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When seconds matter
New equipment, better methods saving more cardiac patients

LAWRENCEVILLE - Several factors are at play, but the bottom line is simple: More and more cardiac patients in Gwinnett are surviving.

That's due in part to new equipment, improved methods and an overall spirit of cohesiveness among medical workers, said Gwinnett Fire Department Battalion Chief Rodney Dawson, who is also the medical operations chief.

"People work as a team to get patients off the scene," Dawson said. "Now it's more of a team effort, all hands on deck. Everyone is doing something to help that patient."

Not that firefighters, who double as emergency medical service workers, didn't work together before, but now the processes are becoming more streamlined, Dawson said.

"We pick apart a cardiac arrest call," he said. "Then all that information is given back to the paramedic so they can do better next time."

Of about 200 cardiac calls responded to in 2008, more than 25 percent of those patients have had return of spontaneous circulation (their hearts began beating again) in the field, according to department spokesman Capt. Thomas Rutledge.

Clinical research and data have led the American Heart Association to suggest improved methods of caring for and treating patients, Dawson said. For instance, a new protocol that requires two minutes of CPR before any other steps are taken, has been implemented.

"You want to make sure the heart is full of oxygen first, before shocking the heart or administering any medication," Dawson said.

State-of-the-art equipment recently acquired by the department include an airway device for inserting breathing tubes for certain patients and an EZ-IO bone needle that can provide intravenous therapy to patients, such as the elderly, who don't have strong veins.

In situations where minutes - even seconds - matter, response time is critical. Dawson said responders are now accomplishing their mission about 12 minutes faster than before.

"We have gone from about 45 minutes to about 33," Dawson said. "That's from the time the 911 call comes in until we arrive at the (emergency department)."

All the technology and speed in the world aren't much good if responders don't know what to do when they get there, which is why continuing education, quality assessment and realistic scenario drills play a huge role in training personnel to deal with these life-or-death situations.

The department receives an average of 20 to 30 cardiac calls each month, Dawson said. After a call comes in, an ambulance will be dispatched, along with a medical first response unit, which can be another ambulance, a firetruck or a ladder truck.

If you think it odd for a firetruck to respond to an emergency medical call, fear not. Every truck in the department carries all the medical equipment needed to treat emergency patients. The days of an "ambulance driver" showing up with a stretcher are long gone. At least five personnel will respond, as well, with at least one being a certified paramedic. These days, basic EMTs are trained to do what used to be restricted to paramedics or, in some cases, even emergency room physicians.

"The men and women of the department are highly trained and highly skilled professionals," Rutledge said. "They face life-and-death situations on a daily basis. Our goal is to provide the best possible outcome every time we respond to a call."

While praising his personnel, Dawson said responders share their success with the public.

"The key to survival of cardiac arrest is the early activation of 911 and bystander CPR," he said. "Without the help of our fellow citizens, these positive trends in survival would not be possible."