Emergency crews using ‘pit crew’ approach and ‘hands only’ CPR

Emergency medical crews in Wichita and Sedgwick County are borrowing an idea from NASCAR, and it’s getting strong early reviews.

But it’s a change in how CPR is administered by the crews that figures to be noticed more by the average resident, officials say.

Mouth-to-mouth resuscitation is no longer given as a part of CPR when someone has suffered a heart attack, said Sabina Braithwaite, a physician and medical director for Sedgwick County EMS. Many people were reluctant to place their mouth on a stranger’s mouth to blow air into their lungs.

“It turns out it’s not that important anyway,” she said of the mouth-to-mouth component in cardiac cases. “We’re focusing on the compressions.”

Studies have shown patients have better outcomes if someone is giving consistent chest compressions — between 100 and 120 a minute — in the immediate aftermath of a heart attack, Braithwaite said.

The American Heart Association and the Red Cross both recommend the “hands-only” CPR in cases where someone has suddenly collapsed. The Red Cross began promoting the method for cardiac cases in 2010, and the American Heart Association approved it in 2008 for bystanders who didn’t want to perform mouth-to-mouth.

EMS officials hope the change in CPR will make bystanders more willing to help if they happen to be nearby when someone has a heart attack.

“It’s really fine and dandy if your heart and lungs make it,” Braithwaite said, “but if your brain doesn’t survive, that’s really not good.”

The change in internal pressure in the body caused by compressions prompts the body to inhale small but sufficient amounts of oxygen in the minutes immediately following a heart attack, she said.

“The passive ventilation is enough to keep the patient oxygenated while we’re getting the heart primed” for a procedure such as defibrillation, she said.

Dispatchers have been taught how to instruct residents who call 911 how to properly do the chest compressions, Braithwaite said, and there are smartphone applications available as well.

“It’s easier for dispatch to give those instructions,” Lt. Greg Gering said. “All they have to do is press on somebody’s chest fast and hard.”

EMS crews have been given metronomes to set up and help them time compressions.

“They’ve done that in New York City,” Braithwaite said. “Just the metronomes alone bumped up the survival rate.”

EMS crew members say the change has been easy to make.

“This has been one of the least painful transitions we’ve ever had” with a change in treatment protocols, Gering said. “It’s very natural.”

Having to do mouth-to-mouth “ actually slowed down the pace for us,” he said.

‘Pit crew’ approach

Another change in protocols should also improve survival rates, Braithwaite said.

EMS crews now use the “pit crew” approach, meaning each person has a specific role on a call. Two people alternate doing compressions for two minutes each while a third monitors the victim’s breathing and airway.

“Tired people don’t do good CPR,” Braithwaite said. “And good CPR is the most important thing.”

Crew members like the pit crew approach.

“It puts us in a better position to do our job more efficiently,” Gering said.

Lt. Brian Falco called it “a lot cleaner, a lot more organized.”

“This seems to be more cohesive,” he said. “All of us are reading from the same sheet of music. That, in turn, results in better care out in the field.”

A review of cardiac cases in Wichita the first three months of this year showed all 11 patients who received bystander CPR and then defibrillation in the field survived, Braithwaite said. Nine of the 11 were able to go home and function independently.

The phrase “in the field” is meaningful, Braithwaite said, because crews do all they can to stabilize patients where they’re found. The days of simply trying to keep someone going until they can get to the hospital are gone.

“We can bring you everything ... to wherever it is that you dropped,” Braithwaite said. “We give you every chance you have right there.”

Ambulances in Wichita and Sedgwick County come equipped with 12-lead EKG machines, so crews can read heart function and confer with doctors at local hospitals on proper treatment.

“If we can’t get you resuscitated in 20 to 30 minutes there; then dragging you to the hospital doesn’t change that,” Braithwaite said.

One key reason crews focus on reviving at the scene is because it’s tough to do effective CPR on the move, she said.

“I remember when I started doing this, if you were in cardiac arrest, you were dead,” Braithwaite said. “People did not come back from that.

“We’ve learned enough that we can bring people back and get them back in good shape.”

This story was originally published July 29, 2012 at 5:00 AM with the headline "Emergency crews using ‘pit crew’ approach and ‘hands only’ CPR ."