For the past decade, only two fire agencies in Orange County — the cities of Newport Beach and Orange — chose to use automated chest compression devices instead of manual cardiopulmonary resuscitation to keep people alive after they suffer cardiac arrest.
But since Jan. 1, a new policy instituted by Orange County Health Care Agency’s Emergency Medical Services requires that the 10 agencies in the county that respond to 911 calls must use the automated devices.
The decision is based on two things — better outcomes for patients treated in emergencies and increased safety for paramedics who care for those patients the ambulance ride to the hospital, said Dr. Carl Schultz, the county’s medical director for Emergency Medical Services.
He said Orange County is the first county in the state to require the automated devices.
Worth the investment
About two years ago, the county’s emergency response agencies — nine city fire departments and the Orange County Fire Agency — were notified of the impending policy change and given time to decide which particular device they wanted to use. That also gave them time to budget for the financial investment, Schultz said on Friday, during a demonstration by a crew at Newport Beach Fire Department’s Station 8.
Unlike manual cardiopulmonary resuscitation, the automated devices, once strapped on someone’s chest during a 911 response, are able to maintain consistent, effective chest compression. Those compressions can continue, uninterrupted, while a patient is lifted onto a gurney or into the ambulance, or while they’re being navigated up and down staircases and other tight spaces, and throughout the ambulance ride.
While the devices aren’t cheap, Newport Beach found them to be well worth the investment, said Kristin Thompson, emergency medical services chief for the city’s fire department. Newport Beach spent about $250,000 for eight devices.
The AutoPulse device that Newport Beach uses, manufactured by ZOLL Medical Corp., costs about $17,000 each. It is a battery-powered backboard, about the size of a boogie board, with wide disposable bands that strap across a patient’s rib cage to deliver a rhythmic squeeze. For hygiene reasons, the bands are used only once, and cost about $120 per use. Last year, the city used 53 bands. The batteries, which cost about $400, are rechargeable.
But benefits of using the devices are outweighing the costs for Newport Beach Fire, which participates in a national registry that tracks the performance of medical care used on patients experiencing cardiac arrest.
Based on benchmarks from 2018, Newport Beach outperformed the national average in such measures as return of spontaneous circulation (when someone’s heartbeat resumes before reaching the hospital) and in saving people who eventually are discharged from the hospital, Thompson said. Of cardiac arrest patients transported by Newport Beach Fire, 22% leave hospital care with a good cerebral performance score, much higher than the national rate of 8%.
Automated compression devices aren’t the only reason for better outcomes, but Thompson said they have made a difference.
“We just saw the value in an extra set of hands.”
Better response, less liability
In addition to freeing up paramedics so they can help the patient in other ways, the automated chest compression devices make ambulance rides safer.
Instead of standing over a gurney in the restricted quarters of an emergency vehicle, trying to keep CPR going with the ideal 2-inch depth of each compression — all while being tossed about during the ride or lurching at a sudden stop — responders in vehicles equipped with the automated compression devices can sit down and use a seat belt during the ride.
Schultz said a big factor in the decision to require use of the automated devices had to do with injuries in the past year or so to responders performing CPR who could not put on a seat belt because they had to stand in order to have sufficient force.
Schultz would not go into details because of potential litigation issues but said “these were not minor injuries.”
Such injuries can amount to a “significant” unplanned cost for a firefighting agency, compared to investment in automated chest compression devices, he added: “It only takes one firefighter who can’t work anymore. A liability settlement of $1 million adds up to a lot of AutoPulses.”
Less hazardous but equally challenging for firefighters: maintaining effective compression while bringing someone down a staircase or up from the lower deck of a boat — something the Newport Beach Fire Department can encounter.
“Imagine a full size person below deck and you have to go up a circular stairwell that’s barely the width of your shoulders,” said Engineer Justin Kime, a 25-year fire veteran.
Beyond the logistics, there’s the physical effort it takes to continuously perform CPR.
“We’re human. We get tired,” said Emergency Medical Services Captain Brad Smith.
“The AutoPulse doesn’t get tired.”