Technology: Modelled after a race track’s pit crew, a new form of CPR helped a Colorado, US, fire department save more lives
When a heart ceases to beat and a person’s life hangs in balance, Longmont’s fire department in Colorado, US, turns to an unlikely source for inspiration to restore its rhythm. Just as a team of practiced pit crew members use speed, agility and organisation to return a race car to the track, fire fighters use a similar system that brings order to chaos and seeks to give patients a better chance at surviving. Aptly called the Pit Crew Resuscitation model, the Longmont Fire Department has used the life-saving method for the past five years. The team has been so successful in saving lives that other Boulder County operations have adopted the same model. John Michael, the Longmont Fire Department’s EMS operation lieutenant, first heard about the model while at an EMS conference in Dallas. A doctor told the audience about a conversation with NASCAR pit crew chief and how it steered him toward a revamped CPR model. “It dawned on him then that he could use this system in EMS,” Michael said.
Michael brought the idea back to his Longmont fire team. Since then, fire fighters’ use of the system has continued to save lives. In 2014, a person who experienced a medically induced cardiac arrest in Longmont had a 14 percent chance of regaining a pulse, which was comparable to the national rate, according to Longmont fire spokesperson Patrick Kramer. One year after the system’s implementation, that number jumped to 24 percent; then to 38 percent in 2016; 43 percent in 2017; 46 percent in 2018 and more than 53 percent in 2019.
“(The Pit Crew) has had the biggest single impact on our job and our community,” Michael said. “It’s a huge emotional lift and confidence builder because we are giving someone the best chance of surviving this event anywhere in the nation, compared to the national average.”
Before the Pit Crew model was implemented, only five responders arrived at a given scene. And while the tasks to resuscitate the patient were the same, there was no structure to guide them, Michael said.
The new model designates one of eight roles to the six fire fighters and two paramedics who go to the scene. Each is critical to best attempting to revive someone experiencing cardiac arrest. The roles are designated based on the order first responders arrive at the scene.
The positions include compression, monitoring the airway and IV medications. In addition to watching the person’s vitals, remaining first responders work to make sure the scene stays clear. A liaison is assigned to communicate with family or witnesses, gathering any pertinent information about the events leading up to the cardiac arrest and offering some comfort to them in the process. Kramer said this role is also an important one for keeping people out of the way of first responders’ efforts.
Additionally, a scribe records information and tracks the team’s status. Finally, a person working egress assures the path to the ambulance is clear of any obstructions, like moving furniture or even shovelling a walkway clear of snow. Training is paramount to making sure everyone is ready to do each task.
For Michael the added organisation, delegation of responsibilities and increase in personnel has made the model a success. “We didn’t change any of the medicine we are providing, just the efficiency of how we provide it has made it more effective,” Michael said. “It allows people to focus on more task-oriented things, rather than dealing with the chaos.”
The cost to have one more engine and a three-person crew at the scene of a cardiac arrest is about $365 an hour. “Given our phenomenal resuscitation success, the cost of sending a second engine company to a party in cardiac arrest has proven to be money well spent,” Michael said.
At the same time they implemented the Pit Crew, fire fighters also began using a new piece of equipment called an AutoPulse, which delivers mechanical chest compressions to the patient. According to the American Heart Association, CPR is to be administered for at least 30 minutes. For even a trained professional, delivering compressions by hand can be tiresome. A machine delivers consistent compressions and also frees up first responders to attend to other tasks to help the person in need. While the equipment has been a crucial development, Michael said it is still undoubtedly the work of the crew that is the difference between life and death in the patient.
Of Longmont fire fighter’s calls, 70 to 75 percent are medical related, according to Kramer. On average, the fire department responds to 50 to 60 medically induced cardiac arrests annually. Kramer said the Pit Crew model provides some consistency to a situation that is always unpredictable. “You may be going into a third-storey apartment or a basement apartment. You might be responding at 2h00 to a hoarder house. They may be trapped between the bed and the wall. I can’t even tell you how many variables there are,” Kramer said.
To better understand the model’s success, the Longmont Fire Department also looks at the person’s rate of survival once they reach the hospital. What they found is that of the more than half taken to the hospital with a pulse, roughly 36 percent are well enough to be released. Nationally, the rate of survival for cardiac patients after reaching the hospital is a little more than 10 percent, according to The American Heart Association.
First responders asked whether restoring a cardiac patient’s pulse was enough to justify a new system when the chances of surviving a cardiac arrest were still so slim. “Our crews are really smart and really insightful and they questioned whether this was a value or whether we were just racking up a bill for the family,” Michael said.
If Longmont responders successfully get their patient to regain a pulse, their chances of survival increase drastically, less than 1 percent of people who have not regained a pulse before arriving at the hospital survive, Michael said. The chances of someone surviving a cardiac arrest are also greatly improved if the person who found the patient begins CPR before responders reach the scene. In more than 70 percent of the cardiac arrests in Longmont fire fighters responded to, someone had been doing CPR, Michael said. “That buys us time to get there,” Michael said.
Blazing a trail
Boulder Rural Fire, Boulder Fire and the Boulder County AMR adopted the Pit Crew model after seeing the Longmont Fire Department’s success, Michael said. “Most of the county is going to be doing it the same way and taking the lead from us on making it consistent across the county,” Michael said.
Six months ago, Richard Estep, a training chief and CES specialist with American Medical Response Boulder, began using the Pit Crew Model. Estep said the move was “100 percent” influenced by the success seen at the Longmont Fire Department. “Longmont’s numbers are extremely impressive,” Estep said. “It’s impressive that pulses are regained more often and that more patients walk out of the hospital neurologically intact. It’s good to get a pulse back but it’s better by far when that person goes home to hug their loved one.”
Similar to Michael and Kramer, Estep said AMR had an organised approach to responding to cardiac arrests but the Pit Crew Model fine-tuned it by standardising the process, eliminating some of the stress involved.
Michael said he hopes Longmont’s first responders are proud of what they have achieved using the new model. “It really is indicative of how well we are doing that the agencies around us have taken note and said ‘we want to be at the same level as Longmont,’” Michael said.
Source: Times Call