N.C. EMS increases CPR saves by staying on scene

Remaining on scene for 30 minutes to treat cardiac arrest patients has led to three times more CPR saves in a six-month period


By Kathi Keys
The Courier Tribune

ASHEBORO, N.C. — The community can become a significant link in saving more lives in Randolph County.

A team approach involving emergency services personnel is already proving it’s working for cardiac arrests.

Randolph County had three times more CPR saves during the first six months of this year than in 2013. These saves are individuals in cardiac arrest who are administered CPR on the scene of their collapses and arrive at a local hospital with pulses.

Cardiac arrest occurs when the heart malfunctions and stops beating unexpectedly. Immediate attention is needed by starting CPR right away and, if it’s available, using an automated external defibrillator (AED).

Team focused CPR and a chain of survival — involving Randolph’s 911 telecommunicators, fire departments, rescue squads and Emergency Medical Services (EMS) — is helping the CPR Saves initiative. And those who are making a difference are being recognized for their efforts.

Robin Whatley, Randolph County EMS training coordinator and EMT-Paramedic, said emergency medical personnel no longer “scoop up a CPR patient” and transport them with flashing lights and sirens to the hospital. Fire department personnel, other first responders and paramedics now remain on the scene of a cardiac arrest for 30 minutes.

Studies showed that performing CPR in a moving vehicle was often ineffective, but early CPR involving good, quality chest compressions — with hands-only CPR — is a key element in the chain of survival for cardiac arrest patients.

According to the American Heart Association, other chain of survival factors include immediate recognition of cardiac arrest and calling 911, followed by the early CPR, then rapid defibrillation, effective advanced life support and integrated post-cardiac arrest care.

On scene longer

In Randolph County and throughout North Carolina, EMS was encouraged by the N.C. Office of Emergency Medical Services (NCOEMS) to begin team focused CPR. This meant resuscitation efforts on the scene “rather than during transport as this degrades the quality of CPR and places the crews and the public to unnecessary risks,” Whatley noted.

Randolph County adopted the new standard in July 2013, after training and educating fire department personnel and other first responders, emphasizing the need for good quality chest compressions. Hands-only CPR involves the need to administer 100 compressions per minute and switching who’s giving these compressions every 2 minutes.

“We implemented a pretty significant change in how we operate during cardiac arrest responses. … Either we get return of spontaneous circulation or we pronounce the patient deceased on scene,” said Whatley about the new standard. She became Randolph EMS training coordinator in July 2013.

“I had known for years that paramedics could do most everything for the patients that the hospital and ER doctors could do — intubations, IVs, meds, defibrillation, cardioversion and pacing, if necessary. I experienced running a code ‘lights and sirens’ to the hospital for the physician to say, ‘What have you done and how long have you been doing CPR?’, only to have the physician shortly thereafter pronounce the patient deceased.”

This new on-scene procedure came just months before Randolph Emergency Services’ new medical director, Dr. Jason Stopyra, came aboard. With Stopyra, EMS started looking at ways to improve the quality of care being provided to local residents.

One of these was to focus on CPR saves. Statistics showed that — by remaining on the scene longer to administer CPR — more patients were regaining pulses and maintaining them during transport to the hospital.

From January to June, an average of 42.8 percent of the cardiac arrest cases handled in Randolph County were considered CPR saves in 2014, compared to 13 percent in 2013 before the new on-scene procedures were started. The national average is about 20 percent.

In 2013, monthly percentages ranged from 0 to 25 for the six-month period. In 2014, it was 27 to 67 percent from January through June.

Whatley said the statistics show team focused CPR and chain of survival are working.

Team members

The first member of the team involved in the process is the 911 telecommunicator, who determines from the caller — in 60 seconds — if CPR is needed. If so, the caller is instructed on how to administer CPR until first responders arrive.

“If the caller has had the CPR training, the telecommunicator can refresh what they’ve already been taught,” Whatley said, pointing out the importance of the public knowing what to do.

First responders are the second team members and the initial emergency personnel on the scene. These include members of all local fire departments, Ash-Rand Rescue and Piedmont Triad Ambulance and Rescue. They take over CPR upon arrival on the scene and provide the patient with defibrillation with their AEDs. More churches, schools and businesses have AEDs available today.

The Asheboro Fire Department has “at least three firefighters on the first truck,” said Danny Floyd, assistant chief for safety, about having the necessary manpower to administer CPR. He also noted that they have an advantage because they’re able to respond to medical calls quickly, compared to other areas of the county.

The third team members are the paramedics, who are able to provide effective advanced life support before transport.

Randolph County EMS has been keeping track of team members who have been involved in the CPR Saves initiative since Jan. 1, 2014, a heart designating each “save” in the data, and has begun a CPR Saves recognition program.

In October, Asheboro Fire Department became the first agency to be recognized for reaching the first milestone — having 10 CPR saves and “making difference in the outcomes of the citizens you serve,” according to the certificate which Whatley presented.

All three fire department shifts played a part in the 10 CPR saves, which occurred from April through September this year. “We do more than just fires,” Floyd noted about the department’s many responsibilities. Medical calls are among their increasing responses: 1,305 calls in 2012; 1,581 in 2013, and 2,023 from Jan. 1 to Oct. 28 this year.

“It’s a huge recognition, saving lives,” he said. Asheboro City Council is scheduled to also recognize the city fire department at its Nov. 6 meeting.

The CPR Saves recognition data shows the names of each EMS employee and 911 telecommunicator who have been part of the team for every CPR save in Randolph County, one to seven hearts by their names.

And the data shows CPR saves, from January through September, for each fire department and rescue squad:

* 10 saves — Asheboro Fire Department.

* Nine saves — Guil-Rand Fire Department.

* Five saves — Ash-Rand Rescue.

* Three saves — Franklinville Fire Department.

* Two saves — Climax, Randleman and Tabernacle fire departments.

* One save — Bennett, Coleridge, Fairgrove, Level Cross, Liberty, New Hope, Sophia, Staley and Westside fire departments and Piedmont Triad Ambulance and Rescue.

“It’s making a huge, huge difference in getting people to the hospital,” Whatley said.

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©2014 The Courier-Tribune, Asheboro, N.C.

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