Hilton Head Island Fire & Rescue personnel respond differently to cardiac-arrest calls, depending on the severity and type of heart attack. Different codes tell them how severe the heart attack is. Here's what the codes mean.
Code blue: A radio message from the first-arriving unit that the patients is in cardiac arrest. This prompts other responding units to enter with prescribed equipment and assume assigned roles, such as monitoring vitals, aiding in CPR or shocking the heart with a defibrillator.
Code ice: This confirms the patient has been resuscitated and has a steady pulse. Responders are beginning to induce hypothermia -- cooling the patient with chilled IVs and cold packs to protect brain function. Cooling the body stops brain inflammation and slows a patient's metabolism, allowing the brain to rest. It also notifies the hospital a post-cardiac arrest patient is on the way.
Code STEMI: This confirms a specific type of heart attack, caused by a blood clot blocking an artery supplying oxygen-rich blood to the heart, which can be recognized by an electrocardiogram. The message also prompts dispatch to notify the hospital's cardiac cath lab to prepare for an emergency procedure to remove the clot and restore blood flow.
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When racing for the checkered flag, time is precious.
Extra seconds changing a tire and refueling can mean the difference between first and also-ran.
Local paramedics race against the clock, as well, to save victims of serious heart problems. Every second counts; every action matters.
That's why Beaufort County emergency responders have chosen to take a page from NASCAR to save crucial time in treating those who suffer sudden heart attacks.
Hilton Head Island firefighters and paramedics demonstrated their new "pit crew" response to cardiac arrest calls at Tuesday's Town Council meeting. Other emergency medical crews across the country and in Beaufort County have adopted similar models.
Configuring medical crews like pit crews means important tasks can be accomplished simultaneously and quickly, Hilton Head Fire Chief Lavarn Lucas said.
Several studies, including those by the American Heart Association, show more patients survive cardiac arrest when life-saving tactics -- such as cardio-pulmonary resuscitation or a shock from a defibrillator -- are administered quickly.
THE OLD METHODS
Before adopting pit-crew practices, emergency responders -- typically, a team of two paramedics -- were not pre-assigned specific tasks. The results, Lucas says, were delays in performing important treatment because of a rush to move patients to the ambulance and keep them alive until arriving at the hospital.
Now, cardiac-arrest patients get care from seven to nine responders. That includes an ambulance crew, the next two closest units -- either an additional ambulance or fire engine -- and a battalion chief. Each responder has an assigned role. And having additional people allows paramedics to rotate to avoid fatigue when performing CPR, Lucas said.
Their goal is to get a pulse at the scene and avoid interrupting critical tasks.
The Bluffton Township Fire District began using a similar response model in January, as did Beaufort County EMS, according to Bluffton Capt. Randy Hunter.
The Bluffton district sends at least one fire engine with three emergency medical technicians, one ambulance with two Beaufort County paramedics and an EMS supervisor, each with assigned tasks to speed resuscitation, Hunter said. The Burton and Lady's Island-St. Helena fire districts provide the same response.
WHY THE NEW WAY WORKS
A review of cardiac-arrest treatment from a nationwide database managed by the U.S. Centers for Disease Control and Prevention indicates lives are saved when choreographed treatment plans are used.
A 2010 study by the National Institute of Standards and Technology and its partners also showed resuscitation efforts by two-person crews took almost three minutes longer than any other team configuration. The best times were with crews of six or more.
Cardiac-arrest patients begin to suffer irreversible brain damage if oxygen doesn't get to the brain within four minutes, according to studies by the American Heart Association.
Shaving a minute off response times increases the odds of survival by 57 percent, according to a 2005 USA TODAY analysis.
In other words, saving three minutes improves a patient's odds of survival almost four-fold, Lucas said.
"We don't believe it's overkill," he said of sending more responders. "We are creating a situation where there is the most opportunity for survival. We'll cancel resources as soon as we determine they are not necessary."
From 2005 to 2010, about 1 in 10 cardiac-arrest patients responded to by Hilton Head Fire & Rescue survived, according to town figures. That mirrors a national average reported by the CDC. The department began taking steps to improve that rate in 2009, and the pit crew is the latest advance.
For the first half of 2012, Hilton Head Fire & Rescue has responded more than 16 times with a full "pit crew" of one ambulance, two fire engines and a battalion chief, according to town figures.
Thirteen of the calls were for heart attacks that were not the result of trauma, such as a car wreck or shooting. Of those 13 patients, six were successfully revived and discharged from the hospital with good brain function, according to town data submitted to the CDC.
That puts the survival rate at about 4.5 out of 10 of cardiac-arrest cases responded to, Lucas said.
The statistics improve when differentiating between heart attacks that occur when there is a witness to the attack who can immediately call 911.
Of the 13 cardiac-arrest patients Fire & Rescue treated, eight were witnessed. With six survivors, the survival rate improves to 7.5 out of 10.
If that trend continues, more heart-attack patients will be saved than in previous years on Hilton Head.
"We are on track to save an additional 10 lives in 2012," Hilton Head Fire & Rescue Capt. Tom Bouthillet said. "To some people that may not sound like a lot of lives, but to us, it is a lot of lives, because every patient counts. You multiply that out 25 years, that's an addition 250 residents or visitors. That's enough to fill up a jumbo jet."
Follow reporter Tom Barton at twitter.com/EyeOnHiltonHead.