By Blythe Bernhard
St. Louis Post-Dispatch
ST. LOUIS — The same technology that helps snorers breathe at night can help patients breathe while awake and on the way to the hospital.
Paramedics now are embracing the use of continuous positive airway pressure (C-PAP) devices in ambulances. The C-PAP is less invasive and less expensive than a trachea tube and ventilator. And in emergencies where people have trouble breathing, it gets air in and out of the lungs faster.
The C-PAP machines have been used for years in homes where people with obstructive sleep apnea use them to keep tissues in the back of the throat open as they inhale and exhale. Hospitals also have long used the devices to help people with lung disease.
“It’s a really nifty device and the use in the prehospital setting is fairly new,” said Dr. David Tan, medical director for Abbott EMS, which operates ambulances that serve St. Louis and surrounding counties.
As the technology gained popularity among paramedics, dozens of ambulance companies across the country have invested in C-PAP. Abbott recently placed portable versions of the devices on about 30 of its specialty care and advanced life support vehicles. West County EMS put similar devices in its three ambulances two years ago and have used them 70 times.
The devices involve a mask that is placed over the nose and mouth and an attached hose that is hooked up to an oxygen tank. Air sent through the mask helps open blocked airways in the lungs and can also help push any fluids out of air sacs in the lungs.
Recently local emergency dispatchers received a distress call about a 25-year-old woman having an asthma attack. The case was one where paramedics in the past might have used a breathing tube, which involves sedating the patient.
Intubation, or inserting the tube into the trachea, can be especially tricky in a moving ambulance. Some patients fight against the tube or gag on it so they need to be sedated, and the drugs take time to take effect.
With the noninvasive C-PAP, “this is something we can start in the house and really start treating the patient before we get them in the ambulance,” said William Warsing, lead specialty care transport paramedic for Abbott who treated the woman with asthma.
If the patient’s breathing improves within three to five minutes, they are less likely to need a breathing tube. The woman with asthma improved with C-PAP and didn’t need intubation, Warsing said.
Avoiding breathing tubes can benefit the patient because the tubes put the patient at greater risk of infection and usually guarantee a longer stay in the hospital’s intensive care unit. People with chronic lung disease who get put on a ventilator to breathe can sometimes have a hard time breathing on their own again, doctors said.
“Sometimes the patient doesn’t even know what they’ve been spared,” Tan said.
Training paramedics to use the C-PAP device takes five to 10 minutes. Paramedics consider using the device on patients who are having trouble breathing due to congestive heart failure, emphysema or other lung diseases. It offers a third, intermediate option to the breathing tube or a supplemental oxygen mask used in less serious cases.
The one-time-use C-PAP devices cost about $60 each. The device goes with the patient into the hospital, where it can be hooked up to an oxygen source in the patient’s room.
Emergency room doctors appreciate the time-saving benefits of the devices being used in ambulances, said Dr. Dennis Keithly, chairman of the emergency department at St. John’s Mercy Medical Center.
“These people are in trouble and the sooner you do it the better,” he said.