Longmont Fire Department tracks lives saved in out-of-hospital cardiac arrests
Nov. 12--Aug. 22, 2016, is the day Andrea Shipp and Jennifer Goerlitz thought their little girl would not live another day.
"Nobody knew what the outcome was going to be," Goerlitz said. "I think Andrea and I have lived in this denial stage for a while."
If it hadn't been for the rapid response of Longmont firefighters and paramedics, Clara's mothers don't think their daughter -- who has been diagnosed with congenital myopathy, chronic respiratory insufficiency and gastroparesis, or stomach paralysis -- would have survived a cardiac arrest.
That night, the family was having dinner at 3 Margaritas in Longmont, when they realized their 4-year-old daughter needed to go to the hospital immediately after she began throwing up.
They said they didn't have enough time to take her through town to Longmont United Hospital, so they drove half a mile south to the UCHealth Emergency Room. A doctor dialed 911 because they were not equipped to handle her symptoms, requesting assistance from fire and paramedics.
There, not long after they had left the restaurant, blonde-haired, blue-eyed Clara Shipp stopped breathing, entering into cardiac arrest.
On Monday, Clara played with her 7-year-old brother, Ethan, in the family's living room, smiling, giggling and pushing a toy ambulance across the carpet.
"You would never know that 2 1/2 months ago we didn't know that she was going to live," Goerlitz said.
In the last two years, the Longmont Fire Department has restructured the way they respond to out-of-hospital cardiac arrests, hoping with each call to revive the breaths and pulses of all patients before reaching the hospital.
Since being called to more than 150 cardiac arrests since the start of 2014, the fire department has recorded an increase in survival rates of people whose hearts suddenly stop working.
Just this year -- with 34 attempted resuscitations as of Aug. 18 -- the fire department has transported 15 patients, or 44 percent, to the hospital with vital signs, gradually rising up to be close to the nation's top survivability rates.
'Pit-crew resuscitation'
Clara was their 43rd cardiac arrest patient this year.
For Goerlitz, having Fire Lt. Cyndi Fronapfel hold her hand, explain how paramedics were tending to her daughter and assure her everything would be OK was crucial.
"Her job giving me emotional support was just as important as everyone else," Goerlitz said.
Fronapfel was assigned to be the family's liaison that evening -- now considered a designated role for all cardiac arrest calls since the fire department implemented the "pit-crew resuscitation" model halfway through 2014.
Fire Lt. John Michael, who is in charge of emergency medical services training, said the framework was adapted by an Oklahoma fire department from NASCAR's philosophy that assigning roles helps efficiency and organization.
Laminated sheets -- kept at each fire house -- explain the model by a diagram, with the paramedics and the firefighters circling the patient.
Positions 1, 2, 3 and 4 monitor vital signs, while Position 5 records when medications are administered. Position 6 talks to the family, police and anybody else on scene.
"Right now, the focus is repetition on this training to fine-tune it," Michael said.
The goal is to get up to speed with the nation's best cities -- Seattle and Rochester, Minn. -- reporting a survival rate of more than 50 percent (return of spontaneous circulation and pulses), according to the Sudden Cardiac Arrest Foundation.
The nation's premier EMS system is in Seattle, Michael said, and Rochester is the home of the Mayo Clinic.
Other than that, organization of the response team has a lot to do with the high rates, he said.
Not everyone survives a cardiac arrest, but Michael said they want to do everything in their power to try to save lives.
He said the previous response model also identified the six roles, but the delegation fell upon whoever might be leading that call.
"It was very dependent on that individual's own experience and their own sense of priorities and their own ability to organize," Michael said. "We kind of took the individual out of it and made it a process so that any individual would have the exact same process and create continuity in how everyone responded on these."
Now, anyone on shift enters the cardiac arrest scene with a consistent plan.
'How it starts'
To further ensure the six positions could be filled for each cardiac arrest call, the Longmont Fire Department made another structural change in 2015.
Michael decided they should send an extra fire engine along with the one ambulance and one fire engine already sent to all cardiac arrest calls. It increased personnel from five to six responders up to eight to 10 responders.
He credits an increase in survivability rates to the additional staff.
In 2014, eight of 57 out-of-hospital cardiac arrest patients who underwent attempted resuscitations (14 percent) made it to the hospital with vital signs.
In 2015, 13 of 55 patients (24 percent) arrived at the hospital with vital signs.
So far this year, they're reporting a 44 percent survival rate.
In Fire Station No. 1 on a weekday afternoon, a tone sounded over the loudspeaker system.
"We'll listen to this because this is how it starts," Michael said.
The call ended up not being medical-related, but fire spokeswoman Molly Cropp said once they learn if the situation is Code Echo -- or a cardiac arrest -- they prepare for the urgent call.
She said at the end of October, she and other firefighters responded to a call that started off as a "one-engine, one-ambulance response" because they didn't know at first the patient was experiencing a cardiac arrest.
"If we get on scene with one engine and realize this is a cardiac arrest, we will call and get another engine on the way," Cropp said. "In the meantime, we fill those first five positions. We can get the vast majority of things started."
One of their tasks is to set up the AutoPulse -- a CPR device that applies carefully-calculated chest compressions, based on the person's weight, age and heartbeat.
The machine frees the hands of one first responder and enables chest compressions to continue, even as the patient is transported down stairs, through hallways or from wherever they collapsed.
"There were actually two of us available to figure out the exit strategy, which is way more helpful than you might think it would be," Cropp said. "There are times when that's one of the most complicated parts of this whole process."
The machines were added to all fire apparatus and AMR ambulances and in March 2015.
Goerlitz noticed, saying, "The ambulance is like a little hospital room; They've got everything in there."
'In good hands'
On Oct. 2, Clara's family had the chance to thank the Flight for Life crew, firefighters and paramedics at a life saving award ceremony at Fire Station No. 3, 1000 Pace St.
Goerlitz said recovering from that day has been stressful on the whole family, however, "the turning point kind of for all of us was when we got to meet everybody and when we got to thank all these people."
Ethan also was given an award -- kept in a velvet-lined box -- for talking to his sister the night before she came out of her coma.
Goerlitz said in addition to helping her, fire personnel help her son. Ethan nodded, adding he's had tours of the ambulance, fire trucks, police patrol cars and even the Flight for Life helicopter that flew his sister to Children's Hospital in Aurora on Aug. 22.
"His whole goal in life has been to be a police officer, a firefighter, a paramedic, Flight for Life, and I know that's because he's grown up seeing his sister need their help," Goerlitz said. "He knows how important they are."
Since Clara's cardiac arrest, her mothers have called 911 for other medical reasons -- mostly when she's aspirating. They said they didn't know seven years ago when they moved into their house that living near Fire Station No. 3 would be so convenient.
Ambulances usually arrive at their house within three minutes, she said, which is less than the fire department's average five-minute response time.
Goerlitz hopes her daugher's life-threatening disorders won't be as life-threatening in the future. They say she's making huge strides, for example, taking independent steps and being given crutches to walk.
"Everybody in Longmont should know -- not that anybody should have a medical emergency, but if they do -- they're in good hands," Goerlitz said.
Amelia Arvesen: 303-684-5212, arvesena@times-call.com or twitter.com/ameliaarvesen
Copyright 2016 - Daily Times-Call, Longmont, Colo.
