EMS crews sav­ing car­diac pa­tients

Re­spon­ders fo­cus on team­work

Northwest Arkansas Democrat-Gazette - - NORTHWEST ARKANSAS - SCAR­LET SIMS

FAYET­TEVILLE — When hearts stop in Wash­ing­ton County, emer­gency re­spon­ders are ready with a plan, Cen­tral EMS Chief Becky Ste­wart said.

“It’s the sim­plest thing we can do,” Ste­wart said. “It doesn’t cost any money — it’s just fo­cus­ing on team­work. It’s just like a pit crew — ev­ery­body has a job, and it gets done.”

Emer­gency work­ers from mul­ti­ple de­part­ments are work­ing to­gether on a new ini­tia­tive fo­cused on start­ing and keep­ing com­pres­sions go­ing and get­ting pa­tients to hos­pi­tals with pulses, of­fi­cials said.

The ef­fort could save more lives, Ste­wart said.

Na­tion­ally, emer­gency re­spon­ders at­tend to 350,000 car­diac ar­rest pa­tients out­side of hos­pi­tals yearly, ac­cord­ing to the Amer­i­can Heart As­so­ci­a­tion. Cen­tral EMS emer­gency work­ers were called to 93 car­diac ar­rest emer­gen­cies last year.

Car­diac ar­rest is when a per­son’s heart stops func­tion­ing and may not be re­lated to the block­age of blood to the heart, which is called

a “heart at­tack,” ac­cord­ing to the as­so­ci­a­tion’s web­site.

The na­tional sur­vival rate was about 12 per­cent last year, ac­cord­ing to the as­so­ci­a­tion’s statis­tics for car­diac ar­rests out­side of a hospi­tal. The rate is linked to whether a pa­tient’s blood is still cir­cu­lat­ing when he ar­rives at the hospi­tal, of­fi­cials said.

Get­ting blood cir­cu­lat­ing gives emer­gency work­ers or hospi­tal staff more time to find the un­der­ly­ing cause of the car­diac ar­rest and fix it, said Tammy East, qual­ity im­prove­ment co­or­di­na­tor for Cen­tral EMS.

About a year ago, nearly 33 per­cent of car­diac ar­rest pa­tients had a pulse when Cen­tral EMS de­liv­ered them to Wash­ing­ton Re­gional Med­i­cal Cen­ter, ac­cord­ing to Cen­tral EMS fig­ures.

The per­cent­age jumped to 60 per­cent in Jan­uary when Cen­tral EMS and other emer­gency of­fi­cials be­gan a co­or­di­nated ef­fort called “pit crew,” Ste­wart said.

Ste­wart said the ac­tions and team­work are rem­i­nis­cent of race car main­te­nance teams.

Each emer­gency worker, in­clud­ing fire­fight­ers, plays a spe­cific role and takes turns in re­sus­ci­ta­tion, of­fi­cials said. Each has an as­sign­ment — like com­pres­sions, an­swer­ing the ra­dio or treat­ing the pa­tient’s air­way, said Mauro Cam­pos, Fayet­teville Fire De­part­ment spokesman. The as­sign­ments ro­tate ev­ery 5 min­utes, he said.

Cam­pos is the bat­tal­ion chief over the train­ing divi­sion at the fire de­part­ment. Fire­fight­ers are trained paramedics or emer­gency med­i­cal tech­ni­cians and work with Cen­tral EMS.

The pit crew idea came from a new Clin­i­cal Task Force Com­mit­tee cre­ated about eight months ago, Ste­wart and East said. The com­mit­tee in­cludes rep­re­sen­ta­tives from Cen­tral EMS, emer­gency de­part­ments, dis­patch­ers, Wash­ing­ton Re­gional and air evac­u­a­tion, she said.

The hospi­tal is work­ing with Cen­tral EMS to im­prove the care of car­diac ar­rest pa­tients, said Danita Mullins, emer­gency ser­vices di­rec­tor, in an email. No fur­ther com­ment was avail­able from the hospi­tal.

Cen­tral EMS Capt. Star But­ler said fire de­part­ments and Cen­tral EMS co­or­di­nate ef­forts. That in­cludes train­ing to­gether, Cam­pos said.

The key is to fo­cus on im­me­di­ate and un­in­ter­rupted car­diopul­monary re­sus­ci­ta­tion and med­i­cal care, But­ler said.

“It’s just try­ing to be more ef­fi­cient, more pro­fes­sional [and] be­ing more cog­nizant of spend­ing more fo­cus on the qual­ity of the CPR,” But­ler said. “That in­cludes try­ing not to have any in­ter­rup­tions.”

That in­cludes stay­ing longer on scene, Ste­wart said. It can take up to 40 min­utes to re­store cir­cu­la­tion and be able to move the per­son, East said. Com­pres­sions are not as ef­fec­tive in­side the am­bu­lance, Cam­pos said.

Work­ing longer on pa­tients at the scene could worry fam­ily mem­bers, but the method works, But­ler said.

It means com­pres­sions are not in­ter­rupted — not to check pulse, not to load the per­son into the am­bu­lance, not dur­ing the drive to a hospi­tal, East and But­ler said. The im­por­tant thing is to get the blood flow­ing, But­ler said.

“TV tells us that we need to go to the hospi­tal, but to get the pa­tient to the hospi­tal the pa­tient needs to have that heart rate and that pulse,” she said. “For us, the ul­ti­mate goal is to get a heart­beat, a pulse.”

The trend among emer­gency re­spon­ders na­tion­ally is to get the heart ac­tive again be­fore tak­ing a per­son to the hospi­tal, Cam­pos said. Cam­mie Marti, di­rec­tor of Qual­ity and Sys­tems Im­prove­ment at the Amer­i­can Heart As­so­ci­a­tion, said emer­gency work­ers also must work fast to get pa­tients to a hospi­tal.

Lo­cal emer­gency ser­vice agen­cies are do­ing a “phe­nom­e­nal job,” es­pe­cially with pa­tients hav­ing deadly heart at­tacks, Marti said.

Sev­eral stud­ies have shown a sig­nif­i­cant in­crease

in im­proved sur­vival rates and neu­ro­log­i­cal out­comes us­ing the pit crew ap­proach, said Greg Brown, branch chief for the Ar­kan­sas De­part­ment of Health’s Pre­pared­ness and Emer­gency Health Branch wrote in an email.

“We’re putting more em­pha­sis on pro­vid­ing care more ef­fec­tively,” Ste­wart said.

NWA Demo­crat-Gazette/DAVID GOTTSCHALK

Para­medic Doug McCratic (right) trains on in­tu­ba­tion on both in­fant and child man­nequins at the Cen­tral EMS train­ing fa­cil­ity in Fayet­teville.

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