Mobile Life Paramedics pilot new device for heart patients

[JetPhoto 626]

From the Times Herald Record

Paramedics pilot new device for heart patients

1 of 2 By Alexa James

Times Herald-Record

July 05, 2007

Newburgh — A Hudson Valley paramedic service has been authorized to test out a new treatment devise that could save heart patients' lives, stunt hospital stays and slash medical bills.

As of July 1, Mobile Life Support Services is carrying a new system called Continuous Positive Airway Pressure or CPAP (pronounced "see-pap") on board every ambulance in Orange. Ulster, Dutchess and Rockland counties.

The six-month pilot program, authorized by the Hudson Valley Regional Emergency Medical Services Council, is designed for patients suffering from early signs of congestive heart failure and a condition known as pulmonary edema, caused by an accumulation of fluid in the lungs.

The CPAP design is simple and cheap: a mask, a strap to hold it over the patient's nose and mouth and tubes connecting to a small air tank. Each one-time-use set costs about $60. It works by continuously blowing oxygen or room air, under low pressure, into a patient's airway. As the patient inhales and exhales, the CPAP's constant air current keeps the lungs partially inflated and helps clear out unwanted fluid and pressure.

Mobile Life used it for the first time Monday morning to help a 64-year-old Newburgh man suffering shortness of breath. When paramedics arrived, he was collapsed in the hallway of his apartment, gasping for air.

The lower left ventricle of his heart had gone sluggish, causing a backup of blood and fluid to leak into the air sacs in his lungs.

"The air sacs filled just like a water bottle," said Mobile Life Vice President Ed Horton. "The patient was literally breathing through water."

In this type of situation, medics roll through a series of treatments. First, they supply oxygen to the patient, then administer a combination of drugs to decrease the heart's workload.

Despite those efforts, the oxygen in the bloodstream of Mobile Life's patient was at half the normal level. He was conscious, Horton said, but could only spit out a word or two at a time.

The next step, in this scenario, is typically intubation — inserting a tube down the patient's throat so he can be hooked up to a ventilator. It's an invasive and potentially dangerous maneuver, and once a patient is on a ventilator, it can take several days in the hospital to get him safely off the machines.

Use of the CPAP often eliminates the need for intubation and accompanying prolonged hospital stay.

As the Mobile Life medics loaded their patient into the ambulance, en route to St. Luke's Cornwall Hospital in Newburgh, they tried the CPAP for the first time, coaching the man to inhale and exhale as the specially designed nasal mask pushed a steady stream of air into his chest.

"The given amount of oxygen flow creates a turbulence in the flooded air sacs," said Horton. "The turbulence creates a virtual valve. After 15 or 20 minutes (with the CPAP) you'll actually start moving that fluid back into the capillary bed."

It worked like a charm on Mobile Life's guy. By the time they arrived at the hospital, Horton said, the man was speaking in full sentences, his blood oxygen at normal levels.

"This is exactly the kind of patient we put this in place for," said Horton. He predicts hundreds of CPAP cases during the pilot project. At the end of the six-month test run, the Hudson Valley Regional Emergency Medical Services Council will evaluate Mobile Life's work and decide if ambulance services throughout the region can use the CPAP. The equipment for the study was purchased by Mobile Life, which is not receiving funding from any CPAP manufacturers.

Paramedics in Albany, Long Island and Westchester County, along with about half the country, already use the CPAP system. "Understand this is not going to substitute in every case," said Horton, but as an additional tool, "this is a no-brainer."

Save your breath

This diagram depicts the microscopic buildup of fluid in a person's lungs as a result of congestive heart failure. This fluid buildup is called pulmonary edema. It occurs when the lower left ventricle of the heart gets weak and sluggish, causing a slushy backup of blood to wash into the blood vessels in the lungs (capillaries). As pressure builds, fluid leaks through the liquid space (interstitium) and into the lung's air sacs (alveoli.) For a patient, this feels like shortness of breath.

[Goose 188]

Because CPAP is so popular elsewhere, i would think the data is readily available. Hudson Valley tends, for a reason beyond me, to be an extremely conservative EMS Council.

[Guest Orpi442]

Its just shows that Hudson Valley is still behind the times. CPAP has been in the protocals for just over a year in NYC. It has been such a benifit. We really need to catch up to the regions around us.

[Goose 188]

It's a rather aggravating situation. In the past 3 weeks I've transported patients at least 3 patients who had to be intubated either in the bus or the ER due severe PE. I'm pretty confident that in at least 2 of those patients if we had the ability to introduce CPAP immediately they could have avoided purchasing a tube. Hey, Hudson valley - NEWS FLASH: CPAP WORKS!!

[Guest Orpi442]

Brother, you are so right. The problem is when will the region listen to us? We could do so much good. Its a shame, I was talking to a individual from way back & he was shaking his head about the changes that was brought back from the past. Why cannt we get up to date now.

[Guest mediconpatrol]

I do not doubt that this will make a world of difference in the long term outcome of patients.

In the ICU I found that some patients are extremely hard to extubate, and would have benefitted greatly from CPAP instead of intubation.

On my nursing side of life, just recently I had to ride with Transcare on a transport because the medic was not comfortable with CPAP.

CPAP is used in the hospitals a whole lot. It would help everyone involved especially the patient if transport companies were more up to date with what we are doing in the hospital.

[Guest alsfirefighter]

Typical...NY EMS region reinventing the wheel. CPAP has been in use down south and out west for years with positive results. Then I forgot "This is NY we do things different here." Must be a huge difference in the air everywhere else in the country but in NY. And save the cost analysis BS. It works and we all deal with tons of CHFer's and COPDer's roll it out and get every ALS agency to buy one. Get grants if you have to.

So when will Westchester wake up and put their toe in the water and have yet another trial study.

Then again a medic can't simply pull a taser probe out of someone by protocol. Only if a medical director ok's it. That's hard with a good protocol and policy. Particulary when over 85% of PD's pull them on their own. Why not give us something we could really use and give us some legal back up.

[Guest partyrock]

I still can't believe FDNY doesn't use CPAP. Half the voluntary hospitals do, but god forbid FDNY step up.

[Jybehofd 85]

I still can't believe FDNY doesn't use CPAP. Half the voluntary hospitals do, but god forbid FDNY step up.

They first have to get glucometer's on there ALS buses

Why is EMS in the city and the island so far ahead the rest of the state??? CPAP is nothing new for them and never is Etomidate by itself with no paralitics

[Guest partyrock]

I can almost see glucometers as you can get by without them, but CPAP, RSI, combi tubes, the list goes on.

[Guest paramedico987]

CPAP study has been under way since the beggining of the year in Yonkers. Thing works like a charm and is far more idiot resistant than I would have imagined, but doesn't get used very often since there are only 2 units on the road and stricter criteria for use because of the study. Hopefully will be worked into the WREMAC ALS protocols soon and will be available on all ALS units with a wider range of candidates.

Regardless of how employees are treated, Empress DOES push over and over again to advance pre-hospital care scope of practice. And regarless of tactics and motivation to make these changes, they have overall been to the benefit of the community at large.

[WAS967 97]

CPAP/BiPAP definatly ranks high on my list of things I'd like to see WCREMAC put into their protocols.

(An AHA 2005 Guideline compliant protocol would be #1 BTW.)

[Guest paramedico987]

Dr. S [i can't spell his name so I won't try] from 803 said that the WREMAC comitee is re-writing the protocols right now [i can only assume to include new ACLS standards of care], so we'll see if it makes the cut... keep your fingers crossed!

[WAS967 97]

They are just rewriting them NOW? Good grief. They should have been done LAST YEAR. Problem too is they have to be approved byt the REMAC here then sent upstate to be approved by the SEMAC. We'll get new protocols just in time for the 2009 guidelines.

[Guest]

In the eyes of M.A.C., we are idiots and need a constant leash around our necks to do our jobs. That B.S. asprin test we all recently had to take is prime example. So WREMAC, keep up the great work in killing trees for B.S. tests and protocol upgrades. Why should you listen to us Medics who do this job day in and day out, what do we know about trying to improve the system. Yeah CPAP works, so do the new IO drills, and so do we. How about instituting a formal Hyperbaric Protocol? Where in the MAC book is there a protocol for Rapid A-Fib? Mark 1 kits....it's nice to have it, but since we only carry enough for one or 2 patients, I guess that means good for us and sucks for the patients huh? OOH OOH OOH.........where in the book does it say we're complete tards and our input means squat. Does anyone know what page that's on?

We (as a region) are about 15 years behind in comparison to agencies in the south and west. Hell, even in comparison to agencies abroad. I've worked EMS in two other countries (Canada and Germany) and lemme tell you......there's A LOT to be learned from them. There are soo many "studies" done, yet soo little progress.