Data Deployed in Wash. Responders` Quest to Improve SCA Survival
April 25--BAINBRIDGE ISLAND -- When a Bainbridge Island teen went into cardiac arrest in front of his friend while working out in January, the friend immediately started CPR.
Firefighters from Bainbridge Fire Department responded and transported him to care. He survived.
His friend's instinct to start CPR and first-responders' lifesaving efforts helped the teen live and are key components to helping increase the survival rate of cardiac arrests.
Kitsap County is now tracking detailed information on cardiac arrests like this one. The goal is to build a reference to see whether new practices and technology aimed at improving the survival rate are working, said Dr. Scott Davarn, medical program manager for Kitsap County Emergency Medical Services and Trauma Care Council, which oversees the paramedics and EMTs at all county fire agencies and provides ongoing training.
Since tracking started in 2011, Kitsap County's fire agencies have made multiple changes to how they respond to cardiac arrests.
The data shows improving outcomes in one group -- those whose event is witnessed by someone who can immediately call 911 and potentially respond with CPR or an automated external defibrillator. The first year data was collected in 2011, 28 percent in that group survived.
In 2014, the survival rate of that group in Kitsap County was 46 percent.
Without having data to drive evolution and changes, improvements can't be made, said Jared Moravec, Bainbridge Island assistant fire chief.
"You need to have those numbers to look at the trends," he said. "And see if where you are focusing your efforts are giving you a better (survival rate) or not."
Each agency sends its data to Kitsap County EMS, which submits it to a national registry -- the Cardiac Arrest Registry to Enhance Survival, started by the Centers for Disease Control and Prevention and Emory University. Departments can compare their own statistics to others around the country.
CHANGES IN HANDLING CARDIAC ARRESTS
Since Kitsap County's fire agencies have started collecting more detailed information on cardiac arrests, there have been several countywide changes to practices and technology.
One of the biggest changes has been the emphasis on CPR -- both for paramedics and bystanders. CPR is now broadly recognized as one of the keys to improving outcomes during a cardiac arrest.
"CPR is the one variable that's not a variable," said David Coatsworth, Bainbridge Island firefighter and paramedic. "It's got to be done."
In 2012, the Kitsap County EMS's protocol changed to use CPR that focused on chest compressions and skipped mouth-to-mouth. It is known as high-density CPR and is recommended by the American Heart Association.
Medical officials were finding bystanders didn't want to do CPR because they didn't want to do mouth-to-mouth, Davarn said.
In 2012, county 911 dispatchers stopped asking callers if they felt comfortable performing CPR and started walking them through the process. Knowledge of the practice was considered so vital that a year later, the state enacted a law requiring high school students to learn CPR before graduation.
Improved technology has also played a role. In 2014, Harrison Medical Center began receiving heart readings from emergency responders at a scene. This allows doctors to determine whether patients need surgery for blocked arteries before they arrive at the hospital.
The new technology has allowed fire departments to "grease the skids," Coatsworth said, and to start preparing patients for surgery on the way to the hospital.
Two county fire departments -- North Kitsap Fire and Rescue and South Kitsap Fire and Rescue -- don't have the ability to send their heart readings to the hospital yet.
The Harrison Medical Center Foundation wants to change that.
The foundation is looking at bringing more tools to add to the county's arsenal, including updating heart-reading machines, providing CPR machines and launching a mobile app.
The cost of the new technology is estimated at about $1 million, said Stephanie Cline, the foundation's executive director.
The CPR machines would provide nearly-perfect CPR at the proper speed and depth -- 100 compressions a minute at a depth of 2 inches -- and can perform accurate chest compression while a patient is in an ambulance, Cline said.
The goal is to supply each of the county's fire agencies and the hospital with a CPR machine.
The foundation also wants to launch an app, called PulsePoint, that aims to alert those who know CPR when they are in the proximity of someone experiencing cardiac arrest in a public location.
PulsePoint also would notify users where the closest automatic external defibrillator, or AED, is.
The app is currently working in Spokane and Portland. Kitsap County would be the first in Western Washington to use the app.
INCREASING SURVIVAL RATES NO EASY TASK
While the goal of PulsePoint and other recent changes is to improve survival rates across Kitsap County, living through a cardiac arrest is rare.
Less than 8 percent of people who suffer cardiac arrest outside a hospital survive, according to the American Heart Association.
Without CPR to push blood through the body, a patient can have severe or fatal brain damage in about five minutes, Davarn said.
"They are all technically dead," he said. "We are actually resuscitating people who are dead."
In 2011, 131 people in Kitsap County had cardiac arrests related to heart problems not related to other trauma or brain aneurysms.
About 21 of the 131 victims -- 16 percent -- survived.
The state had about a 13 percent survival rate that same year, while the national rate was 10 percent.
In 2014, the county had a cardiac survival rate of about 15 percent. The state's survival rate was 17 percent and the national was 10 percent.
DEPARTMENTS BY THE NUMBERS
Individual department collect their own data, but that data is difficult to draw conclusions from because of the small sample size, Moravec, Bainbridge's assistant fire chief, said.
The island had 10 or fewer cardiac arrests each year from 2011-2013. Each county fire agency has had fewer than 60 cardiac arrests a year during those three years.
Even fewer are the witnessed cardiac arrests, where someone can call 911 and perform CPR on the victim.
South Kitsap Fire was the only county department to have more than 10 witnessed cardiac arrests in any one year from 2011-2013. In 2012, it had 55 cardiac arrests, 15 of those witnessed. Seven of those people survived.
Davarn has encouraged local fire departments to think of cardiac arrests like house fires, which require multiple crews to manage the scene. Part of this is because high-density CPR is labor intensive.
The American Heart Association recommends doing high-density CPR at 100 compressions a minute at a depth of 2 inches, switching individuals every two minutes if possible.
Fire departments require plenty of hands to cycle through CPR, as well as take a heart reading, provide medication if needed and talk with hospital officials.
Bainbridge Island Fire doesn't consider any fewer than eight responders enough for a cardiac arrest, Coatsworth said.
The rest of the county fire agencies have a range of four to nine responders, with the option to call for additional help.
Regardless of how many responders are on scene, all Kitsap County fire agencies attempt to restart a patient's heart before going to the hospital, because proper CPR is difficult to do in an ambulance traveling 60 mph down the highway.
Even when CPR is done correctly it has 25-30 percent the efficiency of a normal beating heart.
"The firefighters don't have a stable platform to do effective CPR," Coatsworth said. "And the patient probably doesn't have a very good chance of survival."
Coatsworth knows this from more than 30 years of experience as a firefighter.
Now, he and his fellow firefighters will be watching the county's new data collection for signs on how to save more cardiac arrest victims.
Copyright 2015 - Kitsap Sun, Bremerton, Wash.
