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LAS CRUCES FIRE DEPARTMENT

Fire department ahead of national cardiac-arrest curve

Posted

Out-of-hospital adult cardiac arrests are common in Las Cruces.

In a study of all adult, non-traumatic cardiac arrests within the city conducted in 2020, Las Cruces had nearly twice the United States average of cases for our population. Why Las Cruces has so many cardiac arrests outside of the hospital has not been studied.

In 2020, the Las Cruces Fire Department (LCFD) responded to more than 13,000 calls for medical services, of which 103 were for cardiac arrests. In the study of paramedic-led resuscitations, 35 percent of attempts at restoring a pulse were successful. This is 15 percent higher than the predicted international pooled average of 29 percent.

Given that successful resuscitation at the scene of collapse is predictive of overall survival, this high percentage of successful attempts stands out. It is estimated that without successful on-scene resuscitation, less than one percent of patients will survive to be discharged from the hospital.

The LCFD medical response includes 170 total EMT/firefighters, of which 46 are paramedics. In all, 103 cardiac-arrest calls studied in 2020 had an LCFD paramedic lead the resuscitation.

It has become the usual practice in the U.S. to attempt resuscitations at the scene of the collapse. With paramedics now available, all the necessary skills, medications and procedures are available in the field, just as one would find in hospital’s emergency department.

Carrying a patient while conducting CPR in an ambulance is no longer considered a safe option, and the quality of care is significantly degraded under those conditions. Often assisted by an American Medical Response (AMR Ambulance Service) paramedic when available, an LCFD paramedic typically goes with the resuscitated patient to the emergency department in the ambulance.

Several reasons may account for the high success rate in the study. Of the cardiac-arrest cases studied, 52 percent were witnessed by a family member or a bystander. This led to earlier activation of the 911 system and an faster response by LCFD.

The average response time of LCFD to a cardiac-arrest call was 6.2 minutes, well below the expected number of 10 minutes, which is widely considered a predictive value of success in this type of call.

This suggests that LCFD stations are strategically well placed within the city for rapid response. An additional factor in the success rate is bystander CPR.

More than 30 percent of cases of cardiac arrest had CPR started by a bystander or police officer prior to the arrival of the LCFD team.

Mesilla Valley Regional Dispatch Center dispatchers are trained to give CPR instructions to callers over the phone and may account for some of the attempts at CPR that occurred.

Successful resuscitation is a team effort, and overall survival rests on many individuals in a chain of survival that includes bystanders, dispatchers, paramedics and EMTs, as well as ambulance personnel and hospital care.

Dr. Benjamin Diven, medical director for LCFD since 2015, is a veteran of 36 years of EMS medical direction in Doña Ana County and the State of New Mexico. The 2020 study comprised more than 3,000 individual data points and was a comprehensive look at the performance of LCFD teams with cardiac-arrest patients. It is now in the form of a paper being reviewed prior to submission for publication. If accepted for publication, this will be Diven’s fourth scientific paper on emergency medicine.