MBFD begins using new CPR technology
by Mark McDermott
Seeking to improve the survival rates of patients undergoing cardiac arrest and reduce injuries to paramedics, the Manhattan Beach Fire Department has acquired a new automated CPR technology.
The AutoPulse Resuscitation System is a mechanical chest compression device that can be strapped on to a patient during an emergency response. This enables paramedics to provide ongoing CPR even as a patient is moved.
MBFD battalion chief Mike Boyd said the devices help achieve a critical aspect of successful CPR: continuous application.
“If you look at the majority of homes in Manhattan Beach, almost all are multi-story, meaning you often need to move a patient downstairs while trying to do effective CPR. Naturally, whenever you are moving someone down a hallway or downstairs, there’s not always enough space to accomplish that,” said Boyd. “That’s the great thing about this device. It allows patient pick-up and auto-pulse at the same time.”
This can make a big difference in the patient’s outcome.
“Anytime you stop CPR, there’s a reduction in pulse pressure built up during CPR,” Boyd said. “That adds up to blood not flowing through the heart and not getting profused to the brain.”
The AutoPulse device is a battery-powered backboard about the size of a boogie board with wide bands that strap around the patient’s ribcage and squeeze his or her chest, providing continuous blood flow to the heart and brain.
Boyd said the compression devices will also be used during ambulance transport.
“That’s the other big thing — this can be used instead of having someone standing up in the back of an ambulance trying to do press compressions, meaning our [paramedics] are out of their seatbelts,” Boyd said. “It makes them feel safer and reduces the chance of injury. I think it’s a big step forward for us. We’ll be able to treat patients well and take care of our members at the same time.”
MBFD Chief Daryn Drum said that having paramedics performing CPR aboard a moving vehicle in a so-called “Code 3 calls” — meaning the siren is on and speed is essential — increases the risk for everyone.
“Code 3 transport is our biggest vulnerability, in terms of safety,” Drum said, adding that the automated compression devices also take the physical difficulty of providing CPR for a long period of time out of the equation. “Such as when you lose balance and have to stop and start again. And Let’s not forget fatigue. CPR is physically taxing. Our folks work hard to stay in shape, but now you put a machine on, press a button, and we can concern ourselves with other aspects of the run to the hospital.”
Since Jan. 1, all ten agencies providing paramedic care in Orange County are required to use automated compression devices. Newport Beach has utilized them for years and has outperformed the national average in such measures as return of spontaneous circulation (when someone’s heartbeat resumes before reaching the hospital). According to NBFD, among cardiac arrest patients transported by the agency, 22 percent later leave the hospital with a good cerebral performance score (this measures post-incident brain function); the national average is 8 percent.
Drum said effective CPR consists of three aspects.
“If we want to improve outcomes in our community for sudden cardiac arrest patients, there are three things we absolutely have to have,” Drum said. “We have to have early, high quality, uninterrupted CPR. When I say early, that means done by a bystander; we’ll get there and take over, but that high-quality compression has to start as soon as possible for there to be a return of spontaneous circulation.”
The second crucial aspect, Drum said, is quick access to an electric impulse, i.e., an automatic external defibrillator. This drastically improved locally this year when Leadership Manhattan raised money to install 26 defibrillators in all MBPD patrol cars.
“That’s a really big deal,” Drum said. “Because early defibrillation is crucial to the return of spontaneous circulation and improving our sudden cardiac arrest outcomes.”
The third aspect is the complex entirety of the emergency response system, Drum said, “from 911 all the way through the hospital.” MBFD is known for its quick response times, and the city also has a robust Community Emergency Response Team, a volunteer organization which focuses on emergency preparedness in part by training residents in CPR.
“So that’s how we are going to move the needle in our community, is putting more defibrillators on the streets, training our citizens in CPR, and this piece of equipment that provides high quality uninterrupted CPR,” Drum said. “Those three things: you can take away one of them, and your success rate is not what it can be.”
The City Council approved the acquisition of four AutoPulse devices last fall at a cost of $57,000. The devices were purchased for MBFD by Chevron, as a result of consent decree settlement with the Environmental Protection Agency for failing to comply with the federal Clean Air Act and breaches in refinery chemical accident prevention protocols at several refineries, including the one in nearby El Segundo. As part of the decree, Chevron agreed to provide $1.4 million in emergency response equipment to MBFD and ESFD.
“The AutoPulse is a great device to help our firefighters when moving a cardiac patient,” said Mayor Nancy Hersman. “Moving cardiac patients quickly is important for positive outcomes, but trying to move with the patient while giving chest compressions can be difficult. This will really help in improved care of our cardiac patients.”
Drum also stressed the importance of local residents to utilizing CERT, which offers quarterly CPR training.
“CERT plays a really important role in our community,” he said.
See citymb.info/departments/fire-department to learn more about CERT.