New EMS protocols call for more on-site cardiac arrest resuscitation
ROCKINGHAM – As paramedics respond to a call involving cardiac arrest, neighbors gather outside the house expecting a swift removal of the patient from the house to the ambulance and then a race to the nearest hospital emergency department.
Matthew Harmody, M.D.
This is a scenario that has been played out often in the four counties – three in North Carolina and one in South Carolina – where FirstHealth of the Carolinas provides EMS coverage. However, it is less likely to occur now that paramedics have become so proficient in cardiac resuscitation and as ambulances are equipped with state-of-the-art lifesaving technology and medications.
“The goal has always been to get the patient out of the structure or out of the home and into the truck and on the way to the hospital as quickly as possible,” says Matthew Harmody, M.D., the medical director for FirstHealth Regional EMS. “But the American Heart Association has come out with new research stressing the importance of good, continuous CPR as well as early defibrillation.”
According to Dr. Harmody, a board certified physician with Sandhills Emergency Physicians (the physician practice that staffs all three FirstHealth hospitals), that means the on-site paramedics will do everything possible to regain a pulse before even attempting to transport a cardiac arrest patient to a hospital.
“Efforts beyond that are usually futile,” Dr. Harmody says. “There are also a lot of risks involved with driving at high speeds with other people on the road. These are some of the key factors that have caused us to make this change. Quite frankly, EMS can do what we do in the emergency department, the most important thing being uninterrupted CPR, which is difficult on a moving stretcher or in a moving ambulance.”
The change in cardiac arrest protocol is based on research findings from Emory University, the University of Michigan Health System and the Henry Ford Health System in Michigan, and reported in the Sept. 24, 2008, issue of the Journal of the American Medical Association.
Initiated by the Emory CARES (Cardiac Arrest Registry to Enhance Survival) program and funded by the Centers for Disease Control and Prevention, the study was designed to help local officials determine how well their community performed in each link of the American Heart Association’s “Chain of Survival” – the basic steps necessary to resuscitate a cardiac arrest patient properly, quickly and safely.
- Calling 911
- Starting CPR at the earliest possible moment
- Defibrillation (electric shock that restores a normal heartbeat)
- Prompt transport to the nearest emergency department
Dr. Harmody says it is especially critical for someone – a family member or bystander – to perform CPR after calling 911 and awaiting the arrival of EMS. According to the Heart Association, brain death and permanent death start to occur in just 4 to 6 minutes after the heart stops in cardiac arrest, but the situation can be reversed if it is treated within a few minutes with CPR and defibrillation.
“911 centers will instruct family or bystanders on how to perform CPR when they call,” Dr. Harmody says. “And studies have shown that people are more apt to do CPR if they have taken an American Heart Association CPR course. Early CPR is a key survival factor, and with the rural communities that we serve, families can be doing CPR for several minutes prior to our arrival. In essence, their CPR is as good as our CPR – actually better, since it’s sooner.”
A victim’s chances of survival are reduced by 7 to 10 percent with every minute that passes without CPR and defibrillation, and few attempts at resuscitation succeed after 10 minutes, the Heart Association says.
With the new FirstHealth protocols, paramedics can also pronounce the patient dead on the scene if resuscitation attempts fail – without risking other lives in an unnecessary race to the hospital.
“The paramedics have everything on the ambulance that we have in the emergency department,” says Dr. Harmody. “Sometimes patients are clearly dead. There’s no benefit to rushing to the hospital if the patient hasn’t regained a pulse.”
The change in EMS protocol for cardiac arrest resuscitation began March 1 for the FirstHealth EMS programs in Richmond County, Chatham County and Montgomery County, N.C.
In Chesterfield County, S.C., where FirstHealth of the Carolinas also provides EMS coverage, a protocol change is now being considered.
The FirstHealth Center for Health & Fitness-Richmond offers classes in CPR instruction. For more information on dates, times and costs, call (800) 213-3284.
FirstHealth Richmond Memorial Hospital is a division of FirstHealth Moore Regional Hospital.