‘Pit crew’ method improves cardiac survival rate

The Spokane Valley Fire Department and the Spokane Fire Department have been working together for more than two years when responding to emergencies near their borders. The rule is simple: Whoever is closest to the incident goes.

On Friday, fire crews and emergency medical technicians from both districts and Fire Districts 8 and 9, got together for a refresher course on what’s called “pit crew” CPR.

It’s very structured approach to CPR where every person on scene has a specific role when responding to a cardiac arrest call.

“We used to do CPR without having one person in charge,” said Brian Foster-Dow, battalion chief of EMS for the Spokane Valley Fire Department. “By structuring our response we can do different things and get better results.”

Foster-Dow said when crews from different districts respond to the same incident it’s important that they are on the same page.

The pit crew model puts one person in charge of the scene and assigns other crew members to managing medication, the defibrillator and clearing the patient’s airway.

“This way, everyone knows exactly what to do,” Foster-Dow said, while a crew was practicing chest compressions and using the defibrillator on the floor behind him.

Spokane Valley has used the method since 2012 and reached a 66.7 percent cardiac survival rate last year, that’s up from an average of 50 percent over the past five years.

Spokane Fire Chief Brian Schaeffer said via email that Spokane has been doing pit crew since 2010. Schaeffer said the department was still analyzing the data to determine its “save rate.”

The Sudden Cardiac Arrest Foundation reports that every year 326,200 people in the United States experience sudden cardiac arrest and on average only 10.6 percent of victims of any age survive.

Spokane Valley Fire Department’s 66.7 percent survival rate is based on the “Utstein Bystander” measurement, which means the sudden cardiac arrest must be witnessed by someone else, it has to be of cardiac origin (not caused by trauma), a bystander must intervene with CPR and the patient has to have enough of a heart rhythm that a defibrillator may be used. Not all cardiac arrests meet all these conditions.

In 2014, the Washington state average survival rate using the Utstein Bystander measurement was 50.4 percent.

Getting a heart back to beating is a complicated process that includes performing 100, 2-inch deep chest compressions every minute.

That’s fast enough to make a firefighter break a sweat pretty quickly and it’s common to rotate crew members in and out of that position.

“If your heart is not beating, your chances of survival go down by 10 percent each minute,” Foster-Dow said. “By 10 minutes, there is pretty much no chance of survival.”

Every time chest compressions stop, it takes longer to get the heart back to pumping, Foster-Dow said.

“Coaching is so important when our crews work together,” Foster-Dow said.

On Friday, the crews also got to ask questions about procedures and equipment, in between turns with the rescue dummy on the floor.

Foster-Dow said the goal is always “spontaneous return to circulation on the scene” – to get the patient’s heart beating again before they have to be transported somewhere.

“No matter what happens, we don’t stop chest compressions,” Foster-Dow said. “We don’t tolerate bad CPR.”