When minutes matter
Speed is essential, we’ve been told time and again, when it comes to getting trained personnel to the scene of medical emergencies.
Whether it’s a case of cardiac arrest, heart attack, an injury accident, or others, the general assumption held by the public is that faster is better in getting emergency responders to a scene and getting a patient to a hospital.
With that as a basic premise, it’s hard to understand why Tampa ambulance was the one dispatched to a “possible heart attack” southeast of Lincolnville over the weekend, when sending Marion’s ambulance obviously would’ve been faster.
Tampa crewmembers had to get up and go to their ambulance; Marion’s crew sleeps within steps of its unit. Both units would have traversed the final miles along unpaved roads, but Tampa’s 18.9-mile route along paved county roads, over a railroad crossing, and through Lincolnville to US-77 was longer and slower than Marion’s 11.9 mile trip along US-56 and US-77.
Also concerning is why Lincolnville first responders, just 4 ½ miles away, weren’t paged out at the same time as the ambulance. Simultaneous callouts of ambulance and first responders are common practice for less serious emergencies, yet six minutes elapsed before a first responder page was issued.
Minutes are most critical when a heart in cardiac arrest is quivering and can’t pump blood. If an electric shock from a defibrillator is administered in the first minute, 90 percent of people suffering sudden cardiac arrest survive.
Each minute of delay after that decreases survival chances by seven to 10 percent.
Immediate, continuous CPR can improve the odds slightly, and the speed in which trained medics can take over from lay people can be an extra edge.
Given that information, Saturday’s best chance at a good outcome appears to have been a nearby first responder equipped with an automatic emergency defibrillator. A Lincolnville fire truck with an AED was en route about eight minutes after the first responder page was issued. That was 14 minutes after the initial ambulance page.
It’s absolutely impossible for anyone to know if that six-minute delay made any difference in the outcome. Accustomed to speed being better, one might wonder, but cases of cardiac arrest have a deadly speed unique unto themselves.
It had to be hectic for dispatchers in the first few minutes after receiving the call. A caller in that situation would surely have been distraught, an extra layer of challenge when trying to get initial location and condition information for a dispatch.
Five minutes after the ambulance page, it was clear from radio transmissions that dispatchers were acting in accord with the latest American Heart Association recommendations. They had been trying to get information about how the patient was breathing. If a patient is unresponsive and breathing abnormally, AHA directs dispatchers to treat it as a cardiac arrest and immediately initiate dispatcher-guided CPR. That’s what they reported doing, right after paging out first responders.
As for speeding to a hospital with a patient in cardiac arrest? That’s not a straightforward question these days.
In March, Rhode Island became the latest to adopt a practice that in some cases delays heading to a hospital for 30 minutes. There’s evidence that staying on scene when CPR has been started and doing it continuously, rather than breaking rhythm to immediately load someone on an ambulance, may improve survival rates. Randolph County, North Carolina, reported three times more cardiac arrest saves over six months with that procedure.
We’re not recommending this — that’s a call for people with far more medical knowledge to make. However, it illustrates that as hard as it is for medical professionals to keep up on everything, it’s even harder for the general public. We tend to fall back on what we think we’ve known for years.
Going beyond cardiac arrest, we’re back in the realm of speedy response and transport. Most times, it goes off just the way it should.
But there have been instances in which rescue units weren’t dispatched to an accident until firefighters have called in to say they should be. Responders have been sent out heading to one address, then sent another direction when they’re on the road. A set of responders different from the initial dispatch has occasionally changed on re-broadcast. Often this falls on callers who give incomplete or inaccurate information. Other times, it doesn’t.
Any system designed to save lives needs to be regularly reviewed and updated. Given the significant change EMS has undergone to a service driven by full-timers, any and all protocols developed for the all-volunteer system we once had deserve a look, and we know some of that has been done.
A full response to many situations involves ambulance, fire, law enforcement, and dispatch, and they all use roads maintained by the road and bridge department, so everyone needs to be at the table, free of turf issues and united in a shared goal to make things work their best for the public.
Dissenters need to be respectfully heard, as there might be something that was overlooked in unanimous agreement. If units are dispatched according to pre-drawn boundaries and service areas, there needs to be something that clears the way when necessary to abandon those.
We won’t pretend to know a whole lot about specific procedures and protocols for all these folks. We don’t. What we know is that public safety and saving lives is demanding for not only the technical aspects, but because of potential consequences. Any call provides an opportunity to ask if something can be better. The answers aren’t always easy, but the rewards are clear, and potentially life-saving.
— david colburn
Last modified Nov. 2, 2017