Five years after paramedics and firefighters in Charlotte changed how they respond to someone whose heart has stopped beating, first responders say the percentage of patients they’re able to save is outpacing the national average.
For the fiscal year ending in 2014, roughly half of all cardiac arrest patients attended to by Charlotte firefighters regained a pulse, according to the Charlotte Fire Department.
In North Carolina, the average for that year is 35 percent, according to the Fire Department’s annual report. The national average is 15.5 percent.
Paramedics in Mecklenburg County have seen even bigger gains. In 2010, 52 percent of patients whose hearts had stopped regained a pulse after being attended to by paramedics. So far this year, 80.4 percent of such patients regained a pulse.
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“I did CPR for 30 years and never remembered a save,” said Chief Jon Hannan, a certified EMT who’s been a firefighter since 1983. “Now we’re running a 50 and 60 percent save rate. About five or six times a month, somebody walks out of the hospital because of the way we do it now.”
At its core, CPR involves helping an unconscious person breathe and pumping his heart so that blood keeps circulating in the body. For years, CPR protocols focused on breaths, even requiring first responders to stop compressions to breathe into victims’ mouths.
In Charlotte, that started changing on Aug. 27, 2009, when Medic, the county’s paramedic service, required county first responders to switch to “focused CPR.”
Instead of prioritizing breathing, first responders began to focus on chest compressions: Even though someone isn’t breathing, they still have oxygen in their bloodstream.
Over the past five years, they’ve encouraged first responders to form an ad hoc “pit crew,” to attend to patients.
“Everybody has a job,” said Lester Oliva, a spokesman for Medic. “It’s orchestrated. When we used to do CPR, it was pretty much somebody did CPR as long as they could, until they got tired. It wasn’t organized.”
Now, a hockey-puck-size device counts compressions as a team captain makes sure they go at a clip of about 110 compressions a minute, nearly two pumps a second. After every 20 compressions, another firefighter or paramedic gives the victim a puff of air.
Meanwhile, an emergency medical technician delivers drugs that help restart a person’s heart.
After 200 compressions everyone switches. Studies have shown that most people performing CPR tire after 200 compressions, making the CPR less effective.
During the switch, another first responder can decide whether to shock a patient with a defibrillator.
After every interaction, Oliva said, Medic analyzes data to determine which tactics work best.
“We collect data on every call,” Oliva said. “We found that some things work, and some things might work better.”