MedStar will no longer 'run hot' with cardiac arrest patients inside

Posted Wednesday, Apr. 21, 2010




MedStar ambulances will no longer "run hot" -- that is, with lights flashing and sirens blaring -- when paramedics inside are giving chest compressions to patients in cardiac arrest, officials say.


The new policy, which took effect Friday, will affect about 1,400 of the more than 100,000 calls to which MedStar responds annually in the 15 Tarrant County cities it serves.


MedStar's ambulances run hot on about 10 percent of calls, officials said. MedStar is thought to be one of the first ambulance providers in a metro area to adopt the policy involving chest compressions, said Robert Suter, past president and past chairman of the EMS section of the American College of Emergency Physicians.


Running hot saves an average of one minute and 43 seconds per hospital trip, said Matt Zavadsky, MedStar's associate director of operations. But the time saved rarely improves the patient's outcome, he said.


Running "cold" -- without lights and sirens -- may prevent damage along the way, Zavadsky said.


Cardiopulmonary resuscitation is best done without any motion, a near impossibility while ambulances are running hot, stopping short to avoid motorists and compensating for motorists who are trying to avoid them, Zavadsky said.


When a patient undergoing CPR is being transported, it is better that the ride be nice and slow, Zavadsky said.


The ambulance provider also considered the potential trouble that comes with running hot.


"Statistically, for every ambulance crash, there are three wake-effect crashes," he said. "About 74 percent of our crashes happen while we're running hot.


"Our first call is to do no harm. It's part of the oath we take. When we're running hot, we're hurting our own people and we're hurting others."


Sometimes the ambulance driver is not aware of wrecks that may have happened during the race to the hospital. Those wrecks often occur after the ambulance has passed, Zavadsky said.


Running cold may help in other ways. Flashing lights and loud sirens tend to raise the blood pressure and heart rates of some people -- not the best therapy for someone who has had a heart attack, Zavadsky said.


Something else to consider is that the time lag does not make any difference for the patient. Paramedics deliver the same type of care and use the same medications and equipment that hospitals use to treat cardiac arrest, said Jeff Beeson, MedStar medical director. When MedStar receives a cardiac arrest call, a minimum of seven people are sent, Beeson said. Rushing to the nearest hospital is not helpful in these cases, Beeson said.


But sometimes saving time does make a difference, Zavadsky said. For some heart attacks or for strokes, every second counts, Zavadsky said. Paramedics cannot administer certain medications or perform certain procedures, Zavadsky said.


The best chance for a person in cardiac arrest is for the nearest person to recognize the symptoms and begin CPR and for someone else to call 911, followed by immediate defibrillation, Beeson said.


"If we get a pulse back, we will transport," Beeson said. "We will not run lights and sirens in most cases. We're trying to provide the most efficient and the safest care, not only to your loved ones but for the community.


"We have to learn from our European counterparts, who almost never run lights and sirens. It's the right thing to do."