“Time” is the heart attack victim’s biggest adversary. When the heart stops first, respirations stop all most immediately. With 400,000 people experiencing STEMI type heart attacks every year, Northwest Ambulance District has made a long standing commitment to public education that includes CPR training.

We have added new training aids such as “Fat Old Fred”, the first and only CPR manikin to offer the realistic size and appearance of an older, heavier cardiac victim; the kind rescue personnel are most likely to encounter in the public setting.

Another important addition to our teaching took kit is a choking manikin, on which students can practice proper hand placement, effective abdominal thrusts, and protocols for working with pregnant, older, or heavier choking victims.

Both “Fat Old Fred” and the “Choking Charlie” manikins have anatomical landmarks including sternum, rib cage, and substernal notch. All of our teaching manikins have airways that can be manipulated for obstruction, choking, and CPR.

Also new this year are 2 professional teaching packages with 4 adult “Brad” manikins, 2 child “Kyle” manikins, and 2 newborn “Kim” manikins. These manikins are realistic and feature accurate anatomical landmarks.

We are dedicated to providing a quality teaching environment and a top notch hands-on experience for each CPR student.

It remains an on-going commitment by Northwest Ambulance District’s staff to reduce disability and death from cardiovascular diseases and stroke.

“STEMI” is an acronym meaning “ST segment elevation myocardial infarction,” which is a type of heart attack. This is determined by an electrocardiogram ECG test.

Myocardial infarctions (heart attacks) occur when a coronary artery (the blood vessels that feed the heart muscle) suddenly becomes at least partially blocked by a blood clot, causing at least some of the heart muscle, being supplied by that artery, to become infracted (dead). Heart attacks are divided into two types, according to their severity. A STEMI is the more severe type.

Every year 400,000 people experience STEMIs, the deadliest type of heart attacks. A significant number don’t receive prompt reperfusion therapy, which is critical in restoring blood flow. Worse yet, 30% of STEMI victims don’t receive reperfusion treatment at all.

Northwest Ambulance began the process to close the gaps that separate STEMI patients from timely access to appropriate treatments. This project began in 1999 when NAD took part in a nationwide study to place a drug called Retavase on ambulances.

I am pleased to report to you that after much training, working with University Hospitals, PhysioControl and the Lifenet STEMI management solutions system, we can now make a big difference in the outcome if you experience a “STEMI”.

NAD personnel, by use of the Lifenet system, can deliver your 12 lead ECG to the emergency room and the treatment team in Cleveland. It is a web-based system and the first of its kind. All the medical personnel are able to consult on the best care, make a rapid trip to a Cath Lab in Cleveland or administer clot busting drugs in the field. All this takes only moments and the necessary information to save your life is seen by all members of the medical team at the same time.

There is no doubt lives will be saved! NAD is proud to be the first ambulance service, in Ashtabula County, to have the clot busters on its squads. The relationship with UH GMC, UH Cleveland, University MedEvac, Geneva dispatch and a willingness of our board and staff to deliver care that makes such a difference made this possible.

This is the kind of work we are able to do because of your continued support.

I have written about “STEMI” before, one of the most severe types of heart attacks. “STEMI’s” have the possibility to stop the heart.

When the heart stops, CPR is the order of the day. Chest compressions consist of rhythmic applications of pressure over the lower half of the sternum. These compressions create blood flow by directly compressing the heart.

Blood flow generated by chest compressions delivers a small but critical amount of oxygen to the brain and heart. Good chest compressions increase the likelihood that a defibrillation (electrical shock) will be more successful.

Effective chest compressions are essential for providing good blood flow during CPR.

To give effective compressions, “push hard and push fast”. Compress the adult chest at a rate of 100 times per minute with a depth of 1 ½ to 2 inches and minimize interruptions in the chest compressions.

Proper technique is so important that the Northwest Ambulance has purchased 2 “Lucas Chest Compression Systems”. These systems provide near perfect compressions to the chest. When used by our staff, there are no interruptions and rescuer fatigue is no longer an issue.

We have seen a sharp increase in field resuscitation since putting the Lucas systems in service. The units have a price tag of $15,000 each. It remains an on-going commitment by N.A.D. staff to reduce disability and death from cardiovascular disease.

How well we do depends on what you do before we arrive, so remember, PUSH HARD AND PUSH FAST.

CPR

50 Years and Millions of Trained Citizens Later

In 1960, Xerox introduced the first paper copy machine. At the same time across the country, coronary artery disease had reached epidemic levels. So it was fortuitous, and a bit ironic, that the year coronary artery disease peaked also marked the birth of modern CPR.

Studies have shown the chances of surviving cardiac arrest are roughly doubled for those who receive CPR prior to EMS arrival. CPR started right away extends the window in which the defibrillator can be effective from 4 to 6 minutes to 10 or 12 minutes.

“The lessons of the 1960s are as valid today as they were then…”

“CPR has to begin in the first minutes of a cardiac arrest and the defibrillator has to arrive at the scene as fast as possible. If we can spread that message to every part of our society, and make defibrillators as common as smoke detectors, than you will have resuscitation rates of 60 to 70 percent.”

Dr. Mikey Eisenberg
Director King County EMS

Northwest Ambulance District is dedicated to providing quality hands-on CPR training to each student. We remain committed to reducing disability and death from cardiovascular disease and stroke.

Hats off to Dr. Safer, Dr, Jude, and Dr. Kouwenhoven who introduced the combination of rescue breathing and compressions that came to be known as CPR. Countless lives have been saved because of these doctors.

CPR - 50 years old this year.
 

We see it every day on uniforms, signs, medical equipment and ambulances.

Most people do not know what the symbol represents.

The “Star of Life” was created after the American National Red Cross complained in 1973 that they objected to the common use of an Omaha orange cross on a square background of reflective white which clearly imitated the Red Cross symbol. (NHTSA) National Highway Traffic Safety Administration investigated and found the complaint to be justified.

The new designed symbol the “Star of Life” was adapted from the Medical Identification symbol of the American Medical Association and was registered as a certification mark on February 1, 1977.

The blue bars of the Star of Life represent the 6 system function of EMS:

Detection, Reporting, Response, On Scene Care, Care in Transit, and Transfer to definitive care

The staff with a serpent coiled around it is the symbol for medicine and health. The staff and serpent have their origin in Greek Mythology.

The Star of Life, like EMS, has a rich history of tradition and honor. It has become a time honored symbol of emergency medical care.

EMS History

Paintings of Roman Battlegrounds reveal that some of the troops wore different garments from those worn by warriors and it appears that these individuals cared for the wounded rather than engage in combat.

2000 years later ambulance service in the US was a fast ride to any hospital close by and was provided by funeral homes. Funeral homes used combo limousines as both hearse and ambulance.

In 1965, the US Congress passed the Highway Safety Act. The Act initiated several programs to reduce death and disability from highway crashes. One of those programs was designed to improve emergency medical services and it was assigned to the US Department of Transportation.

A new job title was born “Emergency Medical Technician”. The new job title was accompanied by a training program that was more involved than the traditional first-aid courses. Over the next few years, ambulance to hospital communications, better ambulance vehicles, and in the 60’s better care for heart attack victims were developed.

In 1971, only 12 certified Paramedic units operated in the US. By 1974, there were over 300 regional projects. In 1981, there were nearly 450,000 trained EMTs in the United States with 35,000 of them trained as Paramedics.

The improvements made in EMS during the past years are nothing short of phenomenal.

The first Paramedics in Ashtabula County were in Conneaut and were only able to perform at the paramedic level when transporting to Brown Memorial Hospital due to the fact they were not state certified. 1 year after that the Ohio State certification program began and most of these medics had to re-attend “Paramedic” school.

Only 3 people from the first non-certified class are still on the line responding to calls. All three are in the winter of their EMS careers. One can only imagine where EMS will be 30 years from now.

Shift to shift everything remains the same, but when I look back over the past 30 years or so everything has changed.

The first ECG suitable for use in the field weighed in at 45 lbs. For the next few years we produced a 2 lead strip; now, we produce a 12 lead cardiogram that is diagnostic quality equal to any hospital; price tag - 4 times as much as the early model.

IVs came only in glass bottles which were easily broken in our environment and took up way too much space in our drug boxes. Most IV solutions today come in plastic bags. Speaking of drug boxes we were stocked with less than 10 drugs, today more than 34 medications are carried on most ALS ambulance units.

Training in the early 70’s consisted of American Red Cross “Standard” and “Advanced” first aid, some of us were lucky enough to attend the Erie Ambulance Attendant’s Course. Present day, none of these programs even exist. Today’s classes qualify you to work as a First Responder, EMT, or Paramedic. By the way, back then, Erie Ambulance Attendant’s course had a price tag of $45.00 compared to today’s Paramedic class cost of around $3,500.00.

On car crashes, we would arrive and leap to action with hack saws, sledge hammers, homemade nadir pin cutters, pry-bars (few of us with large and small pry-bars) and brute force. Some squads were lucky enough to have porta-powers. Some victims were saved but many times it simply took too long for disentanglement and the victims expired on the scene. If they were lucky enough and the stars were aligned they may have made it to the local ER and expired there. 30 years ago, many victims that expired would have lived in the same crash today. We now have modern hydraulic tools that are faster and more powerful that ever dreamed of back then. Modern hydraulic tools have a price tag near what an ambulance cost in 1970.

My shift today will most likely be the same as my last one, yet it’s all changed and will continue to change. Change in our field is driven by patient needs and progressive leaders who work tirelessly to deliver the best possible care.