s death was completely unnecessary and totally preventable. If it were not for the unreasonable neglect of the staffof the Nisqually Corrections Center, Andrew Westling would be alive today and would very likely enjoy a normal life span. Westling, Andrew: Cummins Report Page 3 RECORDS REVIEWED I had access to and reviewed the following documents related to Andrew Westling: - Records ofTenino Family Practice; Yelm, Washington. Included in these records are an electrocardiogram, an event monitor report, and an echocardiogram. 0 Multiple Emergency Department Visits to Providence St. Peter Hospital; Olympia, Washington 0 The following documents from Nisqually Corrections: 0 Initial Medical Screening Incident Report 0 Segregation Referral 0 Thurston County Medic One Incident Report 0 Thurston County Coroner?s Report, and In-Custody Death Incident Investigation Report, prepared by Karen Peek, Deputy Coroner, and co-signed by Gary Warhock, Thurston County Coroner - Thurston County Coroner?s Autopsy Report, with autopsy performed by Gina M. Pino, MD 0 Transcripts of taped interviews by Detective Mason of the Lacey Police Department conducted between April 12 and April 15, 2016, of the following of?cers of the Nisqually Police Department: Michael Althauser Marco Garay Keenan Kalama Edna David Arron Robertson Michael Pino Tully Bailey Westling, Andrew: Cummins Report Page 4 PAST MEDICAL HISTORY The following summary of past medical history con?rms Andrew Westling?s diagnosis of the heart condition, PSVT. June 22, 2010. Visit to Leyton E. Jump at Tenino Familv Practice. At this outpatient visit Andrew Westling was 14 years old. 0 He complained of dizziness, light-headedness and near syncope. He had a queasy feeling while shopping at Walmart, with vertigo, and ?palpitations at ~lOO/min." This episode improved with sitting down, and lasted about l-2 min. 0 Dr. Jump noted normal vital signs, cardiac examination, and thyroid function. A 12-lead ECG was over-read by a cardiologist as showing heart.? Dr. Jump?s final assessment was ?palpitations.? June 19, 2012. Visit to Karen Carlson, ARNP at Tenino Familv Practice. Two years later, at age 16, Andrew returns to Tenino Family Practice. 0 On this visit he is again complaining of episodes of heart racing and palpitations. He tells Nurse Practitioner Carlson that he had been experiencing episodes of syncope. weakness. His palpitations had occurred with exertion at a friend?s house when he had an attack of'some sort. The attack was associated with lightheadedness, chest tightness, and 0 He reported several previous episodes of heart racing with activity. His worst episode followed 15 minutes of jump roping when his heart was pounding. He had to lay down. When he got back up he felt his heart stop, then start to beat slowly again, and then returned to normal. 0 Nurse Practitioner Carlson noted normal vital signs, normal cardiac examination, and fairly high level ofcaffeine intake. A 12?lead EKG was largely unchanged from the EKG ofJune 22, 2010; but showed possible pre-excitation, a short PR-interval, and a delta wave in several leads that raised a possibility of WPW a cardiac abnormality often associated with PSVT. - NP Carlson refers Andrew for a King-of-Hearts event monitor, and to see a Cardiologist for further evaluation and treatment. Three days later, on June 25, 2012, the King-of?Hearts monitor unit transmits a single tracing which demonstrated a sinus at 60-75 beats per minute, and no ventricular or supraventricular December 28, 2012. Care bv Paramedics at a local ?re station in Olympia, with subsequent evaluation at St. Peter Medical Center ED, Olympia. Jonathan Babbitt, MD, working in the St. Peter ED documented another episode of PSVT. 0 Andrew reported that he was just texting on his phone with his kicked in, making him feel lightheadcd and dizzy. Westling, Andrew: Cummins Report Page 5 0 He went to a nearby fire station, and paramedics were summoned. The medics made a diagnosis of PSVT on their monitor and started an IV. They followed standard field? protocols for PSVT, administered two doses of adenosine 12 mg IV, followed by two doses of the calcium-channel blocker. diltiazem IV. These medications did not phannacologically convert Andrew to normal sinus so the medics decided, appropriately, to proceed to electrical cardioversion. After sedation with versed 5mg lV, they delivered a shock of 100 joules from their defibrillator. This successfully converted Andrew to normal sinus - He was then transported to St. Peter?s ED for further evaluation and stabilization. There Dr. Babbitt decided Andrew was stable and could be discharged to close follow~up with the cardiology clinic and with his primary care provider, Leyton Jump, MD. January 7, 2013. Visit to Leyton Jump, MD at Tenino Family Practice. A week and a half later, Andrew followed up with Dr. Jump. 0 Dr. Jump reviewed the above December 28, 2012 episode, and gathered additional past medical history. Andrew reported tachycardia bouts since about the third grade, and that they were happening more often. The episodes produced oflightheadedness, syncope, chest lightness and weakness. Andrew had learned that he could stop a bout of tachycardia with what are called ?vagal maneuvers?, such as a Valsalva action, or by stimulating a dive re?ex with ice water. The use of ice-water on one?s face or head, and other physical maneuvers ("vagal maneuvers?) are appropriately taught to patients, as they will often easily and quickly reverse an episode of tachycardia without the need for the patient to seek medical assistance or even use medication. Medication is sometimes prescribed as well, either to suppress the PSVT or for the patient to have as a backup if the patient?s self-administered maneuvers do not work. 0 Dr. Jump discussed starting the medication diltiazem to take on a daily basis to suppress the frequency ofthe PSVT episodes. Alternatively. Andrew could try the ?pill?in-the-pocket" approach, in which he would a take a medication, such as the beta-blocker metoprolol, at the onset of a PSVT episode. Andrew chose to try the "pill-in?the?pocket" approach, and Dr. Jump wrote him a prescription for metoprolol 100 mg, to take "when heart is going fast.? 0 Dr. Jump ordered an echoeardiogram for Andrew, and referred him to Cardiology for long- term management. January 14, 2013. Visit to Olvmpia Multispecialtv Clinic for echoeardiogram. The echoeardiogram study concluded that Andrew had ?normal systolic left ventrieztlar?metion with an excellent ejectionfraction (3/6770: normal aortic valve and right truce rnitral, pnlmonie and trieitspid valve regmgitation; and mild bi-cttrictl enlargement with no evidence of?pnlmontny hypertension. A normal echoeardiogram would be expected in a patient with PSVT. Westling, Andrew: Cummins Report Page 6 SENTINAL EVENTS: NISQUALLY CORRECTION CENTER Monday, April ll,_2016; 00:39. Andrew Westling, 19 years old, had been arrested by the Yelm, Washington PD on misdemeanor charges of 4th degree assault and being a minor in possession of alcohol. 0 The arrestng of?cer from the Yelm Police Department, Chris Davis, informed Karen Peek, Deputy Coroner, that Andrew was intoxicated at the time ofhis arrest. Mr. Westling was not medically assessed, and a breathalyzer test was not conducted. 0 In the early morning hours of April 1 l, 2016, Andrew was booked into Nisqually Corrections. He completed the Nisqnally Corrections Initial Medical Screening form. On this form, he checked that his physical condition was ?good?; that he was not currently taking medications; and that he had no history of heart disease. He checked ?no? to a question about whether he was currently having shortness of breath or chest pain. He also checked ?no? to a question about whether he had any other medical problems that the Correction Center should know about. Later, however. Andrew made multiple medical complaints to jail staff(see below). 0 Approximately twenty-four hours later Andrew Westling was pronounced dead in his holding cell. Mondav, April 11, 2016 GD 1800 hours: first episode of door-pounding. According to correction of?cers? interviews, Andrew became anxious and upset at some point in the afternoon of April 1 l, 2016. This occurred after a telephone conversation with the judge who would be ruling on his case. 0 The Incident Report completed by CO Althauser at approximately 1800 hours stated that Andrew began to bang on his cell door. He was noted to be holding his neck. He told the corrections of?cer (Althauser) that he had a heart condition, and an abnormal heart beat. He informed the of?cer that a prior episode ofhis heart condition required resuscitation by an ambulance crew. An incident report completed by CO Althauser stated: On 4/1 1/2016 at approximately 1800 1 Of?cer Althauser was working House 2. l/M Westling, Andrew began to bang on the door, Westling was holding his neck. When I talked to Westling he mentioned his heart condition, and said the last time that his heart acted up he had to be [sic] in the ambulance. I called for an available of ficer to come to the housing unit so that l/M Westling could go on medical watch until a doctor comes to check on him. He currently resides in Holding 3. 0 Andrew further told CO Althauser and CO Pino that he took a medication for his heart condition but he did not know the medication?s name. 0 Althauser and Pine decided that Andrew ?needed to go on medical it'atch?tr his heart condition.? Althauser, and Pino, moved Andrew to a ?medical watch? holding cell. A simultaneous Segregation Referral, was completed by C0 Althauser. This documented why Westling, Andrew: Cummins Report - Page 7 Andrew was moved to a medical watch holding cell, and noted that Andrew was complaining about irregular heartbeats, and that he had a heart condition. It stated: Westling, Andrew was complaining about irregular heartbeats, mentioned his head condition, placed in holding for medical watch." 0 The corrections officers claim to have observed that Andrew failed to note the existence of a heart condition on his initial medical screening form, or that he was supposed to be taking a medication for it. They claim that Andrew informed them that he did not have the medication available because of lack of funds. 0 Despite the medical screening form, CO Althauser and Pine now knew that Andrew was having a recurrence of distressing from a significant heart condition. This condition had required emergency medical treatment in the past. They knew that he lacked an important medication previously prescribed for his heart condition. They knew he was experiencing and complaining of heart?related conditions for which he had had to be ?resuscitated? in the past. 0 CO Althauser and Pino, however, failed to respond appropriately to the information reported by Andrew at 18:00 hours. They did not arrange for him to be evaluated by a nurse or medic, even though he complained again of his abnormally beating heart to an additional CO ('Kalama). He was told to relax, get some air and get some water. Mondav, April 1 1, 2015 1800 to 1930 hours: change of shift. A change of shift occurred at 1800 hours. A new shift of correctional officers became responsible for Mr. Westling. These correctional officers all had information as to why Andrew had been moved to the medical watch holding cell. Copies of the Segregation Referral documenting Andrew?s heart condition and that he was complaining of irregular heartbeats had been copied and distributed according to CO Kalama. 0 None of these officers, however, took additional actions, they failed to request further nursing or medical evaluation, and they failed to call for an EMS response. No medical professional of any kind was summoned. Mondav, April 11, 2016 1930 to 2000 hours: second episode of door-pounding. Between 1930 and 2000 hours, Officer Edna David reported a second episode of Andrew becoming medically distressed and from his rapid heartbeat. CO David reported that when she first saw Andrew he had already been moved into Holding 3, the medical observation holding cell. 0 She stated that she initially observed Andrew between 1930 and 2000 hours. She witnessed Andrew "pounding on the door am] said that he was having heart Skip, beats and he was leaning over the toilet area with a wet towel draped over the hack of'hfs He was leaning over the toilet on his knees. He had the towel wrapped around him. The towel was drenched, but CO David was unaware of how the towel got drenched. 0 CO David looked through Andrew?s file to see ifhe had any medical conditions, and noted that ?there?s nothing written on his medical." She stated she had not been briefed on Andrew Westling, Andrew: Cummins Report Page 8 at all by the other COs. She understood that Andrew was just there for medical observation, and that no nurse or medic had been called to evaluate him. Nevertheless, she had now been told specifically by Andrew that he was experiencing cardiac which were clearly persisting following Andrew?s previous complaints to COS Althauser, Pino and Kalama. CO David claims it was her impression was that Andrew was detoxing "because he kept talking about his heart coming out 0f. 0r hefelt like like his thumping was coming out this skin. She reported this episode to Arron Robertson, the CO in charge at the time. Despite this second episode of obvious distress and the documented reason for the medical segregation and the previous reports to the other of?cers, neither CO David nor CO Robertson took any further action. They failed to check his pulse or vital signs, failed to request a nursing or medical evaluation, failed to call for EMS response and failed to summon any medical provider. Indeed at no point prior to his unresponsiveness more than six hours later was any medical provider summoned or even called for consultation. Mon?y, April 11, 2016: 20:00 hours to Tuesday, April 2015: 00:50-01:26. It is unclear what, if any, ?monitoring? was done while Andrew was on ?medical watch.? Westling, Andrew: Cummins Report According to the coroner?s report, video shows Andrew?s last movements in his cell to have occurred at approximately 00: l, which was more than 6 hours after his initial door- pounding and cardiac complaints, and more than 441/2 hours after his second door-pounding and cardiac complaints. At approximately 00:50 hours, CO Kalama noticed that Andrew appeared unresponsive. This was approximately 40 minutes after his last movements per the video. CO Kalama called for backup and activated a local emergency response. The of?cers started CPR in the holding area cell, and retrieved the unit?s AED (automatic external defibrillator). When attached and turned on, the AED did not detect a shockable and no shocks were delivered. The officers continued CPR until Thurston County EMS units arrived At 00:53 the 91 I call from Nisqually Corrections was logged in at Thurston County Medic One. Medics were en-route 3 minutes later (00:56), arriving on scene to Andrew Westling 1 minutes after the 91 1 call at 01:04 hours. The Medics found Andrew in a flatline (asystole). They started an IV and administered resuscitation medications (epinephrine 1 mg 4 doses, and sodium bicarbonate 1 dose. Time of death is listed on the EMS records as GI :26 hours. However, Andrew would have already been dead for quite some time, likely following his last movements at approximately 00:1 1 and well-prior to his "discovery" at 00:50. Page 9 AUTOPSY AND REPORT The scene investigator from the coroner?s office was Karen Peek. She noted ?whitefoam in Andrew Westling?s nostrils. This indicated that Andrew had developed acute pulmonary edema during the hours of his untreated rapid tachycardia from PSVT. This diagnosis was confirmed by Gina Fino, MD, the pathologist who performed the autopsy on Mr. Westling two days later on April 14, 2016: 0 Respiratory system: the larynx and trachea contain white?iamy?aid The primary. secondary and tertiary bronchi also contain whitefoamy?nid The cat surfaces show crepitant deep red with marked edeme and congestion. 0 On microscopic sections of the lungs Dr. Fino found edema and congestion. Alveolar hemorrhage in areas of marked congestion. On microscopic section of the brain Dr. Fino noted an additional diagnosis of brain edema and congestion. At autopsy the examination of Andrew Westling?s heart also found congenital coronary artery and myocardial anomalies: hypoplasia ofthe circumflex and right coronary artery; as well as myocardial bridging of the distal left anterior descending coronary artery. Commentamg. It is important to point out that even though the diameters of the circumflex and right coronary artery were small (1 to 2 mm), both of these arteries were open and carrying blood. Neither of these arteries were blocked with a blood clot or thrombus that would have precipitated an acute myocardial infarction. The left main coronary artery was noted to be ?within normal limits with a maximum diameter of4 mm In other words, the circum?ex and right coronary arteries, even though hypoplastie, were still up to one-quarter to one-half the diameter of the nomial left main coronary artery. [n my opinion the hypoplasia of the circum?ex and right coronary arteries was an incidental ?nding. Those arteries did not generate Andrew Westling?s cardiac and should not have been listed as a cause of death. The myocardial bridging ofthe distal left anterior descending coronary artery was also an incidental autopsy finding, unrelated to Andrew Westling?s fatal cardiac This abnormality, present since birth, comprised only a small, bridge of myocardial tissue, passing over the distal end of the left anterior descending coronary artery. This artery, also, was open and not thrombosed. Westling, Andrew: Cummins Report Page 10 SUMMARY MEDICAL OPINIONS 1. Andrew Westling had Paroxysmal Supra- Ventricular Tachycardia or PS VT. The most salient conclusion that emerged from my review of Mr. Westling?s past medical history was con?rmation of this diagnosis.? This is a cardiac condition in which the patient is predisposed to develop (sudden, abrupt onset, with sudden, abrupt cessation) of very rapid heartbeats. During these which the individual feels in the chest as an uncomfortable, rapid pounding, the heart can beat so fast that it fails to fill with an adequate volume ofblood. This can lead to a reduced blood pressure, which, in turn, causes the individual to experience dizziness, light-headedness, and near?fainting sensations. Definitive confirmation of this diagnosis comes from cardiac strips that demonstrate the diagnostic findings of the various types of SVT. PSVT, however, can also be a clinical diagnosis based on the paroxysmal nature of the of heart-pounding, rapid pulse, dizziness and light-headedness, all of which Andrew experienced. In particular, Andrew?s PSVT was often responsive to classic "vagal maneuvers" of breath-holding, ice-water immersion, carotid-sinus massage (holding his neck as described in the Nisqually records). Left untreated for periods, rapid PSVT can eventually lead to acute congestive heart failure, pulmonary edema, shock, cardiovascular collapse, and cardiac death. This is what happened to Andrew Westling in the Nisqually jail on April 1 1?12, 2016. Over the course of6+ hours, his untreated, rapid PSVT led to pulmonary edema, cardiovascular collapse and cardiac death. 2. Andrew Westling?s April 11-12, 2016 episode of PS VT was eminently reversible and treatable. This young man ?s death from this condition was a true tragedy that would not have occurred had medical attention been provided at virtually any point in the hours leading up to his death. People rarely die from PSVT. This is because PSVT is a relatively common condition, easily diagnosed from a cardiac strip, and then effectively treated. Many healthy people suffer periodic bouts of PSVT. All emergency providers are trained to recognize the condition, and they are familiar with multiple effective therapies that are available. This opinion is supported by the December 28, 2012 episode of PSVT treated in the field by Olympia paramedics. They immediately recognized the PSVT based on their cardiac monitor. They initiated a standard sequence of medications and electrical therapy?if 1'1 one treatment fails to convert then move on to the next. They started with adenosine for two 1 Since the 2010 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care the clinical term ?Paroxysmal? has been eliminated from discussions about the Supraventricular ?l?achycardias, in favor of more speci?c etiologic categories such as atrial flutter or ?brillation, multifocal atrial tachycardia or atrioventricular reciprocating tachycardia (which, in my opinion, was Andrew Westling?s most likely diagnosis). 1 will use the term ?paroxysmal? supraventricular tachycardia, or PSVT. because it matches perfectly with Andrew's clinical picture. Westling, Andrew: Cummins Report Page 11 doses, diltiazem for two doses, and then electrical cardioversion that restored normal sinus The effectiveness of this treatment was subsequently con?rmed by the follow-up evaluation in the Providence St. Peter Hospital?s Emergency Department. In my opinion, Andrew Westling?s PSVT could have been rapidly and effectively treated at any time over manv hours during his Nisqually Corrections incarceration. This interval started when he ?rst began to communicate his to the Nisqually Correctional Of?cers at 18:00 hours on April 1 l, 2016. Up until his death, more than 6 hours later, his PSVT was imminently correctable and reversible. At any point until near the time ofhis death, basic standard?of-care assessment and treatment by a medical provider would have returned Andrew?s heart to normal His death would have been avoided and he would have had no lasting physical impact from his PSVT. The opportunity to correct Andrew's heart and avoid his death existed for many hours. It was only because his PSVT was allowed to persist for such a long period without medical care that he died. 3. Andrew Westling experienced hours ofpain and suffering during his untreated episode ofPS VT on April 11-12, 2016. The Nisqually Corrections Center records and correctional of?cer interviews document two episodes of Andrew pounding on his cell or holding area door. He was experiencing the physical discomfort of heart palpitations, rapid beating and pounding in his chest. These started at 1800 hours when he ?rst brought these to the attention of correction of?cers. Their only response was to move him to a medical Observation holding cell. A second episode, witnessed by CO Edna Davis, occurred between 19:30 20:00 hours, when Andrew again pounded on his cell door with complaints of his tachycardia His efforts at self-cardioversion were unsuccessful and his pain and suffering persisted. Prolonged PSVT is generally highly distressful to patients. At some point in these hours Andrew began to suffer further side effects ofhis sustained, untreated tachycardia. He began to go into the state of acute pulmonary edema that was well-documented by his autopsy. This would have produced of shortness of breath and air hunger. In emergency medicine (shortness of breath) and air hunger are well?known to be highly distressful. It is highly likely that Andrew experienced signi?cant mental and emotional distress, fear, and anxiety caused by the prolonged, untreated cardiac he experienced. 4. The correction officers of the Nisqually Corrections Center demonstrated gross neglect by their luck of a meaningful response to Andrew Westling?s medical complaints The corrections of?cers failed to initiate an urgent evaluation of an inmate complaining multiple times ofa heart problem. It is a major tenet of standard emergency care that all cardiac complaints be taken seriously and evaluated expeditiously. On at least two occasions Andrew orally communicated to the C03 information that indicated he had a valid and urgent problem: he had a speci?c diagnosis (palpitations and tachycardia); he had experienced a Westling, Andrew: Cummins Report Page 12 prior emergency that required advanced treatment with medications and electrical cardioversion; he had seen multiple care providers including cardiologists; and he was supposed to be taking a prescribed medication. It was tragic that this oral history was ignored completely by the 0?s because, apparently, Andrew had not mentioned his heart condition, or his medication on his intake medical questionnaire. His real-time complaints and verbal account of his prior history should have trumped the absence ofa history on his medical screening form. The fact that the COS ignored his active complaints in the cell because he had not mentioned his condition on his screening form demonstrated a level of reckless indifference that strains credulity. A particular tragedy in this matter is that there were so many easy, effective and meaningful responses available to the C05. A simple pulse check or vital sign review by the correctional staff would have been alarmingly abnormal, leading a reasonably prudent CO to seek further help and evaluation. A call to the facility?s contracted physician, available 24-7, could have provided valuable recommendations. A 91 1 call from the correctional staff would have brought the Thurston County Medics to the scene. The EMS providers would have, in my opinion, reprised the same effective treatment the Medics demonstrated on December 28, 2012. Finally, transferring Andrew Westling to the nearby hospital and emergency department in a timely fashion would have led to the same rapid sequence ofdiagnosis and treatment. 5. The autopsy identification of congenital coronary artery anomalies (hypoplasia and myocardial bridging) were incidental ?ndings, that played no role in his PS VT, no role in his death, and were unlikely to a?ect his life expectancy. I respectfully disagree with any conclusion that the fatal event in this case was due to congenital coronary artery anomalies. Rather, it is well established that PSVT is most often caused by aberrant conduction tissue pathways located in the atria or atrio-ventricular node. This is particularly true for the subtype of PSVT that Andrew had (atrioventricular reciprocating tachycardia). PSVT is not (or rarely) associated with either myocardial bridging or hypoplastic coronary arteries. While it is true that there is a risk of fatal and sudden cardiac death in some individuals with congenital coronary artery anomalies and myocardial bridging, this risk is extremely low. In my opinion the relatively minor degree of hypoplasia, the distal location of the myocardial bridging, and the lack of thromboses in the coronary arteries makes it extremely unlikely that these incidental findings on autopsy played any role in Andrew Westling?s death. Indeed, there is little evidence that these congenital anomalies are associated with a reduced life expectancy. It is very likely that Andrew would have experienced a normal life expectancy had he not died in the Nisqually jail. More often than not, patients who experience the relatively common condition of PSVT experience normal, active lives and manage their over the course of decades with self-administered vagal maneuvers, medication when necessary, and basic medical treatment when self-administered maneuvers and/or medication do not return the heart to normal Westling, Andrew: Cummins Report Page 13 Respectfully submitted, Sm Richard O. Cummins, MD, MPH. Westling, Andrew: Cummins Report Page 14- CURRICULUM VI UNIVERSITY OF WASHINGTON MEDICAL CE NTE EMERGE NCY MEDICINE SE RVICF. BIOGRAPHY and CURRICULUM VITAE Richard Oliver Cummins, M.D., M.P.H., Professor of Medicine University of Washington Medical Center Emergency Medical Services 1959 NE Pacific Street Seattle, Washington 98195 Phone: 206/548-4228 Fax: 206/325-9202 Internet: timing-yin xxuthglunulu PAGE I ()1?24 CURRICULUM Biographic Sketch Richard O. Cun'imins, MD. MPH, MSG Professor of Medicine University of Washington Richard O. Cummins grew up in eastern North Carolina. He attended the University ot?North Carolina in Chapel Hill, as a John Motley Morehead Scholar. He attended medical school at Case Western Reserve in Cleveland; and received post-graduate training in Medicine and Pediatrics at the University of Virginia in Charlottesville. For two years he served in the US. Public Health Service in a medically indigent community in rural Virginia. He was awarded a Robert Wood Johnson e/lowsliip to the University of Washington School of Public Health where he obtained graduate training in Epidemiology, and a Master?s in Public Health Degree. He was awarded one of ?ve National Memorial Fund Fellows/zips to study for two years at the London School of Hygiene and Tropical Medicine of the University of London in England (obtaining a Master?s of Science degree); and at the London Royal Free Hospital. He joined the faculty of the Department of Medicine at the University of Washington in 1981, and was promoted to the rank of full Professor in 1993. As a member of the Division of Emergency Medicine he works as an attending physician in the UWMC Emergency Department providing clinical care, supervising medical students and residents in training, as well as providing direct patient care. 1 Dr. Cummins is Board-certi?ed in both lntemal Medicine and Emergency Medicine. He has served as the co-director of the Center for Evaluation of Emergency Medical Services, and as the Medical Director of the Early De?brillation Programs in the Seattle-King County EMS Division. Dr. Cummins' research themes have been in epidemiology and treatment of sudden cardiac death including long-term survival, resuscitation, de?brillation, transcutaneous pacing, and the pharmacology of resuscitation. He has written and published more than 150 articles and book chapters on emergency cardiac care and related topics. Dr. Cummins has served as the Chair of the National AC LS Subcommittee; the National ECC Committee; and co-chair of the lntemational Liaison Committee on Resuscitation He has also served as a Senior Science Editor within the AHA's ECC programs. in this position Dr. Cummins has helped develop ACLS guidelines, instructor manuals, provider manuals, handbooks, and textbooks. He has been the Editor for 3 editions ot?the ACLS Textbook; 2 editions of the ACLS instructors Manual; and 6 editions of the ECC Handbook. He originated the ACLS for Experienced Providers Course and wrote the Instructors Manual and Toolkit. He lives in Seattle, WA with a rescued black lab, an alpha cat, and his wife Jenny with whom he has observed, but not in?uenced, the growth and development of daughters Caroline and Elisabeth, and son David. His life changed dramatically with the birth ofhis ?rst granddaughter, Adela, in 2006, to whom he devotes two full ?Papa-Play-Dates" a week. His second and third granddaughters, Delphine and Sibyl made ol'fwith the rest of his heart in 2009 and 2012. El PAGE 2 24 UM Vll?Al?z RICHARD Professional Biography Richard 0.. Cummina, MD, MPH, MSC EDUCATION Richard O. Cummins, MD grew up in eastern N?llCarolina. ln high school he was awarded the John Motley Morelzcad to attend the University of North Carolina in Chapel Hill from which he graduated Phi Beta Kappa in 1968. He attended medical school at Case Western Reserve University Medical School in Cleveland, Ohio (1968-72); graduating with Alpha Omega Alpha honors in 1972. Post- graduate, residency training in Medicine and Pediatrics took place at the University of Virginia in Charlottesville (1972-73; 75-77). For two years he served in the U. S. Public Health Service in a medically indigent community in rural Virginia (1973-5). He was awarded a Robert Wood Johnson Fellowship to the University of Washington School of Public Ilealth where he obtained graduate training in Epidemiology (obtaining a Master?s in Public Health Degree; 1977?79)). He then competed for and was awarded one of five national Milbank Memorial Fund Fellowships to study at the University of London in England (obtaining a Master?s of Science degree; 1979-81). ACADEMIC APPOINTMENTS He joined the faculty as an Instructor in the Department of Medicine at the University of Washington in 1981. By 1993 he rose to the rank of full Professor in the Department of Medicine. He is a member of the Division of Emergency Medicine at UWMC, and a member of the faculty of the Madigan Army Medical Center-University of Washington Af?liated Emergency Medicine Residency Program. He now works full-time clinically as an Emergency Medicine physician, in the UWMC Emergency Department, providing clinical care, supervising medical students and residents in training, as well as providing direct patient care himself. BOARD CERTIFICATION Dr. Cummins is Board-certi?ed in the specialties of Internal Medicine (1977) and Emergency He obtained his 10-year recerti?cation in Emergency Medicine in October, 2006 after completing all of the recerti?cation requirements ofthe American Board of Emergency Medicine. RESEARCH ACTIVITIES AND THEMES He has served as the co?director of a research-focused collaboration between the University of Washington and the Seattle?King County Public Health Department, called the Center for Evaluation of Emergency Medical Services. As a community service Dr. Cummins served as the Medical Director of the Early De?brillation Programs in the Seattle-King County EMS Division. Dr. Cummins' research themes have been multiple: the epidemiology and treatment of sudden cardiac death; long-term survival and quality of life; techniques ofinitial resuscitation, early de?brillation, transcutaneous pacing, and the pharmacology of resuscitation. He was one ofthe first researchers in the United States to evaluate the new technology of automated external de?brillation starting in the early 1980's. He has consistently been a proponent of AEDs as the key link in a community?s chain ofsurvival. His publication list includes more than 150 articles and book chapters on emergency cardiac care and related topics. PAGE 3 OF 24 VllAl.: RICHARDO. NATIONAL AND INTERNATIONAL LEADERSHIP Dr. Cummins has risen to national and international prominence through volunteer work with the American Heart Association. He has played a number of leadership roles with the National AHA, including the following: Chairman, National AC LS Subcommittee; Vice-Chair, National ECC Committee; Chair, National ECC Committee; founder and co-chair ofthe International Liaison Committee on Resuscitation (ILCOR). In these positions, Dr. Cummins has served as the lead Editor of the 1992, 1997 and 2003 Editions ofthe Textbook of ACLS, and for 5 editions ofthe Handbook of ECC and CPR. Under his editorship there were, at one time, more copies ofthe Textbook of ACLS distributed to readers than any other medical textbook in the World. As the co-leader of ILCOR, Dr. Cummins initiated the development ofa series of ?Utstein Style? guidelines on out-of?hospital, pediatric, and in-hospital resuscitation, resulting in more than 12 publications. AMERICAN HEART SENIOR SCIENCE EDITOR (December, 1977 to July, 2003) From December, 1997 to July, 2003, Dr. ummins served as Senior Science Co?Editor of the ECC programs (with Mary Fran Hazinski, RN as Senior Science co-editor). He received funding from the AHA to support a 50% commitment to this work. In this position Dr. Cummins had overall responsibility for the development of all of the AllA?s scientific publications on CPR and ECC. On August 22, 2000 the 2000 Guidelines on CPR and ECC was published as an entire issue of CIRCULATION with Dr. Cummins as the senior co-editor. This was followed by these books edited by Dr. Cummins: 2002 ACLS Provider Manual, 2002 ACLS Instructors Manual, 2000 and 2003 Handbooks of ECC and 2000 ACLS Manual for Experienced Providers, the 2000 ACLS-Experienced Providers Instructor Manual, and, published in May, 2003 the 2-volume 2003 ACLS Textbook: ACLS the Reference Textbook: volume Principles and Practice; and volume 2: ACLS for Experienced Providers. lie is co-author of ACLS Scenarios core concepts for Case-based teaching (1996), and co- author of 1998 Heartsaver-AED Textbook. HONORS AND AWARDS In 1994 Dr. Cummins received the National Award (if'Meriiorious Service from the AHA, as well as the Time, Feeling and Focus Award. In 1995 he received the National AHA Volunteer oft/2e Year Award. In September, 2002 he was presented with the Hans Dali/1 Award from the Citizen CPR Foundation for significant and outstanding contributions to research and education in ECC and CPR. In January, 2005 he was honored at the American Heart Association lntemational Guidelines Conference as a ?Giant of Res'usciiamm?, an award given every five years for a career of outstanding contributions to the field of resuscitation. (Citation from Award Ceremony on following page.) PAGE 4 ()17 24 CURRICULUM VITAE: RICHARD O. CUMMINS. 2005 HONOREES Richard 0. Cummins, MD, MPH, Richard Cummins is a giant in ail aspects of resuscitation science. including clinical practice. research? international consensus development. teaching writing, and editing. He has advocated AHA and international evidence?based research in resuscitation science. creating the framework and templates that we are using today for resuscitation evidence evaluation. For many years he promoted international collaboration to evaluate CPR and ECC science and develop common treatment recommendations, He and Dr Donglas Chamberlain founded the initial International Liaison Committee on Resuscitation (ILCOR), and they co?chaired this organization for ll) years. These efforts culminated in the publication of the intemationai Guidelines 2000 for CPR and HCC, which he Coucdited. Dr has had a profound effect on the way we treat sudden cardiac arrest. He ?rst defined the ?Chain of Survival Many of his more than l30 peeoreviewed publications are cited throughout the Reguscitation Guidelines. l-le identi?ed the. need for uniform reporting guidelines for outcomes of CPR. He helped organize the first Utstein conference to define guidelines for adult out?of?hospital arrest and edited the pediatric Utstein guidelines, the Utstein guidelines For reporting in-hosnital arrest, and the educational Utstein guidelines. He was an early advocate of pi'ehospital AED use by trained rescuers. Dr Cummins proposed many of the AHA recommendations to promote AED CPR programs. He drafted the final version of the federal Cardiac Arrest Survival Act that was ultimately signed into inw. and heiped write the reconmiendations used in many state AED regulations and legislation. Dr Cuminins has been instrumental in the development of ECC, especially ACLS teaching materials. in the early 19903 he created the first Handbook and transformed the ACLS course to case-based instruction. The 1994 ACLS Tic/xtbook. which he edited? became the largest seliing English language medical textbook. He originated the course ACLS for Experienced Providers and edited the ACLS Provider rl/[amtal and the ACLS Reference i'hxz?book. Dr Cummins is an unselfish mentor who nurtures colleagues and gives them. credit for joint projects. He is a superb editor and a role model and colleague. During tigl'it deadlines he often provides the encouraging message or humorous card that buoys team spirit. He is a compassionate and skilied clinician it is no surprise that he has wort awards as a clinical instructor at the University of Washington. He has taught many of us more than we can say. learnedfmm the giants who came before me. During my residency at the University of Wrginicr, i Spent time as the Imbalance doctor" going out on EMS calls. This system had been. inspired by one of the ?rst Giants c'JfResuscimtion.? Dr Frank Pantridge. Mickey Eisenberg, another ECC giant. offered me a chance to work with him on a project to evaluate something called an (automated external defibrillator: 'Ii?ten yet another giant, Sir Douglas helper! me ?nd an airline in Great Britain on which we established the world ?rst airline de?brillarion program. PAGE 5 OF 24 (?l'liltif'l il UM Vl'l'Mi: ORIGINAL CONTRIBUTIONS Dr. Cummins, along with a number of fellow experts for each topic, has been given credit for making unique and original contributions to the field of resuscitation. Perhaps more accurately he has frequently added to others? original ideas by a more concise and defined conceptualization, and by articulating in publications extensions of the original ideas. This applies to the following concepts and principles: I the principle of early de?brillation by first responding healthcare providers, I adding to documentation ofthe value of early CPR and early de?brillation, I original formulation of the Chain of Survival Concept, I articulating the principle of public access defibrillation, I adding to documentation ofthe accuracy and effectiveness of automated external defibrillators, I adding to documentation of the reality of sudden cardiac death during commercial air travel and generation of the idea of using AEDs for cardiac arrest; I documentation of the ineffectiveness of transcutaneous pacing for asystole I documentation ofthe ineffectiveness of high-dose epinephrine in out-of-hospital arrest I implementation of international uniform recommendations for reporting cardiac arrests (the ?Utstein Guidelines?) I recognition that there were too many causes of cardiac emergencies that went unrecognized and untreated, because of the lack of AHA guidelines (leading to the ACLS for Experienced Provider course; and new editions of the ECC Handbook) I implen'ientation of the ?S-Quadrads" approach to ACLS education by creating the AC LS for Experienced Providers Course I bringing a more formal epidemiological and evidence?based approach to the development and ECC Guidelines I fostering the principles of ?zero-risk therapeutics? in ECC and CPR guidelines I initiating and leading a new ?scienti?c outreach effort? to make guideline development an ?international consensus on Science? I installing the principles of evidence-based medicine into the daily work of guideline development and consensus PAGE 6 24 UMMWS. CURRICULUM VITAE Richard Oliver Cummins, M.D., M.P.ll., Emergency Medical Services 1959 NE Paci?c Street Seattle, Washington 98195 Phone: 206/548-4228 Internet: .lmt .l"ll gm. cm. PERSONAL DATA El Dorado, Arkansas. Birthdate: October 4, 1945 Marital Status: Married; Jenny; (August 24, 1968) Children (DOB): Caroline (Feb 24, 1975) Elisabeth (Mar 10, 1977); David (Feb 25, 1983) EDUCATION University of North Carolina, Chapel Hill, North Carolina, A.B., 1964-1968. Case Western Reserve University School of Medicine, Cleveland, Ohio, M.D., 1968?1972. University of Washington, Seattle, Washington, School of Public Health and Community Medicine, M.P.H. in Health Services Research, 1977-1979. (Robert Wood Johnson Clinical Scholar). London School of Hygiene and Tropical Medicine, London, England, in Epidemiology, 1979-1981 (Milbank Memorial Fund Scholar). POSTGRADUATE TRAINING University of Virginia Internship, Medicine and Pediatrics, 1972-1973. National Health Service Corps; General Practice, Louisa, Virginia, [973-1975. University of Virginia Hospital; Department of Medicine, Charlottesville, Virginia; Internal Medicine Residency, 1975-1977 FACULTY POSITIONS IIELD Professor, Department of Medicine, University of Washington; July 1, 1992 to present Associate Professor, Department of Medicine, University of Washington, July 1, 1985 to June 30, 1992. Assistant Professor, Department of Medicine, University of Washington, 1981-1985. Instructor, Department of Clinical Epidemiology and General Practice, Royal Free Hospital School of Medicine, London, England, 1980-1981). Instructor (on leave), Department of Medicine, University of Washington, 1979-1981 .Acting Instructor, Department of Medicine, University of Washington, 1977-1979. IIOSPITAL POSITIONS IIELD National Health Service Corps; Louisa, Virginia, 1973-1975. Attending Physician, Primary Care Center; Harborview Medical Center, Univ of Washington, 1981-1982. Attending Physician, Emergency Medicine Service; University Hospital, University of Washington, 1982- present. IIONORS and AWARDS John Motley Morehead Scholarship, University of North Carolina, 1964. Phi Beta Kappa, University ofNorth Carolina, 1968. Alpha Omega Alpha, Case Western Reserve University, 1972. James Kindred 'l?eaching Award, University of Virginia, 1977. PAGE 70F 24 V1 IAI-I: RICHARD O. CUMMINS, Robert Wood Johnson Clinical Scholar, University of Washington Milbank Memorial Fund Scholar, University of Washington, 1979. American Heart Association, Distinguished Service Award, Washington State ACLS Af?liate Faculty, Oct, 1990. American Heart Association, Distinguished National Service Award, (ACLS National Chair); May 17, 1994 American Heart Association, Volunteer ofthe Year Award, Washington State AHA Af?liate, July, 21, 1994 American Heart Association, ?Time, Feeling and Focus Award? National Volunteer Award, November 18, 1994 American Heart Association: ?National Award of Meritorious Achievement. (one of four given Nationally); June 21, 1995 Citizen CPR Foundation: National Hans Dali/l Outstanding Contributions to the Field of EC and September, 2002 Emergency Medicine Friar/(V: linieul Teacher oft/1e Year A ward?2004. From the graduating residents in Emergency Medicine; UW/Madigan Army Medical Center EM Residency Program BOARD CERTIFICATION Diplomate of the American Board of Internal Medicine, June, 1977 (#60678) Diplomate of the American Board of Emergency Medicine (ABEM) July 15, 1996 to December, 2006 (#930960). ABEM 10-year recerti?cation: December, 2006 to December, 2016. LICENSURE Current: State of Washington, 1977; Number 252-09. State of Virginia, 1973; Number 023835 (inactive). United Kingdom, 1980 (inactive) PROFESSIONAL ORGANIZATIONS Active: - Society for Academic Emergency Medicine - National Association Emergency Medical Services Physicians - American College of Emergency Physicians - American Medical Association (Washington State) American Board of Internal Medicine (inactive) Past: - American College of Physicians - American Heart Association American Medical Association American Public Health Association - Society for Medical Decision Making EDITORIAL RESPONSIBILITIES (Past) - Associate Editor, Currents in Emergency Cardiac Care, American Heart Association, Dallas, 1988-1999 - Associate Editor, Journal of General Internal Medicine; 1994-99 - Editorial Board, American Journal of Emergency Medicine; 1986?92 - Editorial Board, l?rehospital and Disaster Medicine; 1986-90 - Editorial Board, Annals of EmergencvMedicine; 1988-1993 - Advisory Panel, Journal American Mm A_ss_ogati_on (Section on Concepts in Emergency and Critical Care); 1985-90 - Advisory Panel, Journal American Mew Association (Panel on Diagnostic Therapeutic Technology Assessment); 1985?90 JOURNAL PEER-REVIEVV SERVICE (Past) PAGE 8 OF 24 ll VlI?Ali: th'llARl) American Heart Journal American Journal of Emergency Medicine Annals of Emergency Medicine Canadian Medical Association Journal Chest Circulation Journal ofthe American Medical Association Journal of Chronic Diseases Journal of Emergency Medical Services Journal of Prehospital and Disaster Medicine Journal of General Internal Medicine New England Journal of Medicine Medical Decision-Making Resuscitation European Journal of Emergency Medicine Academic Emergency Medicine SPECIAL NATIONAL AND INTERNATIONAL RESPONSIBILITES (PAST) Senior Science Editor; American Heart Association; Emergency Cardiovascular Care; Appointment: Dec, 1997 Chairman, National Emergency Cardiac Care Committee; American Heart Association (Term runs 1996 to 1999) Member, American Heart Association National Oversite Committee, Task Force on Five-Year Business Plan Member, (1994-present) American Heart Association National Task Force on ?Safety and Efficacy of Automated External Defibrillators? Vice-chairman, National Emergency Cardiac Care Committee; American Heart Association; Dallas, Texas (1995-6) Chairman, (1991-94) National Advanced Cardiac Life Support Subcommittee, American Heart Association. Liaison, (1992) American Heart Association to the European Resuscitation Council Co-Chaimian (1992) International Liaison Committee on Resuscitation Guidelines in Emergency Cardiac Care (American Heart Association, European Resusciation Council, Australian Resuscitation Council, Resuscitation Councila of Southern Africa) StateCo-chairman (1992?93) Washington State American Heart Association, ECC Committee Planning Committee. American Heart Association National Fact-finding exercise. Dallas, Texas; Sept 26-30, 1992 Planning Committee. American Heart Association National Guidelines Conference. Dallas, Texas; February 22-26, 1992. Co-Chairperson, Emergency Cardiac Care ?92 Update Conference; Seattle, Washington, April 9-1 1, 192. Member, National Advanced Cardiac Life Support Subcommittee, American Heart Association (1987? present) Member, National Emergency Cardiac Care Committee, American Heart Association Member, Board of Directors, Citizen's CPR Foundation. C0-Chairperson, Emergency Cardiac Care Update National Conference; Seattle, Washington, 1992. Co-Chairman, Utstein-ll Conference on Recommended Guidelines for Uniform Reporting of Cardiac Arrest Outcome Data, December 9?1 1, 1991; Bagshot, Surrey, England. Chairman, Task Force on Automated De?brillation Training and Education, Advanced Cardiac Life Support Subcommittee, American Heart Association Member, Conference Planning Committee, 1992 National Conference on Guidelines for Emergency Cardiac Care and Cardiopulmonary Resuscitation, American Ileait Association; Dallas, Texas. PAGE 9 24 VI IAE: RICHARD - Chair, Committee on Emergency Medical Services Systems, 1992 National Conference on Guidelines for Emergency Cardiac Care and Cardiopulmonary Resuscitation, American Heart Association; Member, American Heart Association Council on Cardio-Pulmonary and Critical Care Medicine Scienti?c Adviser, First Vienna Congress on Sudden Cardiac Death; March 24-26, 1993 Symposium Organizer, ?Chain of Survival in Europe and America; First Vienna Congress on Sudden Cardiac Death; March 24, 1993 Scienti?c Adviser, 6th World Congress on Disaster and Emergency Medicine; Hong Kong; 1989. - Scientific Adviser, 7th World Congress on Disaster and Emergency Medicine; Montreal, 1991 - Symposium Organizer, Cardiology Session, 6th World Congress on Disaster and Emergency Medicine; HongKong; 1989. - Symposium Organizer, Cardiology Session, 7th World Congress on Disaster and Emergency Medicine; Montreal, 1991 - Member, National Program Committee, Society for Academic Emergency Medicine; 1989 Annual Meeting; 1990 Annual Meeting. Member, Defibrillation Standards Committee, American Association for Medical Instrumentation. 0 Member, Subcommittee on Standards for Automated External Defibrillators, American Association for Medical Instrumentation. - Moderator, Scienti?c Papers Session, Society for Academic Emergency Medicine, 1989 Annual Meeting, 1990 Annual Meeting. - Member, Center Devices and Radiologic Health National Committee on De?brillator Use Problems (Chair, Subcommittee on Manuscript/Report Preparation). SPECIAL WASHINGTON STATE RESPONSIBILITIES (PAST) - State AHA ECC Committee member 1994- present - EMS Task Force on CPR Protocols 1992-1995 - State AHA ECC Committee Co-Chairman 1994 to 1995 State AHA ACLS Committee Member - Member, State AHA Board of Trustees Member, State AI IA Research ommittee UNIVERSITY, DEPARTMENTAL AND MEDICAL CENTER RESPONSIBILITIES (PAST) - Acting Director, UWMC Affiliated Residency Program in Emergency Medicine, University of Washington and Madigan Army Medical Center - Associate Director, Emergency Medical Services; University of Washington Medical Center. - Senator, Department of Medicine to the Faculty Senate of the University of Washington (1989-1992) 0 Member, University of Washington Medical Center, Quality Assurance Committee. 0 Chairman, University of Washington Medical Center, Quality Assurance Committee. (1991-present) - Member, Standing Committee: Introduction to Scienti?c Method in Science, School of Medicine. - Member, Advisory Committee: Epidemiology Course for Medical Students - Member, Medical Thesis Committee, School ofMedicine. Member, Patient Care Information Subcommittee, Medical Care Information Systems Project, University of Washington Medical Center. - Member, Quality Planning Council, University of Washington Medical Center - Member, Physicians Focus Group on Quality Improvement, UWMC. RESEARCH FUNDING (PAST) . Principal Investigator: "The early use ofti'anseiItanerms paeng by emeigenev Medical technicians. Grant from the National Center for I Icalth Services Research, Washington D.C. Ed Principal Investigator: controlled clinical trial rgf'uutunmferl errernul defibrillators by Emergench Medical Tee/mieimzs". Grant from the National Center for Health Services Research, Washington, DC. PAGE 11) 24 CURRICULUM VITAE: RICHARD 0. CUMMINS, 12. 13. 14. 15. Co-Principal Investigator: "The use ofautomatic defibrillators by the companions and?mtily members oflzigli risk cardiac patients. Grant from the National Center for Health Services Research, Washington, DC. Co?Principal Investigator: "The development ofa enter for the Evaluation of'Emergency Medical Services", series of grants from the Asmund S. Laerdal Foundation (one for 3 years, and one for 5 years.) Co-Principal Investigator: "Evaluation ofa semi-automatic external defibrillators used by community responders, andfamily member ofliiglz risk patients Grant from the Physio?Control Corporation, Redmond, Washington. Co-principal Investigator: "Evaluation of a solid state medical control module in a semi-automated external defibrillator". Grant from the Asmund S. Laerdal Foundation, Stavanger, Norway Laerdal Traveling Scholar Fellowship: awarded 1991 from the Laerdal Foundation for Acute Medicine. Support for Comparative evaluation of Emergency Medical Services in Europe. Principal investigator: "The use of automated external de?brillators for the treatment ofin-ltospital cardiac arrest. Grant support from the Physio-Control Corporation. Principal Investigator: "The ORCA Project: Outcome Research in Cardiac Arrest. A multicenter, multidisciplinary project submitted to the Agency of Health Care and Policy Research. (Submitted June 1, 1991 for funding to begin April 1992). (Approved, Not funded) Resubmitted June 1, 1992 (Approved Not funded) Principal Investigator: population-based registry of survivors of out-of-hospital cardiac arrest: interventions, quality of life and long?term survival? National Center, American Heart Association; Submitted July 1, 1992 for funding to begin July, 1993 [Not funded] Co-Principal investigator: ?Women and Sudden Cardiac Death: epidemiology and survival?. National Heart Lung and Blood Institute. Submitted December, 1992 for funding to begin July 1, 1993. [Not funded] Principal investigator: ?The Quality of Survival following Out-of?Hospital Cardiac Arrest.? Seattle Medic One Foundation. Approved: September 23, 1993 ($40,000 for two years). Principal investigator: ?Survival from Out-of-Hospital cardiac arrest: relationship between interventions and activity level and function in survivors.? Submitted July 1, 1993 to the National Grant-in-Aid program of the American Heart Association. (Approved: May, 1994; $150,000 over three years) Co?Principal investigator: ?Amiodarone used in refractory cardiac arrest due to VF in the Prehospital setting.? Seattle Medic One Foundation. Approved: October 4, 1993; $25,000 per year for three years) Co-Principal Investigator: Public Access Defibrillation Clinical Trial. National Heart Lung and Blood Institute. 1999-2004. PAGE 11 OF 24 13M Vl'l?AlZ: BIBLIOGRAPHY PEER-REVIEW JOURNALS 1978 1. Cummins Suratt PM, Horwitz. Disseminated strongyloides stercoralis infection-association with ectopic ACTH and depressed cell-mediated immunity. Archives of Internal Medicine 1980-1989 2. Cummins R0, Smith RW, Inui TS. Communication failure in primary care: failure of consultants to provide follow-up information.JAMA 3. Cummins R0, LoGerfo JP, lnui TS, Weiss NS. High-yield referral criteria for post-traumatic skill roentgenography: response of physicians and accuracy of criteria. AMA 4. Curmnins RQ. Clinicians' reasons for overuse of skull radiographs. Am Roent (This article also appeared in the Am Neuro Radiol 5. Cummins R0. Learning to Write. Can books help? Med Ed 6. Cummins R0, Jarman B, White PM. Do general practitioners have different "referral thresholds?" Brit Med] 7 Cummins R0, Shaper AG, Walker M, Wales C. Smoking and drinking by middle-aged British males: Effects of social class and town of residence. Brit Med] 8. Cook DG, Cummins R0, Bartley M, Shaper AG. l-lealth consequences of unemployment in middle? aged men in Great Britain. Lancet 9. gimmins R0, Cook DG, llume R, Shaper AG. Tranquilizer use in middle-aged British males: Association with smoking, drinking, and unemployment. Royal Coll Gen Pract 10. Cummins R0. Recent trends in salt consumption and stroke mortality: Any help for the salt? hypertension debate? Epidemiology and Comm l. Cummins R0, Eisenberg MS, Bergner L, Murray A. The sensitivity, accuracy and effectiveness of an automatic external defibrillator: Report ofa field evaluation by Paramedics. Lancet 1984ziiz318- 320. 12. Cummins R0, Eisenberg MS, Bergner L, AP, llearne Murray JA. Automatic External De?brillation: Evaluations of effectiveness in the home and in emergency medical systems. Ann Emerg Med 1984 (Part 2, 13. C_um_mins RC), Knowles P. Emergency Department advice telephone calls: Who calls and why? .1 Emergency Nursing 14. Eisenberg MS, AP, Carter WB, Cummins R0, Bergner 1., Pierce J: Emergency CPR via telephone. of Public Health PAGE 1201?24 UM 15. 16. 17. 18. 19. 20. 21. 23. 24. 25. 26. 27. 28. Cummins R0, Eisenberg MS. Prehospital Cardiopulmonary Resuscitation: Is it effective? JAMA Cummins R0, Eisenberg MS, AP, Litwin PE. Survival ofout-of-hospital cardiac arrest with early initiation of cardiopulmonary resuscitation. Am of Emergency Medicine 1985;311 14- 118. Cummins R0, Eisenberg MS, Moore E, Hearne TR, Andresen E, et a1. Automatic External De?brillators: Clinical, training, and public health issues. Ann Emerg Med Cummins R0, Eisenberg MS, AP, Heame TR, Graves JR. What is a "save"?: Outcome measures in clinical evaluations of automatic external defibrillators. Am Heart 1985;110:1133? 1138. Eisenberg MS, Bergner L, AP, Cummins R0. Sudden cardiac death. Scienti?c American Eisenberg MS, Cummins R0. Detibrillation performed by the emergency medical technician. Circulation l986;74(suppl Eisenberg MS, Cummins R0, Litwin PE, AP. Out-of?hospital cardiac arrest: signi?cance of in patients collapsing before and after arrival of paramedics. Am Emerg Med . Cummins R0, Eisenberg MS. Automatic external de?brillators: clinical issues for cardiology. Circulation (This article also appeared in Current Views from Circulation: editorials and perspectives, Sobel BE, ed. Monograph #127; Dallas, American Heart Association, 1987.) Eisenberg MS, Carter W, AP, mniins R0, Litwin PE, Heame TR. Identi?cation of Cardiac Arrest by Emergency Dispatchers. Am of Emerg Med Moore E, Eisenberg MS, Andresen E, Cummins 1:0, AP, Litwin PE. Home placement of automatic external de?brillators among survivors of ventricular ?brillation. Ann Emerg Med Cummins R0, Eisenberg MS, Austin D, Graves JR, Litwin PE. Ventilation Skills of Emerg Medical Technicians: a teaching challenge for emergency medicine. Annals Emerg Med 1986;] 5:1 187-1192. Moore E, Eisenberg MS, Cummins R0, AP, Litwin PE, Carter W. Lay person use of automatic external de?brillation. Ann Emerg Med 1987; 16:669-672. Currunins R0, Eisenberg MS, Litwin PE, Graves JR, Hearne TR, AP. Automatic external de?brillators used by emergency medical technicians: a controlled clinical trial. AMA Cummins R0. EMT-De?brillation: National Guidelines for Implementation. Emerg Med Litwin PE, Eisenberg MS, AP, Cummins R0. Location of cardiac arrest and its effect on survival from cardiac arrest. Annals Emerg Med PAGE 13 24 CURRICULUM VITAE: RICHARD 0. Cl 30. 31. 32. 33. 34. 35. 36. 37. 38. Cummins R0, Stults KR, Ilaggar B, Kerber RE, Schaeffer S, Brown DD. A new library for testing automatic external de?brillators: performance of three devices. Am Coll Cardiol Cummins R0, Chapman PM, Chamberlain DC, Schubach JA, Litwin PE. In??ight deaths during air travel: how big is the problem? JAMA Cummins R0. De?brillation. Emergency Medicine Clinics of North America 1988 240 Cummins R0, Austin DA, Jr., Graves JR, Hambley C. An innovative approach to medical control: semi-automatic de?brillators with solid state memory modules for recording cardiac events. Ann Emerg Med Cummins R0, Austin DA, Jr. The frequency of "occult" ventricular ?brillation masquerading as a flat line in prehospital cardiac arrest. Ann Emerg Med Hcame TR, Cummins R0. Improved survival from cardiac arrest in the community. PACE 1988 (Part Cummins R0, Schubach JA, Litwin PE, Ilearne TR. Training lay persons to use automatic external de?brillators: success of initial training and one year retention of skills. Am Emerg Med 1989;72143-149. Eisenberg MS, Moore J, Cummins R0, Andresen E, Litwin PE, AP, Hearne T. Use of the automatic external de?brillator in homes of survivors of out?of-hospital ventricular ?brillation. Am Cardiol Cummins BO, Schubach JA. Frequency and types of medical emergencies among commercial air travelers. JAMA 1990-1999 39. 40. 41. 42. 43. Cummins R0, Haulman J, Quan L, Graves JR, Bilnowski W, Horan, S. Near fatal yew berry overdose treated with transcutaneous pacing, and digoxin-speci?c antibodies. Ann Emerg Med Eisenberg MS, Horowitz R, Cummins RQ, Ilearne TR. A tale of 29 cities: cardiac arrest and resuscitation. Ann Emerg Med Chesemore KD, White RD and the De?brillator Working Group. De?brillator Failures: causes of problems and recommendations for improvement. AMA 1990(Aug Eisenberg MS, Cummins R0, Ilearne TR, Damon SK, et al. Survival rates from cardiac arrest: recommendations for uniform de?nitions and data to report. Ann Emerg Med Cummis R0, 'I?hies W. Automated external de?brillators and the Advanced Cardiac Life Support Program: A new initiative from the American Heart Association (editorial). AmerJ Emerg Med PAGE 14 0F 24 VllAlz: RICHARD 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. Cummins R0 Ornato, JP, Thies, W, Pepe, PE, ct al. Improving survival from cardiac arrest: the chain of survival concept. Circulation 1991 Cummins R0, Chamberlain DA, Eisenberg MS, Bossaert L, Holmberg S, et al. The "Utstein Style": recommended guidelines for uniform reporting of data from out-of-hOSpital cardiac arrest. Circulation 1991 - (Note; as the product of an international consensus conference this article was reprinted in Annals of Emergency Medicine An abridged version appeared in the Br Heart Eur Anaesthesiol - The article has been translated into German: (Notfall. Empfehlungen zur einheitlichen Datenerfassung bei Herzstillstand-Teil 1 Der ?Utstein-Style?. (Translated by A. Schmidt and W. Dick). Notfallmedizin This German version was reprinted in Intensivmedizin und Notfallmedizin). - The article has been translated into French (?Recommendation pour une description uniforme des donnces concernant l?arret cardiaque extra-hospitalier: le style d?Utstein? (Translated by Carli P, Riou B, Barriot P, Lambert Y). JEUR 1991 Joumal of Emergencies) Cummins R, Chamberlain D. The Utstein Abbey and Survival from Cardiac Arrest: what is the connection? Annals Emerg Med Eisenberg MS, Quimnins R0, Larsen MP. Numerators, denominators and survival rates: reporting survival from out-of-hospital cardiac arrest. Emerg Med 1991 Quan L, Graves JR, Kinder DR, Horan S, Cummins R0. Transcutaneous cardiac pacing in the treatment of out-of?hospital pediatric cardiac arrests. Ann Emerg Med Brown CG, Martin Pepe PE, Stueven H, Cummins R0. Gonzalez and the Multicenter High- dose epinephrine study Groups. A comparison of standard-dose and high-dose epinephrine in cardiac arrest outside the hospital. New Engl Med Cummins R0, Graves JR, Larsen MP et al. The use of transcutaneous pacing for asystolic out-of- hospital cardiac arrest. EnglJ Med 1993;328(May lloekstra, W, Banks, JR, Martin DR, Qmmins R0, Pepe PE, et al. The Effect of First-responder automated defibrillation on time to therapeutic interventions during out-of-hospital cardiac arrest. Annal Emerg Med 1?2 Larsen MP, Eisenberg, MS, Cummins R0. Predicting Survival from out-of-hospital cardiac arrest: a graphical model. Ann Emerg Med Martin DR, Gavin T, Bianco J, Brown CG, Stucvcn H, Pepe PE, Cummins R0, Gonzalez E, Jastremski M. Initial countershock in the treatment ofasystole. Resuscitation 53A.Qimmins, R0. La ?cadena dc sobrevida": un concepto quc puedc salvar vidas. Enero 1993:1245-47. 54. Martin DR, Soria DM, Brown CG, Pepe PE, Gonzalez E, M, Stueven H, Qummins R0. Agreement between paramedic-estimated weights and subsequent hospital measurements in adults with out-of-hospital cardiac arrest. Prehospital and Disaster Medicine 1994; 9:54-7 PAGE 15 0F 24 ll liM VI lAli: RICHARD 55. 56. 57. 58. 59. 60. 61. 62. 63. 64. 65. Martin DR, Mill J, Brown CG, Pepe PE, Gonzalez E, Jastremski M, Stueven H, Cummins R0. Outcome of insulin-treated diabetics receiving epinephrine during cardiac arrest. Am Emerg Med 1994 Mar 12(2). P. 147-50. Dull S, Graves JR, Larsen MP, Horan S, Cumrnins R0. Expected Death and unwanted resuscitation in the prehospital setting. Ann Emerg Med Zaritsky AR, Nadkamy V, Cumrnins R0, Hazinski MF et al. The Utstein style for reporting outcome data for Pediatric Resuscitation. Circulation 1995 ;92(Oct Pediatrics 779, Annals of Emergency Medicine, Resuscitation (simultaneous publication) Appleton GA, Cumrnins R0, Larsen MP, Graves JR. CPR and the Single Rescuer: Should they Call First? or Call Fast? Annals of Emergency Medicine 1995;25(No 4; Biros MH, Lewis RJ, Olson CM, Runge W, Cumrnins R0, Fost N. Informed Consent in Emergency Research: Consensus Statement from the Coalition Conference of Acute Resuscitation and Critical Care Researcher. JAMA (April 26). Idris A, Becker L, Omato, JP, Hedges, JR, Bircher, NG Chandra, NC, Cummins, R0, Hazinski, MF et a1 Utstein-Style Guidelines for Uniform Reporting of Laborartory CPR Research: A Statement for Healtcare Professionals. Circulation (also jointly published in: Annals of Emergency Medicine, Resuscitation (Circulation (November 15, 1996) Benson D, Klain M, Braslow A, ummins R, Grenvik A, Herlich A, et a1. Future Directions for resuscitation research. 1. Advanced airway control measures. Resuscitation Kerber RE, Becker LB, Bourland JD, Cumrnins R0, AP et a1. Automatic external de?brillators for public acces de?brillation: recommendations for specifying and reporting analysis algorithm performance, incorporatiing new waveforms, and enhancing safety. Circulation Cummins R0, Chamberlin D, Hazinski MF, Nadkarni V, Kloeck et a1. Recommended Guidelines for Reviewing, Reporting, and Conducting Research on ln-hospital Resuscitation: the ln-Hospital ?Utstein Style?. Circulation (Joint publication in Annals of Emergency Medicine Cumrnins RQ, Sanders A, Mancini E, Hazinski MF. ln-hospital resuscitation: executive summary. Ann Emerg Med. 1997 ummins R0. Human research on cardiopulmonary resuscitation: current constraints on implementation. New Horiz. 1997 Review. 66.. 67. ummins R0, Hazinski MF, Kerber RE, Kudenchuk P, Becker L, Nichol G, Malanga B, Aufderheide TP, Stapleton EM, Kern K, Ornato JP, Sanders A, Valenzuela T, Eisenberg M. Low-energy biphasic waveform defibrillation: evidence-based review applied to emergency cardiovascular care guidelines: a statement for healthcare professionals from the American Heart Association Committee on Emergency Cardiovascular Care and the Subcommittees on Basic Life Support, Advanced, Cardiac Life Support, and Pediatric Resuscitation. Circulation. 1998 Apr erin JM, Ansell BA, Larsen MP, Cummins RO. Automated external defibrillators: skill maintenance using computer-assisted learning. Acad Emerg Med. 1998 PAGE 16 24 CURRICULUM VllAli' 68. Cummins R0, Hazinski MP. The next chapter in the high?dose epinephrine story: unfavorable neurologic outcomes? Ann Intern Med. 1998 Sep 69. Cummins R0, Hazinski MF. Resuscitations from pulseless electrical activity and asystole: how big a piece of the survivors' pie? Ann Emerg Med. 1998 70. Kloeck W, Cummins R0, Chamberlain D, Bossaert L, Callanan V, Carli P, Christensen J, Connolly B, Omato JP, Sanders A, Steen P. [Special situations in resuscitation]. Arq Bras Cardiol. 1998 Dec;71 Suppl 1:29-42. Portugese. 71. Kloeck W, Cummins R0, Chamberlain D, Bossaert L, Callanan V, Carli P,Christenson J, Connolly B, Ornato JP, Sanders A, Steen P. [Early de?brillation]. Arq Bras Cardiol. 1998 Dec;71 Suppl 1:17? 8. Portugese. 72. Cummins R0, Hazinski MF. Apples and oranges. Ann Emerg Med. 1999 73. Cummins R0.Why are researchers and emergency medical services managers not using the Utstein guidelines? Acad Emerg Med. 1999 74. Kudenchuk PJ, Cobb LA, Copass MK, Cummins R0, Doherty AM, Fahrenbruch CE, AP, Murray WA, Olsufka M, Walsh T. Arniodarone for resuscitation after out-of?hospital cardiac arrest due to ventricular ?brillation. Engl Med. 1999 Sep 75. Cummins R0, Hazinski MF. Cardiopulmonary resuscitation techniques and instruction: when does evidence justify revision? Ann Emerg Med. 1999 2000-2009 76. Cummins R0, Hazinski MF. Guidelines based on fear of type II (false-negative) errors Why we dropped the pulse check for lay rescuers. Circulation. 2000 Aug 22;102(8 77. Cummins R0, Hazinski MF. Guidelines based on fear of type II (false-negative) errors. Why we dropped the pulse check for lay rescuers. Resuscitation. 2000 Aug Review. 78. Cummins R0, llazinski MP. The most important changes in the international ECC and CPR guidelines 2000. Circulation. 2000 Aug 22; 102(8 79. Cummins R0, llazinski MP. The most important changes in the international ECC and CPR guidelines 2000. Resuscitation. 2000 Aug 80. Cummins R0, Hazinski MF.Guidelines based on the principle "?rst, do no harm" new guidelines on tracheal tube con?rmation and prevention of dislodgment. Circulation. 2000 Aug 22;102(8 81. Cummins R0, Hazinski MF. Guidelines based on the principle ?First, do no harm'. New guidelines on tracheal tube con?rmation and prevention of dislodgment. Resuscitation. 2000 Aug 23;46(1- Review. 82. Chamberlain DA, Hazinskj MF and Writing Group from the American Heart Association, European Resuscitation Council, and the International Liaison Committee on Resuscitation. Education in Resuscitation. Resuscitation 2003;59:1 l-43. PAGE 17 0F 24 Vll'Al?' MMINS 83. 84. 85. 86. 87. 88. Ornate JP, McBurnie MA, Nichol et al. and the Public Access Defibrillation Trial Investigators. The Public Access Deli/H'il/ation (PAD) Trial: study design and rationale. Resuscitation Mosesso VN HJ r. Brown LI-I, Greene HL, et al and the Public Access Defibrillation Trial Investigators. Conducting research using the emergency exception?'om informed consent: the Public Access DefibriI/ation Trial experience. Resuscitation Sayre MR, Travers AH, Daya M, Greene L, Salive ME, et al and the Public Access Defibrillation Trial Investigators. Measuring survival sudden cardiac arrest: the elusive de?nition. Resuscitaion The Public Access Defibrillation Trial Investigators. Public-Access Detibrillation and Survival after Out-of?Hospital Cardiac Arrest. Engl Med Cummins R0, Chamberlain D, Montgomery WH, Kloeck WGJ, Nadkami V. International Collaboration in Resuscitation Medicine Circulation Aufderheide T, Hazinski MF, Nichol G, Cummins, R0. et a1. Community Lay Rescuer Automated External De?brillation Programs: Key State Legislative Components and Implementation Strategies A Summary ot?a Decade's Experience for Healthcare Providers, Policymakers,Legislators, Employers and Community Leaders. Circulation 2006;] 13: 1260-1270 BOOKS 1. Cummins R0, Eisenberg MS (eds): The Blue Book of Medical Diagnosis. Philadelphia; WB Saunders, 1985. Cummins R0, Graves .1 R, Austin D, Jr: RapidZap! Automatic De?brillation by Emergency Medical Technicians. Brady Training Publications. Englewood Cliffs, N.J.: 1989 Eisenberg MS, CumminsRQ, Ho (eds): Code Blue: CardiacResuscitation. WB Saunders and Company. Philadelphia; 1986. Cummins R0, Editor; and the members ot?the National ACLS Subcommittee. The 1994 Textbook of Advanced Cardiac _Lit?e Support. American Heart Association, 1994; Dallas Texas. Cummins R0, Editor; and the members of the National ACLS Subcommittee. Handbook of Algorithms and Drugs for Advanced Cardiac Life Support. American Heart Association, 1993; Dallas Texas. Billi JA and Cummins R0, editors, Instructors Manual of Advanced Cardiac Life Support. American Heart Associations; 1994; Dallas, Texas Cummins R0 and Graves JR. ACLS Scenarios: core-concepts for case-based learning. St Louis; Mosby Publishers; 1994. Cummins R0, Editor; and the members ot'thc National ACLS Subcommittee. The 1991-92 Textbook ol?Advanced Cardiac Life Support. American Heart Association, 1994; Dallas Texas. PAGE 18 24 CURRICULUM VITAE: RICHARD 0. CUMMINS. 8. Hazinski MF, Cummins R0. The AHA 1995 (2?1d edition) Handbook of Emergency Cardiac Care: BLS, ACLS, PLS. American Heart Association; 1995, Dallas, Texas. Later editions: 3rd Edition?-1997; Edition--1999; 5th Edition?2000 9. Cummins R0, editor; 2001 Instructors Manual of Advanced Cardiac Life Support. American Heart Associations; 2001; Dallas, Texas 10. Cummins R0, Hazinski, ME. The ACLS-2001 Provider Manual. American Heart Association; 2001; Dallas, Texas 11. Cummins Editor. ?e E_xperienced Providers? Instructor?s Toolkit. 1999; American Heart Association; Dallas, Texas. 12. Cummins R0, Editor; and the members of the National ACLS Subcommittee. ACLSA the Reference Textbook: vol 1 ACLS Principles and Practice; for Experienced Providers._Dallas, _American Heart Association publisher; 2003 (ISBN numbers 0-87493-341-2 and 0-87493-424- 9). AHA catalog number 70-2500 (1 of2 and 2 of 4/03. Above AHA publications can be ordered from the following distributors: banning Bete Company Laerdal Medical Corporation WorldPoim? C, Inc. worldpoint?ecc. com) BOOK CHAPTERS 1. Graves JR, Cummins R0: "De?brillation by Emergency Medical Technicians: A review". In Hafen BQ, Karren KJ (eds) PrehOSpital Emergency Care and Crisis Intervention: EMT-Review. 2nd ed. Englewood, Colorado; Morton Publishing Company; 1983. Denver, Colorado. 2. Cummins R0. "Options to shorten time to definitive care" in: Sudden death in the Community. Eisenberg, MS, et al (eds): traeger Scienti?c Press, 1984. 3. Cummins R0, Graves JR: "De?brillation by Emergency Medical Technicians". In: Heckrnan JD, Rosenthal RB, et al (eds), Emergency Care and Transportation of the Sick and Injured, 4th ed, Park Ridge, Illinois; American Academy of Orthopedic Surgeons; 1987:572-586. 4. Cummins R0, Graves JR Clinical Results of Standard CPR: Out-of-hospital and ln-hospital. In McKaye W, Bircher N, eds. Advances in Cardiac Resuscitatiin. pp. 87-102. New York, Churchill Livingstone, 1988. 5. Cummins R0. "Epidemiology of Sudden Death Outside the Hospital: Implications for prehospital emergency medical systems". In: Proaress in Clinical Pacing. Eds Santini M, Pistolese M, Alliego A. Current Clinical Practice Series 51. Amsterdam; Excerpta Medica; 1988:329-342 6. QumrninsRQ. "Cardiac Arrest during Commercial Air Travel" in Chapman PJC, .Medical Emergencies during gom_mercial Air travel. Churchill, Livingstone; London, 1989. 7. C_ummins R0, Graves JR. "Sudden Cardiac Arrest", in Rakel RE, ed. Conn's Current Therapy. WB Saunders; Philadelphia, 1990. PAGE 19 01:24 UM V'llAIi: RICHARD 0. 10. ll. 16. 17. 18. I9. Cummins R0. "Traveling in Poor Health: cardiopulmonary health problems during commercial air travel" in .long EC (eds) Health Advice for Travelers' Ilealth Alert. American Health Consultants. 1990. Atlanta Georgia. Cummins R0. "Automated External De?brillation" in 'l?extbook of Advanced Cardiac Life Support, 3rd edition; American Heart Association; Dallas, Texas,l990 Cummins R0. "Dementia", In: The Blue Book of Medical Diagnosis. Cummins R0, MS (eds): Philadelphia; WB Saunders, 1985. Eisenberg Cummins RO. "Acid-Base Problems", In: IBID. Mns?g. "Mononucleosis", In: IBID. Cummins RO. "Monoarticular Arthritis", In: IBID Cummins RO. "Systemic Lupus Erythematosus", In: IBII). Cummins R0. "Progressive Systemic Sclerosis", In: IBID. Cummins R0. "Spondylarthropathies", In: IBID. Cummins R0. "Anemia", In: IBID. .Cummins R0: "Ankle Injuries". In: IBID. Cummins R0: "Initial assessment of trauma patients?. in: IBID Cummins R0. "Knee Injuries". In: Eisenberg MS, Copass M, eds, Emergency Medical Therapy, 3rd edition. Philadelphia, WB Saunders, 1987. Cummins R0: "Basic Cardiopulmonary resuscitation?. In: Eisenberg MS, Cummins R0, 110 (eds): Code Blue: Cardiac Resuscitation. WB Saunders and Company. Philadelphia; 1987. Cummins R0: "Transcutaneous cardiac pacing? In: IBID. Cummins R0: In: IBID. anmi? RQ: "Airway management techniques", In: IBID Cummins R0, Graves JR. Prehospital Cardiac Care: European and American perspectives. In Skinner I). Swain A, Peyton R, Robertson C. Cambridge textbook of Accident and Emergency Medicine. Cambridge; Cambridge University Press; 1997 Cummins R0, Chamberlain D. Consensus Development in Resuscitation: the growing movement toward international emergency cardiac care guidelines. In Cardiac Arrest: the Science and Practice of Resuscitation Medicine. Ed by Paradis NA, Halperin II R, Nowak RM. Williams Wilkins; Philadelphia; 1996; 935?951 Cummins R0, Field J. ?Acute Coronary in 'l?extbook ofACl.S. Dallas; American Ilcart Association; 1997 PAGE 2(101?24 UM V?llAli: 0. 28. Cummins R0. Hazinski MF. Public Access to De?brillation: Response to Emergencies at Athletic Events-Economic, Training, and Cost Implications. In I-Estes NAM, Salem DN, Wang PJ (eds). Sudden Cardiac Death in the Athlete. Armonk, NY: Putura Publishing Co., Inc.; 1998: 189-204 OTHER REVIEW JOURNALS 1. 2. 9. 10. 15. 16. Cummin_s R0. A Yank Reads for Pleasure. Brit MedJ Cummins R0. Review of Emergency Medicine: and Clinical Practice by Peter Rosen et a1, 1983. In JAMA 1983;250:3233. Cummins R0. Review of Current and Treatment, by John Mills, Donald Trunkey, Mary 110, 1983. In JAMA 1984;252:2408. ummins R0. Review ol?CurrentEmergencv Procedures, by James R. Roberts and erris Hedges. 1984. In JAMA 1985;254:2477. Cummins R0. Review of Flint's Emergency Treatment and Management, edited by Harvey D. Cain, 1985. In JAMA Cummins R0. Review of Principles and Practice of Emergency Medicine, edited by George R. Schwartz et al, 2nd ed, 1986. In JAMA 1987;257:2096. Cummins R0. Review of?mergen_cy_Medicine: Concepts and Clinical Practice by Peter Rosen et a1, 1987. In JAMA 1988;259:2321 (2nd edition). Cummins R0. Cardiac Arrest: Lessons from the Filth Purdue Conference on CPR and Delibrillation (editorial). of Emergency Medicine l985;3: 171-173. Cummins R0. Cardiopulmonary resuscitation and sudden cardiac death. An annotated bibliography ofthc 1984 literature. Am ofEmerg Med 1985;32485-493. Eisenberg MS, Cummins R0. Termination of CPR in the prehospital arena. Ann Emerg Med Cummins R0, MS. Cardiopulmonary resuscitation--American Style. Br MedJ MS, Cummins R0. Automatic external de?brillation: Bringing it home. Am Emerg Med 1985;32568?569. Cummins R0. Interhospital transfer of acutely ill cardiac patients JAMA CununinsRQ, Crowell R, Shao X. Emergency Medicine in China--l 987. Annals Iimerg Med Cummins R0. High-altitude flights and risk ofcardiac disease. .IAMA (Q and A section). (7L1111111i11s R0. Infection control guidelines for CPR Providers. .IAMA 1989;262(Nov l7):2732- 2734. PAGE 21 01? 24 11M VIIAE: 0. 17. 18. 21. 22. 23. 24. 25. 27. 28. Cummins R0. From Concept to Standard-of-Care? A review ot?the clinical experience with automated external de?brillators. Ann Emerg Med Cummins R0. Expanding the use of automatic external de?brillators to home and community. West ofMed 1987;146:609. Cummins R0. Decision analysis, the Journal ot?General Internal Medicine. and the General Internist (editorial). Gen Int Med 1990;52June-July :512-514 Cunmtins RQ, Eisenberg MS. From pain to reperfusion: what role for the 12-lead Annals Emerg Med Cummins R0, Ornato J, Thies et a1. Encouraging Early de?brillation: the American Heart Association and automated external de?brillators. Ann Emerg Med Cummins RO. Getting ready for the 1992 National Conference on ECC and CPR. Am Emerg Med 1991;92295(May) Cummins R0, Chamberlain DA. The Utstein Abbey and survival from cardiac arrst: what is the connection? Ann Emerg Med 1991 Cummins R0. Matters of Life and Death: conversations between doctors and terminally ill patients. (Editorial). Gen Int Med Cummins R0. CPR as a Medical intervention (Editorial). Am Board Fam Practice 1993;6(Mar- Apr)1137-141 . Cummins,__R0. Guidelines for cardiopulmonary resuscitation and emergency cardiac care, 11: Adult Advanced Cardiac Life Support. JAMA Cummins. R0. Emergency Medical Services and Sudden Cardiac Arrest: The ?Chain of Survival? Concept. Annu Rev Publ l-lealth Chamberlain D, Cummins R0. lntemational emergency cardiac care: support, science, and universal guidelines. Ann Emerg Med 1993;22(Feb Part 1 Cummins R0. Moving towards uniform reporting and terminology. Proceedings ot?the Methodology in Cardiac Arrest Research Symposium. Annals of Emerg Med CumminngO. The Utstein Style for uniform reporting of data from out-of-hospital cardiac arrest. Proceedings ofthe Methodology in Cardiac Arrest Research Symposium. Annals of Emerg Med R0. ?Code Magic" for A Piece ot?my Mind. JAMA 1993;269:3076 . Cummins R0. Code Smoke. Annals of Emerg Medicine . Cummins R0. Red Lips and Painted Toenails. Journal ol?General Internal Medicine 1994; May Issue: pp. Cummins R0. ?Witnessed Collapse and bystander CPR: what is really going on?? (editorial). Academic Emergency Medicine PAGE 22 01' 24 UM VI IAI.: RICHARD 35. 36. 37. 38. 39. 40. 41. 42. 43. Cummins R0. and Ventricular Fibrillation: Lasts Longer, Ends Better (editorial) Annals of Emerg Med 25(June): 833?836. Cummins R0, White RD, Pepe PE. Alil)s and the FDA: Confrontation without comprehendsion? Annals Emerg Med 621-631 Thompson W, Bellamy R, Cummins, R0 et a1. Funding Resuscitation Research. Crit Care Med Cummins R0. Human Research on CPR: current constraints on implementaion. New Horizons Cummins R0, Sanders A, Mancini E, Hazinski MF. Iii-hospital Resuscitation: Executive Summary. Annals Emerg Med (also published in Circulation (April 15, 1997) ummins R0, Hazinski MF. The next chapter in the high dose epinephrine debate: Unfavorable Neurologic Outcomes? Annals Internal Medicine 1998;]29 Sept 15 Issue Cummins R0, Hazinski MF. Resuscitations from pulseless electrical activity and asystole: how big a piece of the survivors? pie? Annals Emerg Med Cummins R0. Review of An Introduction to Clinical Emergency Medicine: Guide for Practitioners in the Emergency Department, edited by Mahadevan SV, Garmel GM. New York: Cambridge University Press; 2005. In Annals of Int Med Cummins R0, Hazinski MF. The Quest for a Terminator. Annals Emerg Med OTHER PUBLICATIONS: REVIEW JOURNALS Cummins R0, Eisenberg MS. A proven concept.. Emergency Cardiac Care: National Faculty Newsletter. American Heart Association. Eisenberg MS. Carter WB, Cummins R0, Bergner L: Dispatcher CPR Instruction via telephone. Emergency Cardiac Care: National Faculty Newsletter. American Heart Association. Pierce .1, Wendt R, Andresen E, lIearne TR, Eisenberg MS, Cummins RQ, Litwin PE, A. Automatic External De?brillation: Lay person use in the home. I Emer Med Services 1986;] 1:58- 60. Cummins R0: ls EMT-D right for you? Cummins R0. Current status of EMT-D. In: Making EMT-I) Work: Proceedings from the University of Iowa Workshop. Part I. Emerg Medical Services Cummins RO. Medical Control. ummins R0, Graves JR, Stults KR: The coming of automatic external defibrillation. In Making EMT-D Work: Proceedings from the University of Iowa Workshop. Part 2. limerg Medical Services 1986;] 1:50?56. Cummins R0, Eisenberg MS, Graves R, Austin I), Damon S. EMT?Defibrillation. Part 3: Achieving Medical Control. Emerg Medical Services PAGE 3.3 24 CURRICULUM V1 RICHARD 0. 10. ll. 12 16. Eisenberg MS, Cummins Latest advances in de?brillation. Resident and Staff Physician. Stults KR, Cummins R0. Choosing between fully automatic or shock advisory external de?brillators. Emerg Med Services Cummins R0, Austin DA, et a1. Training Curriculum for EMT-De?brillation Programs using standard manual de?brillators. Olympia, Washington State Emergency Medical Services Department, 1986. (Copyright King County EMS Division, Department of Public Health). Cummins R0, Austin DA, et a1. Training Curriculum for EMT-Detibrillation Programs using automatic external de?brillators. Olympia, Washington State Emergency Medical Services Department, 1986. (Copyright King County EMS Division, Department of Public Health). Cummins R0, l-lazinski MF. ?Who Better to Implement Public Access De?brillation than EMS Physicians and Directors?? Editorial. National Association of EMS Physicians Newsletter. July, 1998; page 13. Chicago; National Association of EMS Physicians Cummins R0. Editorial commentary on Swor RA, Krome RL. Administrative support of emergency medical services medical directors: a profile. Prehospital and Disaster Med 1990530 (Jan-March). Cummins R0. The ?Chain of Survival Concept: how it can save lives. Heart Disease and Stroke Viderol, N. ?The Defender ot?De?b?. Emergency: the Journal of Emergency Services. (profile of Cummins with interview) Cummins R0. The 1992 ACLS Guidelines: what?s new? What?s different? Coronary Acute Care; Cahners Publishing Company; March, 1993 Cummins R0. Automated external defibrillators: where we?ve been and where we?re going. Resident and Staff Pnysieian Published Abstracts of Scienti?c Research These number more than 50. Available upon need and request. Most eventually appeared as publications in peer-reviewed journals and are accessible through the published article. PAGE 2-101" 24