PIT CREW: South side recipient of life-saving protocol
Published 7:54 pm Saturday, August 2, 2014
CHOCOWINITY — This week, EMS squads and fire departments on the south side of the Pamlico River put a new protocol into practice. It’s one advocated by the American Heart Association. It’s been catching on, slowly but surely across the country. But it goes against what many think they know about cardiac arrest.
“People don’t think about it until it happens,” said Capt. Dana Hunnewell, of Chocowinity EMS. “Basically, they believe what they’ve gotten from TV and movies: the ambulance takes them to the hospital and the hospital brings them back. That’s not true. That doesn’t happen. What this system does is: we are doing everything we can to save someone’s life.”
What Hunnewell refers to is called Pit Crew CPR, an organized method of CPR that assigns a crew of six emergency personnel to specific duties and positions around a cardiac arrest victim. It involves backup personnel, from both EMS and fire departments, for a relay of continuous chest compressions. It involves a paramedic as part of the pit crew, who stands back and assesses the situation, making all medical calls.
What it doesn’t involve is an ambulance ride to the hospital.
“We are not going to leave the scene while we’re doing CPR. We could be there for upwards of an hour. But studies have shown, once you decide to move a patient that you are performing CPR on, their survival rate goes to zero,” Hunnewell said. “CPR is about continuous compressions. Every time you stop, it takes between six to 10 pumps to get blood moving again. The survival rate goes down five to 10 percent for every minute stopped. … Their survival rate is 30 to 40 percent and you keep stopping? That rate goes to zero pretty quickly.”
Stopping to put a patient on a gurney; stopping to wheel a cardiac arrest victim out of the house; stopping to load them in an ambulance — all actions that can drop survival rates simply because chest compressions, thus circulation, must necessarily stop.
The AHA, in 2010, started advocating for the pit crew method: take the medical expertise to the cardiac arrest victims, rather than take the victim to the hospital. As Chocowinity EMS began operating at the paramedic level on July 1 and, so far, 75 EMS and fire department personnel have completed Pit Crew CPR training, on the south side of the river a cardiac arrest victim is better off where they are.
“As far as cardiac arrest is concerned: we do the same thing in that house as they do at the ED (emergency department),” Hunnewell said. “We continue until we get a pulse back or we have done everything we can possibly do.”
At the behest of Beaufort County EMS Medical Director Emilie Pendley, Hunnewell and Capt. Sam Williams, with Aurora Rescue Squad, have led the transition to Pit Crew CPR. Chocowinity EMS, Aurora Rescue Squad, Chocowinity Volunteer Fire Department and Aurora Volunteer Fire Department have all undergone Pit Crew CPR training in the past three weeks. Blounts Creek Volunteer Fire Department personnel will be training this week. The classes are taught by Billy Respess, a Chocowinity EMS paramedic, supervisor for Pitt County EMS and paramedic instructor at Beaufort County Community College. Pitt County paramedics and support personnel have employed Pit Crew CPR for the past year.
“He’s seen it work,” Hunnewell said. “It was good for him to teach it because he has firsthand knowledge.”
According to Williams, Pitt County’s survival rates for cardiac arrests that happen outside of a hospital has jumped to between 30 and 40 percent.
It’s a change they say many might take a while to get used to — the idea of having a heart attack and not being immediately loaded onto an ambulance. For now, Pit Crew CPR will only be used on the south side of the river in Beaufort County. However, as more county EMS squads begin to operate at the paramedic level, the protocol will be applied throughout the county. Paramedics have both the life support equipment and the ability to administer medications — exactly what a cardiac arrest victim would find in an emergency room.
Williams pointed out that chest compressions, however, should start immediately on anyone suspected to have cardiac arrest, before emergency personnel even arrive.
“It’s very important to give chest compressions. You don’t have to do the (mouth-to-mouth) breathing, but chest compressions. That will help us a lot with our success rate,” Williams said.
Pit Crew CPR was launched Friday and will be the standard by which emergency personnel operate in half of Beaufort County.
“If you lose your pulse on the south side of the river, this is what’s going to happen,” Hunnewell said.