Gary Cosby Jr.
The Tuscaloosa News, Ala.
Wes Michaels remembers one of the first calls he made nearly 14 years ago when he helped resuscitate a patient in cardiac arrest. Michaels, the driver on Engine 4 stationed in Alberta, is one of Tuscaloosa Fire Rescue’s paramedics and has responded to numerous cardiac arrest calls during his career.
“It was way out on the north side of the river. We got there and a lady was doing CPR on her husband, who was in his late 50s or early 60s. We took over the CPR. We shocked him one time. We actually had to take the breathing tube out on the way to the hospital (because the patient regained consciousness). Two weeks later, he came by the fire station and had a meal with us. That was just great. You don’t always get that, but when you do, it’s really a good feeling to know you made a difference for that family,” Michaels said.
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Unfortunately, that’s not the way all cardiac arrest calls turn out; however, the inclusion of advanced life-saving equipment on each piece of Tuscaloosa Fire Rescue Service apparatus has helped increase the number of those success stories. Numbers provided by Tuscaloosa Fire Rescue indicate that successful resuscitations have risen by 13.1% in 2021 over the same reporting period in 2020, covering January through May of both years.
In January, Tuscaloosa Fire Rescue added advanced life-saving equipment including the LUCAS automated cardio-pulmonary resuscitation devices to each piece of responding fire equipment in the city. The devices can be used by any firefighter or emergency medical technician, but become especially effective when a paramedic or advanced EMT are on the responding equipment, according to Chief Randy Smith.
“We put the new ALS (advanced life-saving) equipment with the new LUCAS devices and the new cardiac monitors on all the engines and ladders the first of January. Since then, you can see versus 2020 we went from 28.6% to 54.5% return to spontaneous circulation,” Smith said. “Overall, for a running total, we had 51 cardiac arrests in the first five months of 2020. We resuscitated 16 in 2020. In 2021, we’ve had 54 (cardiac arrest calls) and resuscitated 24.”
Michaels said the addition of the LUCAS device along with the cardiac monitors and the life-saving drugs included on each piece of equipment has been a huge positive.
“We used to do a load-and-go. You got to the scene, you put the patient on the backboard, put them in the ambulance and hit the road. Now, we are basically working the patients on scene to figure out if we have a viable patient to take to the ER. We are trained to do and can do, (we) have the equipment to do, pretty much the same thing they are doing in the emergency room,” Michaels said.
Smith said the inclusion of the new equipment is not solely responsible for the increased rate of return of spontaneous circulation, meaning the patients heart resumes beating and circulating blood without the assistance of manual CPR or the use of the LUCAS automated CPR device. Many factors are considered in whether a person in cardiac arrest can be resuscitated, not least being what happens between the time a person is found in cardiac arrest and the arrival of the first rescue units.
Smith said that a person’s chances of survival are much higher if the person who finds a victim in cardiac arrest begins CPR before the arrival of emergency units.
“The chain of survival is a really big thing,” Smith said. “Someone has to recognize there is a problem, whether it is a sudden cardiac arrest or if someone just isn’t feeling right. Recognize the problem and call 911. Start CPR if they go unconscious and look for an AED (automated external defibrillator) if they are in a public building. The dispatcher is going to give CPR instructions if you don’t know how to do it. Usually, our first fire trucks are going to arrive on the scene within five to six minutes at the very most.”
Smith said there are factors that can slow down response times, such the volume of emergency calls and traffic. And some fire companies may be off duty on a call or in training.
“We are going to try to start a hands-only CPR initiative in the next year, basically to help start the community doing CPR. You can teach someone hands-only CPR in about 60 seconds, it’s proper hand technique and rhythm,” Smith said.
That critical window of time before trained help arrives often makes the difference between a successful outcome or a death.
“One little cog in the wheel can really mess up everything, but as long as people recognize there is a problem, call 911 as soon as possible, and start compressions as soon as possible, that is what starts it,” Smith said. “If someone is doing something before we arrive the chances of survival increase dramatically. If no one is doing anything, they have to wait for us to get there.”
Smith said it is important for a person who is coming to the aid of someone who is down to take a quick look around the area where the victim is found to ensure the rescuer does not endanger himself. A person could have been electrocuted or fallen victim to some other problem that could endanger the life of the rescuer. Smith said the rescuer must make sure he or she will not put his or her own life at risk by taking a quick look at the surroundings before engaging in life-saving efforts. Even if a person does not feel safe in coming to a victim’s aid, they should at least call 911 to get trained responders on the way.
Every fire company has at least a basic emergency medical technician, while some have EMT advanced level providers and some do have paramedics. When Smith took over as chief two years ago, he formed an emergency medical services committee, which recommended putting paramedics on engines with advanced life-saving equipment. Reorienting the department’s personnel took a little over two years to match paramedics with engine companies carrying advanced life-saving equipment.
Smith said the purchase of advanced life-saving equipment for all the department’s emergency response vehicles came through a combination of money from the CARES (Coronavirus Aid, Relief and Economic Security) Act, a federal grant used to buy the LUCAS devices, and a Community Block Development Grant that helped buy the medical kits, which include the life-saving drugs paramedics can use.
“When we have a paramedic or an advanced EMT on the scene, they have the tools to start advanced life-saving procedures. Any of our firefighters can use the LUCAS device. The advanced life-saving equipment has to be used by an EMT advanced or paramedic,” Smith said. “To get the full effect, the paramedic is the best way. First and foremost, we are trying to enhance the capabilities for the community. That is why we have EMTs on every truck. We send firefighters to EMT school to get their advanced EMT certification and we hope they will go on to become paramedics, but if they don’t, we still are supplying a greater level of care for our community.”
Paramedics in the field can also contact the emergency department doctors at DCH Regional Medical Center to get orders for patient care in the field. Additionally, paramedics, advanced EMTs and basic EMTs all have preassigned medical care protocols they can follow without a doctor’s order.
Tuscaloosa Fire Rescue has three advanced life support rescue trucks and four advanced paramedic fire trucks. Tuscaloosa Fire Rescue has paramedics with Engine 8 in the West end, Engine 6 near the VA Hospital, Engine 9 in Woodland Hills, and Engine 10 on the north side. Additionally, the department has paramedics with Rescue 21 at Station 1 on Greensboro Avenue, Rescue 24 is at Station 4 in Alberta, and Rescue 27 is at Station 7 on Skyland Boulevard. Every engine and ladder truck in the city also carries advanced life-saving equipment and will carry at least a basic EMT and many times advanced EMT personnel.
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