The Modesto and Stanislaus Consolidated fire departments are testing CPR devices that could conserve manpower, reduce stress on the bodies of personnel and, most important, save lives.
Two engine companies in each department have been trained on Lucas Chest Compression System devices, which fit in a backpack, easily can be set up on a patient and deliver consistent chest compressions all the way from emergency scene to hospital.
Protocols in Stanislaus County have emergency medical services personnel performing CPR up to 40 minutes on cardiac-arrest patients, said Tim Tietjen, Modesto Fire Department division chief of support and EMS. Even using “pit crew” CPR, in which personnel rotate positions every couple of minutes, that’s a lot of wear on knees, backs and shoulders, which can reduce the effectiveness of CPR, he said.
“Where we can set this device up by sliding it quickly beneath the patient’s back and over the chest, and it can do effective compressions during the same time we’re administering other care,” Tietjen said. “It saves us from having to call an additional crew out to a scene to perform CPR. Basically, the goal is not to interrupt the CPR process.”
When CPR is performed manually, there are moments in nearly every case where it’s momentary suspended, said Tietjen and David Dalman, EMS coordinator for both Modesto Fire and Stanislaus Consolidated. Those instances include transferring a patient onto a gurney, going down a narrow hallway or down a flight of stairs, and loading the gurney into an ambulance.
If there is an opportunity to get them (patients in cardiac arrest) back, this is going to give you the best opportunity.
Tim Tietjen, Modesto Fire Department division chief
In all these cases, the device keeps up the compressions.
And because the device snaps into its own rigid backboard, it can be used in circumstances where normal CPR simply would not work. Like in a single-wide mobile home where the bed takes up the entire bedroom space, Dalman said. Effective CPR can’t be administered on a bed because the mattress absorbs the compression.
It also can be used when patients are transported by helicopters, he said. Helicopter crews haven’t taken patients in cardiac arrest because there isn’t the manpower to keep CPR going, Dalman said. Now they can. Whether by air or ambulance, the device “can follow the patient through X-ray, into the cath lab, all the way to surgery,” keeping up that lifesaving circulation of oxygenated blood, he said.
“Where this really comes in handy is when transporting,” Tietjen said. “With pit-crew CPR, you don’t move patients until there’s a pulse. And when you do, they often will rearrest.” (Dalman cited a study that 33 percent of patients resuscitated through CPR go into cardiac arrest again while receiving emergency treatment.)
In December 2016, Modesto Fire responded to 34 calls requiring CPR. November through January typically are the highest months for such calls.
“The heart is like a pump, and you have to prime it like the pump of a well. When you come off the chest for more than 15 seconds, you lose that prime and it takes so many compressions to get the heart where it’s full of blood again, and during that period of time is where you’re having brain death and nonoxygenated blood.”
In the back of an ambulance, for instance, the driver “takes a hard right turn and you’re laying up against the wall and have to get back on and get (CPR) going again. We’re constantly on and off the chest.”
The Lucas compression machines aren’t cheap. Tietjen and Dalman estimated they’d cost between $13,000 and $17,000 apiece. With permission of the Mountain-Valley EMS Agency, the departments are using them on a 60-day trial basis, with an option of extending the trial 30 more days.
“We don’t have these in the budget,” Tietjen said. “Obviously, they’re expensive. It would be $130,000 if I was going to put them on every company and got them for $13,000 each.”
I’ve spoken with personnel in Sacramento, and they like them a lot. ... Fremont, too – they said they rely on them heavily. It’s not the initial tool – manual CPR is always quicker to get started. This is a secondary tool to slide in and continue (CPR) for longevity and during transport.
David Dalman, EMS coordinator for Modesto Fire and Stanislaus Consolidated
He said he’ll likely seek money through Mountain-Valley EMS system-enhancement funds – “I would imagine they’d pay for a couple” – and likely the Federal Emergency Management Agency’s Assistance to Firefighters Grant Program.
“I could put two or three across the city in strategic locations so they could be utilized for CPR calls,” Tietjen said. “That’s the likelihood, is that we purchase one or two if we can find money in our budget,” and perhaps a few more with Mountain-Valley and AFG funds.
At least as early as Wednesday afternoon, a Lucas device already had been used to save a life. A Modesto Fire battalion chief’s report said his department and Stanislaus Consolidated both “responded to the Galaxy Theater in the 2500 block of Patterson in Riverbank for an unresponsive subject. On scene, crews found the patient in cardiac arrest. PIT Crew CPR was started, crews also used the Lucas Chest Compression Device. After several minutes, the patient regained pulses and was packaged and transported to the ER.”