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Save rates up for heart attack patients

New technology, medical advancements and training combine to save lives


by: OUTLOOK PHOTO: MARA STINE - Firefighter/paramedics Greg Renfro and Andrew Nguyen set up a new machine that performs CPR on patients. Thanks to a combination of new technology and better training, heart attack patients treated by Gresham firefighters and paramedics are far more likely to survive.

A whopping 43 percent of patients, or slightly more than four out of every 10 patients who have no pulse when firefighters arrive, have one when crews get them to a hospital. This field survival rate, as firefighters call it, was only 5 percent 10 years ago, or about one out of every 20 patients.

“Ten years ago, when we got someone to the hospital with a pulse, we brought them to a City Council meeting,” said Jason McGowan, a battalion chief with Gresham Fire & Emergency Services. “It was a big deal. Now we have about seven a month.”by: OUTLOOK PHOTO: MARA STINE - Battalion Chief Jason McGowan

Nationally, the field survival rate is about 30 percent, or roughly three out of every 10 patients.

By comparison, Gresham’s numbers are 13 percent higher.

So what’s the secret to Gresham’s success treating heart attack victims?

It’s a combination of advancements in everything from technology to how CPR is administered, coupled with improved training from within the fire department, McGowan said.

Efficient CPR

About five years ago, the department took note of a new trend in business management aimed at improving efficiency. They recorded a mock CPR scenario to see how firefighters and paramedics could improve their response, and as a result, each firefighter and paramedic was assigned one specific duty with one person in charge. “Kind of like a pit crew,” McGowan said.

This resulted in a faster response and less confusion about who is doing what.

It’s been so successful, the model — called crew resource management — has been adopted by fire departments, fire districts and paramedics throughout Multnomah, Clackamas and Washington counties, said Dr. Jon Jui, Multnomah County’s physician adviser who oversees emergency medical services for the county, Portland, Gresham, American Medical Response and the Bureau of Emergency Communications center.

Jui’s job, in short, is to optimize emergency medical care for citizens countywide and he’s beyond impressed by the success Gresham Fire & Emergency Services has achieved.

“They are on the front line of cardiac arrest management,” he said.

Gresham firefighters and paramedics are using advanced technology to administer medicine for heart attack victims. Standard intravenous delivery requires a vein but valuable time can be wasted trying to find one suitable for an IV, McGowan said.by: OUTLOOK PHOTO: MARA STINE - Instead of administering drugs intervenously through a vein, which can be hard to find or not working very well, firefighters now use this device called a bone drill to drill a needle into the top of the shin bone.

Now, they are using a tool that looks like a needle, but is actually a tiny drill that’s inserted into the leg bone just below the knee. It’s fast, easy and effective, allowing medicine to be administered in about 30 seconds to one minute.

The department also uses a new tool to establish airways. Called the King Airway, it can be administered by a firefighter who is not a trained paramedic, as opposed to the prior tool that only paramedics would use. It’s also faster to administer and includes a small inflatable balloon that prevents fluids from coming up.

This saves precious seconds otherwise spent clearing the airway, a process that requires firefighters to stop performing CPR.

Cool, right?

Speaking of cool, Gresham firefighters and paramedics also are cooling saline used for cardiac arrest patients. It helps cool the heart and brain, preserving function, much like those drowning victims we all hear about who survive minutes under water due to freezing temperatures, McGowan said.

New CPR machines

Lastly, the department is responding to advancements in CPR. by: OUTLOOK PHOTO: MARA STINE - The new LUCAS provides consistent continuous chest compressions and never gets tired like firefighters do. New CPR standards call for twice as many chest compressions per minute as before, which can really tire a person out. Firefighters trade off every two minutes to make sure the compressions are given fast enough and with enough pressure. But during those trade offs, a few seconds of chest compression are lost. Plus, it’s impossible to perform CPR on some surfaces, such as stairs or a hill.

So last month, the department began training on how to use its two new mechanical CPR devices, making Gresham Fire & Emergency Services the first fire department in the county to have this technology. Next year, all of the ambulances in the AMR fleet will have them, too, Jui said.

The tool provides “absolute consistency,” Jui said, even while transporting a patient from, for example, the ground to a gurney.

It also can continue to be used at the hospital while doctors remove blood clots in order to restore blood flow to the heart, McGowan said.

“For some cases, it can be life saving,” he said.

The two machines cost between $12,000 and $15,000 each and were paid for through the fire department’s equipment fund.

Jui said only 20 percent of large urban centers have this technology. Rural areas tend to invest in them because they typically have only one station, whereas larger urban areas have many fire stations.

Gresham is strategically placing the machines at two of its six stations, as well as a jointly staffed station with Portland, so the machines are readily available on either end of the city. “It would be nice to a have seven or eight of the machines,” McGowan said, but the city can’t afford it.

Jui said it’s a combination of all of these advancements that have helped improve survival rates for heart attack victims in Gresham, as well as the other cities served by Gresham Fire & Emergency Services, including Troutdale, Wood Village and Fairview.

CPR time cut in half

McGowan estimates that with the advancements, it now takes firefighters and paramedics half the time to establish airways and administer medication as before.

That’s huge both from a life-saving perspective and a service-provider perspective, he said.

Because at least six firefighter/paramedics are needed to perform CPR on a heart attack patient, Gresham Fire deploys two engines, each with three firefighter/paramedics, to every heart attack call.

“That’s a third of our resources for an area of 140,000 people,” McGowan said.

So the sooner a patient is treated, the sooner those firefighters and paramedics can be available to respond to other emergencies.

And that’s music to Bill Hay’s ears. by: OUTLOOK PHOTO: JIM CLARK - Gresham resident Bill Hay, 62, is thrilled by the new advances in technology and training at Gresham Fire & Emergency Services that has resulted in higher survival rates for heart attack patients. Hay had a heart attack 20 years ago and had emergency bypass surgery. He passed a heart stress test last week with flying colors.

The longtime Gresham resident had a heart attack 20 years ago while out for a walk with, of all people, then fire-chief Jim Foreman.

An emergency bypass surgery saved his life. Since then he’s seen his three children grow up, and have fulfilling careers and families. He’s also joined his wife, Mary, working in their home-based Montessori school, the Golden Montessori School.

Just last week, Hay, now 62, passed a nuclear stress test with flying colors. But with his medical history he knows the day could come when firefighters are once again working to save his life.

“All that technology is worth it if it brings one of us back,” Hay said. “And you never know when it might be you.”



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