Cape towns weigh benefits of automatic CPR units

The Eastham Fire Department responded to a rare high number of cardiac arrests this summer – five in eight weeks. A new piece of equipment the department was testing that performs automated CPR chest compressions, however, proved its worthiness.

EASTHAM — The Eastham Fire Department responded to a rare high number of cardiac arrests this summer – five in eight weeks. A new piece of equipment the department was testing that performs automated CPR chest compressions, however, proved its worthiness, according to fire Capt. Bill Piltzecker.

“We had several saves,” Piltzecker said of the demo machine. Also, in what ended up being a drowning off Samoset Road, the use of the machine allowed rescuers to take the woman they found without a pulse and deliver her to the hospital maintaining a heartbeat on her own, he said. “She ultimately passed away but they kept her alive long enough that her family was able to make a decision as to the donation of organs,” he said.

Now, given the device’s effectiveness, the Fire Department has bought two, one for each primary ambulance, with donations from the firefighters union and the firemen’s association. Other Cape fire departments are buying the devices as well, although cost is still a consideration.

Fire departments reported recently spending between $14,000 and $16,000 for each automated CPR chest compression system.

“We’re trying to talk the town into putting it onto the capital improvement plan,” said Mashpee fire Capt. Joseph Peltier. Peltier said the Fire Department has to consider a number of priorities to fund, one being stretchers. “As of right now, nothing is on the plan. They are expensive.”

CPR is a lifesaving technique used in medical emergencies when a person’s heart has stopped. Cardiac arrest is a leading cause of death in the United States, and the survival of a person in cardiac arrest depends on getting CPR immediately, according to the American Heart Association. A primary part of CPR is continuous chest compressions to maintain a flow of blood to the brain, at a rate of 100 compressions per minute, as recommended by the AHA.

For rescue squads across the Cape, the 100-compressions-per-minute would be administered manually from the time the emergency responders find a patient with no heartbeat until the person’s heartbeat returns, or the person is delivered to the hospital. That 100-per-minute pace can be tiring even for the fittest EMTs, and generally requires multiple people on longer ambulance trips, local fire officials said. Also, with manual compressions there can be room for error on the proper, 2-inch depth of the compressions. Often, too, there isn’t enough room in certain tight rescue locations, such as beach stairs or a stairway from a third floor of a house, for the compressions to be administered consistently.

“Not anymore,” Piltzecker said. “This is a machine. It doesn’t slow down. It doesn’t think. It does each and every compression perfectly. It takes up less room and it frees up another paramedic to start other advanced life support. It’s almost like having another person with you. It’s very simple. It’s quiet. It works.”

On Cape Cod, all the town fire and rescue departments either have, are planning to purchase or are considering purchasing automated CPR chest compression equipment. The idea is not new, local fire officials said, but older versions of the equipment were powered by oxygen packs, similar to what firefighters use to breathe when entering a burning building. The newer technology uses rechargeable batteries and is lighter, at 17 pounds, more compact, carryable in a backpack and more affordable, local fire officials said.

“It’s practically impossible to do perfect CPR on someone, as far as compressions,” Bourne Shift Deputy Fire Chief Paul Weeks said. “The machine really does mechanically what we can’t do physically.” Use of an automated chest compression machine can significantly reduce the possibility of rib fractures that occur at times with manual compressions, Piltzecker said.

The LUCAS 2 chest compression system, made by Physio-Control, is a popular choice among Cape Cod fire departments. With the LUCAS 2, a person who needs CPR chest compressions is placed on his back, on a hard plastic shoulder board. Then the wishbone-shaped equipment is placed over the patient, secured on each side of the shoulder board, and a piston with a suction cup is lowered onto the person’s chest. A button on the device starts the piston moving up and down for the compressions.

In 2015, in addition to Eastham, departments in Dennis, Falmouth, Yarmouth, Sandwich and Provincetown bought one or more LUCAS 2 devices, usually one for each ambulance in active use. The Barnstable Fire Department purchased one LUCAS 2 last year for its primary ambulance. The Harwich Fire Department is waiting to do a field test of a LUCAS 2 before making a purchase, and the Orleans Fire Department received a $43,000 federal grant in August to buy three LUCAS 2 devices.

“We live so far away from the hospital you can only do CPR for so long,” Provincetown training officer and fire Lt. Othaine Rance said of the 50-minute, one-way ambulance run from Provincetown to Cape Cod Hospital in Hyannis. The trip from Provincetown to the hospital is the longest on the Cape and among the longest in the state, Provincetown rescue paramedic Daniel Notaro said.

“This way the machine just continues,” Rance said. The Provincetown rescue squad was trained in early August on LUCAS 2 machines, and put three in service right after the training. The machines will be shared with the Lower Cape Ambulance Association, a nonprofit group under contract with Provincetown and Truro to provide emergency medical services and transportation to the hospital, said John Thomas, association executive director.

“We work so close with Provincetown,” Thomas said. “Their truck is usually on the scene with our truck.”

Bourne, Brewster and Hyannis fire departments have been using the LUCAS-brand devices in all their active ambulances for the last few years, fire officials said. The Centerville-Osterville-Marstons Mills Fire Department owns three of the older LUCAS devices, which use oxygen cylinders.

Two fire departments, Chatham and Cotuit, use a different type of equipment, manufactured by Zoll, which uses a chest wrap around the patient, rather than a push-down of a piston, to compress not only the heart but all the large blood vessels in the chest, like “a really expensive hug.”

“Fortunately, we don’t have that many cardiac arrests,” Chatham Deputy Fire Chief Pete Connick said. “Cost is always a drawback. But cost versus benefit, the benefit significantly outweighs the cost. They do phenomenal CPR.”

Generally, fire officials reported they would typically use an automated CPR chest compression device two to three times a month, or less, and usually for heart attacks. Another reason might be drownings or near-drownings. “Many more people have heart attacks than drown,” Connick said.

One surprising benefit of the automated chest compression systems is increased rescuer and patient safety in the ambulance, and decreased rescuer injuries, local fire officials said.

“The most vulnerable place to be is the back of the ambulance, standing up in the middle, leaning over, doing CPR,” Harwich EMS Officer Rob Sanders said. In the case of a front-end collision with the ambulance or even with the brakes slammed on, the rescuer doing manual CPR compressions is a “projectile,” Sanders said.

“Now they can put their seat belt on,” Yarmouth EMS Officer James Roberts said.

Courtesy of CapeCodTimes.com

By Mary Ann Bragg
mbragg@capecodonline.com

October 18. 2015 2:00AM

 

— Follow Mary Ann Bragg on Twitter: @maryannbraggCCT.