When more than 1,000 hearts stop nationwide on an average day, what separates those that start again from the others that don’t?
Locally, medical officials say the difference lies in a complete overhaul of heart emergency procedures in the past three years. A rethinking of what first responders should do when a patient’s heart stops has helped bring the county’s survival rate for cardiac arrest calls to 20.5 percent — 31 out of 151 patients in 2012 and 2013, and more than twice the national figure, according to Napa County Emergency Medical Services.
“We’re kind of unique,” Jesse Allured, county emergency medical services specialist, said last week. “It’s an aggressive way of thinking but, I think, extremely successful.”
Cardiac arrest — when the heart stops contracting and blood stops circulating through the body — strikes about 424,000 Americans a year, according to the nonprofit Sudden Cardiac Arrest Foundation. (The condition is distinct from a heart attack, or myocardial infarction, in which a blockage of blood flow to the heart damages or kills cardiac muscle — though cardiac arrest frequently occurs during a heart attack.)
Despite an abundance of ambulance, fire and other first-responder agencies, just one in 10 U.S. patients in 2012 lived long enough to be discharged from the hospital, according to a report by CARES, a registry of cardiac cases jointly compiled by Emory University and the Centers for Disease Control and Prevention.
Improving on that sobering statistic became the first priority for Jim Pointer, who became the medical director of Napa County EMS in 2011 after holding the same position in Alameda County.
The protocol Pointer began teaching local emergency responders, he said Friday, boils down to one basic goal — compressing the patient’s chest rapidly, without delay and without ceasing for even a moment.
This compression-first approach is a break from the so-called A-B-C system long practiced by emergency responders, in which a rescuer opens a patient’s airway, feels and listens for signs of breathing, then attempts to restart circulation through chest compression. The change stems from a policy the American Heart Association launched in 2008, endorsing “hands-only” CPR as easier and equally as effective as the traditional method.
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“Laymen were doing this but it wasted time, so now we just go straight to the C,” said Allured. “Now it’s C-A-B: circulation, airway and then breathing, in that order, which puts the emphasis on compression. ... If you compress the chest, you can buy that person minutes.”
Paramedics, emergency medical technicians and others now are instructed to perform about 110 chest compressions per minute, and are given electronic metronomes to prevent their pace from slowing. A racing-style pit crew system divides tasks, leaving two workers to do nothing but pump a patient’s chest uninterrupted while others take care of keeping the airway open, using the defibrillator or injecting medications.
Even transporting a patient to the hospital takes a back seat to compression and restoring a pulse — a task far more difficult in a moving ambulance than at the scene, according to Allured.
“Wherever someone collapses, that’s where we work on resuscitation,” he said. “If he’s in the middle of a gym, if he’s at church, we do not just pick him up and put him in the ambulance, because that’s the number one way to kill your patient.”
“This was a little hard to sell at first; some people tend to think hospitals have machines that the paramedics don’t have,” said Pointer. “But this is not true (for cardiac arrests); there is almost nothing a hospital can do that can’t be done by paramedics.”
While Napa County’s survival rate is among the highest reported by a U.S. community, the lack of universal cardiac arrest tracking prevents a fuller profile across the country or state, according to Pointer, who said no more than half of California counties keep tabs on heart-stoppage outcomes.
“I think all communities should publicize what they do for their EMS patients,” he said. “It’s not standardized; you have to call every individual agency. I think the public deserves to know how their public agencies are doing.”