LAS VEGAS -- Heart disease is the number one killer of Americans. So when there is a dramatic change in the survival rate for heart attack victims, it should be considered big news.
In just the past two years, southern Nevada has seen an astonishing rise in the number of cardiac arrest patients who not only survived, but are fully functional. It is the result of a new cutting-edge approach called hypothermia protocols.
A year ago, the Las Vegas Fire and Rescue team had only two cardiac arrest patients who lived and were fully functional. A year later, they had 15. The hypothermia techniques they use are more involved than simply keeping the patients iced down, though that's part of it. It required a change in their whole approach and now it has been implemented by every fire department in the valley.
"These are people that are dead. These are people in full cardiac arrest that are coming out, and a lot of them are walking out, not just living to be discharged, but living normal lives," said Las Vegas Fire Medical Director Dr. David Slattery.
When Dr. Slattery launched his dramatically different approach to cardiac emergencies two years ago, he had no idea how quickly things would change. But they have and the proof is walking around -- people like 44-year-old Valerie Pili who would otherwise be dead instead of appearing before the Las Vegas City Council to thank the firefighters who saved her.
Nationally, the survival rate for full cardiac arrest cases hovers around 5 percent, but in southern Nevada, it's much higher almost overnight.
"Here is our survival here: 5 percent, then 18 percent then 21, 51, and overall for fiscal year 2010 we're at 41 percent. We have been as high as 51 percent," said Dr. Slattery.
Once the other departments in the valley heard about the results, they made the switch as well. Henderson already had a survival rate that was twice the national average. When they introduced Slattery's new protocols, they doubled again.
"Over the course of a year, we are probably talking about 10 to 20 additional lives saved -- and it's not just the life saved, it's the quality of life. They are not going to be in a nursing home, not aware of their surroundings. They are going to go back to work, go back to their families," said Henderson Fire Chief Doug Stevens.
After Henderson, it spread to North Las Vegas and the Clark County Fire Departments, all of which are under budget crunches and assorted political pressures, but still found ways to get it done.
So what changed? Everything, starting with the dispatch center and the medical advice about CPR they dispense just as soon as rescue units are sent on their way. Time is everything. Every minute that goes by makes it 10 percent less likely the patient will survive, which is why the fire department's four to six minute response average is so critical. Firefighters had to undergo extensive re-training to make the new system work. Included in that training is how to use more advanced equipment, including defibrillator units that also monitor the heart and other functions.
And then there's a piece of equipment affectionately known as the Geezer Squeezer.
"This is the most important piece of equipment we have in the rig," said LVFD EMS Coordinator Tim Orenic.
Instead of just pushing down, the device squeezes the heart from all sides, increasing pressure and keeping blood flowing. And it will keep operating even as the paramedics are moving the patient on a gurney or in the back of a rescue unit.
The final change is a big one called hypothermia protocols. Basically, rescue workers are keeping the patient cool in the ambulance and continuing in the hospital.
"They keep the body cool for 24 hours. It gives the body time to readjust to the shock and trauma it just went through and it has just an incredible neurological outcome," said Orenic.
It not only keeps the heart pumping, but protects the brain from deteriorating so that those who make it are still functional.
For paramedics, whether public or private, saving lives is what it's all about. In interviews with fire and rescue personnel from Las Vegas, North Las Vegas, Henderson, and Clark County Fire Departments, not once did we hear a disparaging word about the quality of care provided by employees of the private ambulance companies.
On the streets, there is mutual respect. However, in the hyper-charged political atmosphere where budgets are strained and jobs are at stake, it is perhaps inevitable that the hypothermia protocols would be mentioned in a larger context.
Private ambulance companies American Medical Response and MedicWest have now implemented their own hypothermia programs and have trained their paramedics in how to use the new equipment. But there are still differences between what the private entities can achieve versus what the fire departments can do.
For one thing, the standard for response time is different. Fire departments aim to arrive in six minutes. The allowable standard for the ambulance companies is 12 minutes, though they said their average response is seven minutes. The difference of just a few minutes can be crucial.
"We can quantify these numbers. Six minutes saves lives. Twelve minutes does not save lives," said Jeff Hurley with the North Las Vegas Firefighters Union.
But even if the ambulance companies could match the response time of the fire departments, they can't match the manpower. The departments dispatch six person teams on cardiac emergencies and each member of the team has a specific job to do to help keep the patient alive.
The team sticks with the patient all the way to the hospital since a handoff to anyone else at such a delicate stage would add an unnecessary element of risk. The private ambulances carry two-person teams and while those teams do admirable work, they can't match the work of the six person teams.
In fact, Henderson's Fire Department has the highest survival rate for cardiac cases in the country, yet it has no private ambulances operating in its jurisdiction.
"Firefighters are always the immediate first responders in every community across the country. We have been doing that for well over 21 years here and the paramedic format since 1953. It is the only cost effective way to provide a first response, is using your firefighters. Private businesses can't provide the same service," said Henderson Fire Chief Doug Stevens.
