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Two years ago, I attended a meeting where several EMS medical directors were discussing the implementation of continuous positive airway pressure (CPAP) in their systems. Many were already seeing the significant benefits of CPAP. One reported his system had already reduced the number of patients requiring endotracheal (ET) intubation in the field by 79%. He felt CPAP kept many elderly patients from becoming ventilator-dependent and from “never getting off the vent.”
Another stated that nearly 50% of the patients admitted with ET tubes in one of his facilities ended up being treated for respiratory infections, particularly ventilator-associated pneumonia, and that 54% of these patients eventually died from their infections.
I hadn’t considered these issues as a field paramedic, but I quickly realized how many elderly patients with severe respiratory distress I wouldn’t have intubated had CPAP been available. This would have, in turn, kept some of these patients from becoming ventilator-dependent, developing a respiratory infection and dying.
But the most interesting exchange of conversation I heard that day came when a well-respected medical director from a major urban center stated that his crews weren’t going to use CPAP because they could “be at an emergency department anywhere in his city in 10 minutes or less,” and he felt that wasn’t enough time for patients to benefit from CPAP therapy.
I could see disbelief and disagreement on many of his colleagues’ faces, but it seemed no one wanted to be disrespectful by disagreeing with him. A period of silence followed, and I thought the group was going to move on without addressing his comments when, finally, one physician said she wanted to comment on his statement. All eyes turned to her.
She said, “With all due respect, most of my crews can usually reach our hospitals from anywhere in my city in less than 10 minutes, but we’ve documented that we’ve been able to give most patients an average of 28 minutes of CPAP therapy before they reach our hospitals because of the forgotten time elements inherent in our calls,” she told him, pointing out the following “contact minutes” where CPAP could be beneficial:
• Initial recognition of acute respiratory distress to the start of patient packaging (five minutes);
• Patient packaging (three minutes);
• Transfer to the ambulance
(five minutes);
• Loading and preparing the patient for transport (two minutes);
• Travel time to the hospital
(eight minutes); and
• Off loading of the patient and transferring care to the ED staff, which might not have CPAP immediately available (five minutes).
The doubting physician left the meeting better educated, as did I.
This supplement to JEMS includes articles that will educate you on the important contribution CPAP can make in your system and the multiple patient conditions that can be impacted by your BLS and ALS units with CPAP use.
This article originally appeared in the January 2011 JEMS supplement “CPAP: Why & how it works” as “Introduction: There's usually time for CPAP.”
