Susan Spencer
Telegram & Gazette, Worcester, Mass.
WORCESTER, Mass. — UMass Memorial emergency physician Dr. Joseph Sabato wants to make Worcester’s city logo, the heart of the commonwealth, mean something more than just geography.
He’s on a mission to train as many people as possible to perform bystander cardiopulmonary resuscitation, or CPR, to increase the percentage of people who survive a heart attack occurring outside the hospital from the state’s current dismal 4%.
Massachusetts’ survival rate for out-of-hospital cardiac arrest is only half the national average rate of 8% to 10%.
In cities such as Seattle, which has coordinated regional medical guidelines for first responders, CPR instruction automatically provided over the phone by EMS dispatchers, high levels of the public trained in CPR; and widely available automated external defibrillators, around 19% - about five times the rate in Massachusetts - of people who have a heart attack outside of a hospital survive and are discharged from the hospital alive.
More than 450 lives could be saved annually in Massachusetts with initial best practice improvements, according to data from Dr. Sabato and his colleague, Dr. Andrew Miller. If national best practices could be achieved, it could save 1,500 lives annually in the state.
The key is getting bystanders to start CPR quickly and effectively.
According to 2014 data from the American Heart Association, nearly 45% of out-of-hospital cardiac arrest victims survived when bystander CPR was administered.
“I call them the ‘Gee, whiz’ figures,” said Jack Franchi, a retired U.S. Air Force sergeant and deacon in campus ministry at Anna Maria College in Paxton, about the vast difference in heart attack survival rates across the country.
Mr. Franchi and his wife, Nancy, who volunteers in the intensive care unit and cardiac intensive care unit at UMass Memorial Medical Center, took Dr. Sabato’s CPR and AED training last November.
Dr. Sabato started offering at UMass Memorial a nuts-and-bolts class, teaching hand-compression-only CPR, with no rescue breathing, in January 2018.
He said it takes about five minutes to teach CPR, compressing the center of the victim’s chest to the beat of the BeeGees’ disco song “Staying Alive,” or 100 to 120 beats per minute.
Another five minutes is spent instructing how to use an AED device.
The American Heart Association’s traditional CPR class takes about two hours, according to Dr. Sabato, and “most people don’t remember most of that stuff at six months.”
He said research shows that the five-minute course is just as effective as the more in-depth instruction.
Mrs. Franchi said she had been trained in CPR years ago but, “I wasn’t comfortable being able to do it.”
The Worcester couple had the chance to use their new training to help save a life just three weeks after they took the class. They were at a wine tasting at Total Wine in Shrewsbury, when the presenter, who was opening a bottle, had a heart attack and fell unconscious over chairs at the head table.
Mr. Franchi described telling people to call 911 and put their phones on speaker, while the couple helped place the victim on the floor. Another participant, who is a first responder, started CPR, continuing until EMT teams arrived.
Having seen the impact of effective bystander CPR, the Franchis plan to become instructors and teach others in community groups they’re involved with.
Dr. Sabato tells people to start CPR right away, before they answer a list of questions from public safety dispatchers. And he says to keep giving compressions, taking a brief rest if necessary, until emergency medical help arrives.
“People who get CPR in the first couple of minutes have the best chance of survival,” he said. For every minute that goes by, survival drops by 10%.
Emergency dispatchers can make a huge difference, he added, but if they don’t have the right protocols to promptly guide bystanders in CPR, it can be too late.
Dr. Sabato, who is medical director of the hospital’s clinical decision unit, launched his campaign at UMass Memorial by teaching CPR to family and friends of high-risk patients in the observation unit.
Since then his team has branched out to local EMS agencies, including Marlboro and Auburn, to work with families of patients at high risk for sudden cardiac arrest who get a “prescription” for CPR instruction.
Worcester legislators have filed bills to improve outcomes for sudden cardiac arrest by requiring all 911 telecommunications dispatchers to be trained in telephone CPR instructions, using the most recent nationally recognized cardiovascular care guidelines.
The bills, H. 1938, sponsored by state Rep. Mary S. Keefe, D-Worcester, and S. 1313, sponsored by state Sen. Michael O. Moore, D-Millbury, also require an emergency medicine physician and a regional EMS expert to participate on the State 911 Commission.
“The goal is to change the 911 system,” Dr. Sabato said.
CPR protocol enhancements would come on top of telecommunication improvements directly connecting wireless callers to their local EMS dispatch agency, without callers having to repeat information and waste precious time as they’re transferred from a statewide or regional public safety access point.
Worcester city officials began talks with Dr. Sabato last year as part of an effort to become a Heart Safe Community, Dr. Matilde Castiel, commissioner of health and human services, said.
CPR training outreach has been done at churches, at events such as the Worcester Cares About Recovery Walk and recovery vigil, and in the Latino community.
Dr. Castiel said that 70% of heart attacks occur at home, and it’s important for people - particularly those who might not speak English, live in poverty or are in recovery, who may face barriers in the medical system, to know how to respond quickly.
The city is trying to build a train-the-trainer approach to spread the knowledge. City Hall employees will have a training later this month.
“I’m thrilled with it,” Dr. Castiel said. “We all as community have an active role to participate in this.”
She said the city is “trying to be a model for the rest of the community.” And maybe, she hopes, if the approach goes well, Worcester would be like the next Seattle.
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©2019 Telegram & Gazette, Worcester, Mass.