The Courier-News has a lengthy article about cardiac protocols for Elgin EMS:
The goal for fire departments used to be to getting a patient in cardiac arrest into an ambulance and off to treatment at a hospital as soon as possible.
“But what studies found was that patient outcomes were much worse, because it is impossible to do high quality CPR when moving a patient, or in the back of an ambulance as it bounces down the road,” Elgin firefighter/paramedic Chris Kennedy said. “Along with this, the hospitals gave paramedics more and more skill sets to get to the point where what we can do in the field nearly equals what an ER will do for a patient in full arrest.”
So, in the last few years, the Elgin Fire Department has shifted its procedures for cardiac arrest care in the field, is incorporating new technologies into the process, has upped training to include in-house sessions, and intends to be working more to get the word out about the importance of everyone knowing CPR.
Kennedy said that during 2012-2013 the EFD responded to 108 calls for a patient in cardiac arrest where paramedics attempted resuscitation. In a typical year, the department heads to about 11,000 calls, about 8,500 for ambulance service, he noted.
“Study after study shows that the most important aspect of cardiac arrest care is high quality CPR delivered with as few interruptions as possible,” Kennedy said. “CPR, coupled with shocks delivered from either a cardiac monitor or an AED, has the greatest impact on return of spontaneous circulation (ROSC) rates.”
Pit crews on call
To that end, the department now uses NASCAR-like pit crew style for running a full arrest call.
“The goal of the pit crew is to assign specific jobs to paramedics and EMTs in a full arrest scenario in order to make sure that the highest quality CPR can be delivered in the location where the patient arrested,” Kennedy said. “This makes sure that there is no delay in lifesaving care.”
This process also means that on cardiac-related ambulance calls a fire engine most likely will show up on the scene, too, to provide the extra needed hands. And in some cases fire engines might be first on the scene as newer rigs have been equipped with advance life support (ALS) equipment.
Cutting-edge monitors
“All front line ambulances — and one ALS engine — now have the Zoll X-series monitor,” Kennedy said. “These monitors are cutting edge and were originally designed for helicopter transports. They allow crews to defibrillate, monitor capnography (how well a person is perfusing at the cellular level) and record all other vitals.”
This also allows paramedics to capture 12 lead EKGs in the field and send them to the emergency room via cell phone so an ER doctor or cardiologist can review them and prepare for the patient before paramedics even have started transporting.
Further, the department is in the process of switching to an electronic reporting program from Zoll through which paramedics will upload data captured by the monitor directly into the report the hospital receives after the call.
Battalion Chief Bryan McMahan said that the “ePCR” program will allow the department to integrate all its reports, further streamlining operations and increasing efficiencies.
Hypothermia protocol
As far as the advance cardiac care paramedics provide in the field, Kennedy said, “We are fully qualified not only to perform CPR and defibrillation, but we also intubate, start IVs and IOs (interosseous access through the Tibia bone) in order to give life-saving drugs such as vasoconstrictors (epi and vasopressin) or anti-dysrhythmics such as amiodarone that help the heart reset into a perfusing rhythm.”
Added to the department’s SOPs about a year ago was a hypothermia protocol.
“A study in 2002 showed that patients who were artificially cooled after being in full cardiac arrest and experiencing a ROSC had better neurological outcomes,” Kennedy said. He explained the theory behind this protocol is that as the body temperature drops, the metabolic demand from cells drops as well. This drop in demand helps blunt neurological damage to brain cells that have gone without oxygen.
“This is the same theory as to why someone submerged in cold water for long periods of time can be resuscitated successfully, whereas someone who drowns in warm water can’t,” Kennedy said.
If someone is in full cardiac arrest and paramedics achieve a ROSC, they contact the hospital and confirm orders for hypothermia protocol.
“We then start a large bore IV and pressure infuse up to 2 liters of cold IV fluid (the department has installed small refrigerators on the ambulances to house these bags) in an attempt to cool the body down to about 93 degrees,” Kennedy said.
“Hypothermia protocol is not without controversy,” he added. “Two small studies in 2012-2013 showed no difference in outcomes between patients who were cooled and those who weren’t. More research is required to confirm whether or not outcomes are improved significantly by hypothermia protocol.”
thanks Dan
