EMS response change saves man’s life

WASHINGTON COUNTY, TX — A 74-year-old man traveling to Houston from Austin went from driver to patient when he started to feel chest pain and pulled into the Walgreens Pharmacy parking lot.

He made his way into the parking lot, passed out and rear-ended someone, and the Washington County Emergency Medical Services was dispatched to an accident, EMS director Kevin Deramus said.

“There was a little confusion when the call came in because it was an unresponsive man who wasn’t breathing and an accident,” Deramus said. “Because he was unresponsive and not breathing that moved him to a delta level call and the clock started ticking.”

According to the American Heart Association, every minute the paramedics use to respond to the scene decreases the chances of survival by 10 percent. EMS responded from the U.S. 290 station in three minutes, giving the patient a 70 percent survival rate, Deramus said. If EMS responded from the Blue Bell Road substation, that would decrease the survival rate to 40 percent.

“Based on just where we responded from, this patient’s survival rate went down to less than a flip of a coin,” Deramus said. “We did a lot of research before the station was built on U.S. 290, we noticed 60 percent of our calls came from the Four Corners area.

“If the station wasn’t in the right area, the patient doesn’t live.”

The EMS department changed how it responded to a cardiac arrest patient and brought its patient discharge rate up to 35 percent from 24 percent, Deramus said. The national average for patient discharge after a cardiac arrest event is 7.5 percent, he said.

“We looked at how we responded to these events a few years ago and knew we could do better as a department,” Deramus said. “We look at treating these events a little like a puzzle. If one of the pieces goes missing it messes up the whole picture.”

There are so many pieces that go into getting a patient discharged from the hospital, including dispatch, responding, the actual response, treatment and down to the hospital the patient is transported to, Deramus said.

“If we do away with any of these pieces then the patient doesn’t live,” Deramus said. “It can be something as small as where the EMS station was located, how much experience the responding paramedic has and down to the equipment and techniques we utilize.

“We try to stay on the cutting edge of treatment and training.”

The EMS department took a pit-crew approach to treating patients in order to cut the confusion of what the paramedic’s responsibilities were. The first paramedic to arrive on the scene is responsible for compressions, the second one is responsible for airway and the third is responsible for providing assistance with airway set up, intraosseous infusion set up and provide the LUCAS machine.

“Each paramedic knows his or her role,” Deramus said. “They even know whether to approach the patient on the left or the right side and they are not carrying a lot of equipment with them.

“In many cases, it is just one bag so they can make patient contact as quickly as possible.”

Time is not on a cardiac arrest patient’s side as every minute not spent treating the patient decreases the chance of having a full recovery, Deramus said.

In the Walgreen’s case, the paramedics were on location in three minutes, made patient contact in less than a minute, performed the first defibrillation within a minute and performed the intraosseous infusion within two minutes.

“We had the LUCAS machine compressing and decompressing in six minutes and had him cooling in eight minutes,” Deramus said. “We got a pulse back and sent him to a ‘cool’ facility at Saint Joseph’s Hospital.”

The total time spent with the patient was 20 minutes before he was placed into the ambulance and transported to Saint Joseph’s hospital.

“Our opinion is that we don’t need to get the patient to the hospital as fast as possible anymore because there is nothing more a hospital can do during the resuscitation phase,” Deramus said. “We have everything we need in the ambulance to stabilize the patient, get a pulse back and get him out of the life threatening situation.

“We treated him where he fell and started the hypothermic cooling right away.”

EMS started cooling all non-trauma cardiac arrest patients in 2009 to prevent brain swelling as the oxygen and blood are depleted from the brain during the cardiac event and rush back to the brain when the LUCAS machine performed the compressions.

The paramedic can get a pulse back but if the brain starts to swell, it can be as life threatening as a head injury, Deramus said. The patient continued to cool at the hospital where a neurologist monitored his condition.

“The hospital kept him cool for 24 hours and started to re-warm him one Celsius degree per hour until his temperature reached the normal resting temperature threshold,” Deramus said. “This patient made a full recovery and was discharged about a month after his cardiac arrest.”

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