The two projects are complimentary, but different.
The Mission Lifeline project is focused on developing a system to decrease the ‘field to balloon’ time for patients having a STEMI (ST segment elevation myocardial infarction) heart attack. The outcome of STEMI events depends greatly on the care patients receive and the timeframe in which they receive it. The gold standard is to get a STEMI patient to a hospital and treat them with balloon angioplasty within 90 minutes - preferably less. One of the key activities of the Mission Lifeline project is to provide devices to EMS services that can then send the patient’s 12-lead ECG from the field to the hospital. In effect, the hospital would be ready to take the patient into a cath lab immediately upon EMS arrival if the patient is having at STEMI attack.
Mission Lifeline/STEMI is an element of Cardiac Ready Communities, but this project has a different focus – the cardiac arrest patient. Historically, patient outcomes from cardiac arrest, particularly in rural communities, have been very low. However, changes in how CPR is performed have been changing over the last years and we need to institutionalize such methods in every Montana community. The term ‘high performance CPR’ is becoming an industry norm. In its simplest terms, compressions in CPR are never interrupted or stopped unless absolutely necessary. No stopping for breaths, for applying an AED, or for driving conditions during transport, etc. With a Cardiac Ready System that includes high performance CPR, patient outcomes are increasing from a historical 0-5% to outcomes reaching 40% to 50% (in mature urban systems). We may struggle to get that high in rural communities but anything will be better than current outcomes that are virtually 0% under old techniques.
Helmsley is funding the purchase of the Lucas chest compression device to rural EMS services and hospitals. This device (historically called the ‘thumper’ in old literature) mechanically performs cardiac compressions. Studies demonstrate that two people can only do high performance CPR for 5-10 minutes. Patient transports in rural areas average over 20 minutes (rural response is typically with two people and one of them has to drive the ambulance). Automatic compression devices do compressions consistently (at the same speed / same depth) in a home, on a cot and while being transported to a hospital. They don’t stop because they’re tired.
Quality CPR is very difficult to do for any length of time. Our more urban communities can compensate by responding fire and other responders so that people doing compressions can regularly switch off to someone who isn’t tired. Many times in a rural community, ambulances respond with just two people and there may or may not be someone at a scene to help them with CPR. Two people cannot perform quality CPR for long. When the patient is transported, then CPR is left to only one person and CPR is even less efficient.
The device in itself will not save patients. The importance of the Helmsley grant is that we will use funding to develop Cardiac Ready Communities. To provide cardiac arrest patients the best opportunity to survive their event, the public needs to recognize the signs of heart attack and the need to call 9-1-1. They need to know how to efficiently perform hands-only CPR and they need to know if an AED is available and how to use it. The public needs to call 9-1-1 and dispatchers need to know how to tell someone over the phone how to assess the patient for cardiac arrest and to perform CPR. EMS and hospitals need to know how to perform high performance CPR (which can be enhanced by the use of the Lucas device).
In this project, we will go into Montana communities and assess whether all of those elements exist or not and if improvements can be made. If there are any gaps, we will ‘contract’ with the communities as a shared responsibility to develop Cardiac Ready Communities that improve cardiac care for their citizens. In order to be awarded Lucas devices, the contract needs to be signed that says “we can do better” and we’re going to work together over the next three years (and beyond) to make that happen.
The grant is purchasing 222 Lucas devices. We've projected delivery of at least one of these units to most rural ambulance services, Additionally, many non-transporting units (groups of providers in small community, but no ambulance) will get these as they may have extended CPR times awaiting the arrival of an ambulance. Remaining units will go into rural hospitals. (A hospital may only have limited staff available for a patient that arrives by car at night and the device will be just as helpful to them).
Upon the community undergoing a community assessment and signing a "partnership agreement", the Lucas devices will provided to EMS services and hospitals and personnel will be trained on their use.
We will need to hire a staff person to manage this grant, but we will be then going into communities as soon as possible. We’ve projected getting most units in communities within the first 18 months of the project.
Public education for this project will be community specific and focused on development of Cardiac Ready Communities. The public information strategy will to be to announce the project before going into the community and report on what was found in a community assessment. Finally, we’ll celebrate when the community becomes recognized as a Cardiac Ready Community.