Cardiac arrest – Are you ready to save one of our own?

Firegeezer posted a recent story about a firefighter from Lynn, MA who experienced cardiac arrest on the fireground and was resuscitated at the scene.

Coverage from Firefighter Close Calls is here.

According to the post, the firefighter had “just come out of the house” when he suddenly collapsed and firefighters began CPR immediately.

A news helicopter captured dramatic footage of the resuscitation, which you can see here.

It was not immediately clear whether or not he’s going to be okay, and our prayers are with firefighter Mark Ducharme and his family.

Anyone who reads NIOSH reports knows that heart attacks are the leading cause of LODDs in the United States, and perhaps the world, but how many of us are really prepared to work a cardiac arrest at a fire scene or even on the training ground?

Emergencies are stressful, especially when it’s one of our own.

Is an AED a part of your RIC/RIT kit?

As an ALS unit standing by at every fire scene?

How about the training ground?

Have you ever tried to undress an unconscious firefighter in full gear, including SCBA?

I have. It’s not easy.

This is a drill that every firefighter in the country should attempt at least once.

[youtube=http://www.youtube.com/watch?v=dfTP6fDP_dI]

A couple of observations:

If you think it’s a sudden cardiac arrest as opposed to an asphyxial arrest, just open the firefighter’s turnout coat, start chest compressions, place the combi-pads as soon as possible, and shock the firefighter prior to taking the firefighter’s SCBA and turnout coat off.

Undressing a firefighter in full gear is time consuming and defibrillation is too important.

If it’s an asphyxial arrest, then airway is more important, and you’ll have to address the airway immediately.

Before anyone asks, the BVM in the video had a broken stem so the oxygen tubing couldn’t be attached. It came out of a bin that is used to return equipment to the quartermaster, and I’m assuming that’s the reason it was in the bin.

But you know what? Emergency scenes can be chaotic. Equipment fails. That’s reality!

Obviously some time could have been saved by cutting off the SCBA mask and so on, but I can pretty much guarantee you that you can’t undress an unconscious firefighter as fast as you think you can!

See also:

Incredible video of soccer player saved by ICD (VIDEO)

Another soccer player experiences sudden cardiac arrest on camera (VIDEO)

Scientist shocked by ICD at Copenhagen Summit (VIDEO)

15 Comments

  • giveitdiesel says:

    I hate to be negative but EARLY CPR anyone?It's a good video to learn from, I'd like to have heard the full debrief.I've never actually considered working on a colleague or a fellow emergency services worker, definitely an eye opener.

  • Timothy Clemans says:

    "I hate to be negative but EARLY CPR anyone?"It's unclear if for witnessed VF if responders should shock then do CPR or do 3 minutes of CPR then shock. pg. 101 Resuscitate by Mickey Eisenberg

  • Shaggy says:

    I hate to be negative but EARLY CPR anyone?And how many firefighters are actually certified and competent in CPR as opposed to getting a card from an EMS collegue? Again, see why it is important to have fellow firefighters trained in CPR?It's unclear if for witnessed VF if responders should shock then do CPR or do 3 minutes of CPR then shock. pg. 101 Resuscitate by Mickey EisenbergHave things changed? I thought this was a classic case of early defib first. I thought if witnessed by resucuers, SCA should be shocked first?Either way, the AED and CPR trained firefighters are probably more important than having an ALS unit on scene, though you still need one.

  • Shaggy says:

    I really like the firefighter SCA drill. How many departments actually do that? They drill on everything but the number one killer of firefighters. How many EMS services work with their fire departments on promoting and participating in drills like this? Even when there is animosity between fire and EMS, that animosity needs to be quickly discarded when considering events such as this.

  • Tom B says:

    giveitdiesel – The problem is that when a firefighter is wearing SCBA, his back is at a 45 degree angle to the ground when he's lying supine. That's not the best situation to be performing CPR.It seems to me that you either have to remove the SCBA or shore up the firefighter somehow so that the SCBA isn't a problem during the chest compressions.On the other hand, there's no reason you can't open up the coat, apply the combi-pads, and shock at least once prior to removing the gear, particularly when downtime has been < 4 minutes.Tom

  • Tom B says:

    Timothy -This question is at least partially answered by the ROC PRIMED trial.Neither strategy has been proven superior. However, both groups (the "CPR first" and the "shock first" group) had chest compressions prior to defibrillation. It's just that for the "shock first" group, chest compressions were stopped as soon as the defibrillator was ready.I've seen some studies that suggest that perfusion pressure needs to hit a critical threshold for defibrillation to be successful. It seems to me that some chest compressions are indicated prior to the first shock for virtually any cardiac arrest, but it's not clear that sustaining it for 3 minutes is superior to sustaining it for 30 seconds (for example).Tom

  • Tom B says:

    Shaggy -I assumed that all firefighters were trained in CPR. Anyone who hands out CPR cards should have their instructor card revoked (although how many times do we really need to be shown how to do CPR)?Your point about shocking right away versus chest compressions and then shocking is a critical question that needs to be answered! Certainly if the patient is lying supine on the gurney, with the chest exposed, the monitor on, and the combi-pads attached, you should shock right away.But it appears to me as though perfusion pressure drops precipitously after the onset of cardiac arrest (or after stopping compressions). That's why it's good to minimize the delay between stopping compressions and shocking.So even for witnessed arrest with delayed defibrillation, it seems to me that chest compressions should be ongoing while the defibrillator is being prepared.But what do you do when the SCBA is in the way? Do the best you can with the chest compressions even though the firefighter is lying at an angle? Undress the firefighter as quickly as possible?I'm open to suggestions!Tom

  • Tom B says:

    Shaggy – You're absolutely right! Turf wars aside, when a public safety official (police, fire, or EMS) is down, it's time to work together and do the right thing! It seems to me that this drill should be happening all over America! I'll be doing this drill again with my new crew, and hopefully we'll learn from the last drill.It would be nice if we could create a flow chart for suspected primary sudden cardiac arrest versus suspected asphixial arrest for downed firefighters.Either way, at some point the firefighter needs to be undressed, and it's difficult! Tom

  • David says:

    That was an excellent video in how it highlighted the issues involved in treated a down firefighter in full bunker gear. It's something that hasn't been touched upon in my service, which after watching the video I think it might be useful to be included in a CME. This also reminds me of a few years ago when a Toronto fire recruit (~30 yo) suffered a SCA while training on a fire tower. He and his cohorts were maybe 5 stories up when it happened. They brought him down, got EMS there and they got a ROSC. From what I heard he made a 100% recovery.

  • Tom B says:

    David – Thanks for the comment! Maybe we need a class for treating firefighters in cardiac arrest who are wearing full gear including SCBA! If not a class, then a breakout session for fire-rescue conferences or a webcast of some kind.I'll look for that case you mentioned in Toronto. Sounds interesting! Tom

  • Shaggy says:

    Jon Rittenberger, an attending at our ED who loves EMS folks, doing prehospital research and EMS educatiion (and onehellova nice guy) did a pig study, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2582345/showing early CPR before defib was not so necessary. However I do have reservations with this study (see the Limitations). Regardless, what we do know is early CPR and defib are the two most important factors, and I sense for the longest time, CPR was often neglected.

  • Tom B says:

    Shaggy -That's an interesting study, and I appreciate you bringing it to our attention, but I'm not sure it supports your contention that CPR prior to defib doesn't matter.Comparing 90 seconds of CPR prior to the first shock to 180 seconds of CPR prior to the first shock is definitely a worthwhile investigation, but I'm not aware of anyone that was doing 300 seconds (5 minutes) of CPR prior to the first shock! I did think it was interesting that the study stated:"The 5 minute VF cohort demonstrated improved results, however, rates of ROSC and survival are lower than our prior data where animals received immediate countershock following 5 minutes of untreated VF."One might conclude that swine are still in the electrical phase at the 5-minute mark, but I know from a recent CARES case that it's extremely difficult (if not impossible) to shock VF within 5-minutes of collapse, even when the victim is < 1-minute from the fire station, with no vertical distance (the patient is lying on a tennis court as opposed to lying on the living room floor of a 5th floor apartment).The study also states:"One possible reason for the low rates of ROSC and survival is the low CPPs generated in these animals. Prior research in a series of 100 humans has demonstrated that a minimal threshold of 15 mmHg is necessary for ROSC to occur, though this did not guarantee ROSC."That's the point I was trying to make. I agree that the evidence (from this trial and ROC PRIMED) appears to show no added benefit to CPR beyond 90 seconds (150 compressions) and perhaps even fewer, but it does appear as though CPR prior to the first shock is very important during the circulatory phase (the 5-10 minute range) which is when help is likely to arrive in my community.I guess what I'm saying is that it takes x number of seconds to expose a patient's chest, apply combi-pads, charge the defibrillator, and shock. Perhaps we should be doing as many chest compressions as possible during that time to boost coronary perfusion pressure to above the 15 mm Hg threshold.Perhaps that can be achieved in 60 seconds or less.Tom

  • Rob M. says:

    Another factor to consider is that the turnout gear will be HOT if they just came out of a fire & will burn you if you’re not wearing firefighting gloves. Don’t touch the patient without firefighting gloves on until their gear is off. In this situation, our interventions are ineffective as long as the gear is on. Remove the gear by any means necessary & then go to work.

  • Kina says:

    Both these vids have been around for some time, should thank the team in the training vid, for letting it out there, I have used both these vids, when refreshing the brigade i belong to, I then set up the same scenario, but use a maniquin. Its good and makes people think.

  • Chris says:

    As a fireman… I gotta say. The rescuers would be in pain. Bunker gear, the SCBA frame. If the simulation dude were just pulled from a structure, he's gonna be fricken HOT. Nitrile gloves would be melted to their palms. Gear has all sorts of rivets, buckles, snaps, hooks, D-Rings, etc. Just the surface temp alone is enough to ruin your day.

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