Resuscitation Perspectives: 6 Questions With A Paramedic

Resuscitation response brings a new meaning to the concept of “a team effort.” When a victim goes into cardiac or respiratory arrest, their life is — quite literally — in the hands of the healthcare professionals who are trained to respond. The stakes are high, the pace is fast, and the success of any response depends, at least in part, on the ability of the responders to work together smoothly and efficiently as a team.

That’s the inspiration behind our Resuscitation Perspectives series, where we interview different members of resuscitation teams to better understand their role and impact in emergency response. And while our interviewees preferred to remain anonymous for privacy, we know their insights will resonate and inform readers across all resuscitation roles — from paramedics and nurses to patients and families.

Resuscitation role spotlight: Paramedic

The odds are stacked against any patient who goes into cardiac or respiratory arrest. But proximity to medical care matters, which means that victims of out-of-hospital cardiac arrest have additional hurdles to overcome in their fight to survive the event.

Many of the variables that affect these patients — such as where the event occurs and who witnesses it — are outside of anyone’s control and often come down to sheer luck. But it’s not all a matter of chance. The care that these patients receive from the Emergency Medical Services (EMS) personnel who respond — both at the scene and en route to the hospital — can make all the difference in outcome.

That’s why, for our next installment of our Resuscitation Perspectives interview series, we sat down to talk with a paramedic about the critical, lifesaving support he provides for victims of pre-hospital resuscitation events. Keep reading for his perspective on the role of paramedics in resuscitation response, how advances in medical care can transform the type of support they provide in the field, and why he wishes he could continue to support these patients even after arrival at the hospital.

Current role

What is your current role, and how are you involved with resuscitation/emergency response?

I’m a paramedic, so I respond to all pre-hospital emergencies requiring Advanced Cardiac Life Support response.

How do the unique responsibilities of your role impact your perspective on emergency response?

I’m required to manage the team, safety, and transportation to the hospital. It’s a lot of responsibility, and I’m held to a high standard for the overall care of the patient and situation, ensuring they receive high-quality, optimal, culturally supportive, and safe care.

Impact on emergency response

What are two of the most important changes that you have driven, or been a part of, that improved resuscitation response?

For overall resuscitation: mechanical cardiopulmonary resuscitation (mCPR). For airway and respiratory resuscitations: the use of laryngeal mask airways (LMAs).

The advent of mCPR has had a huge impact in EMS. It relieves the physical needs of CPR, so the medics can do any and all other Advanced Life Support (ALS) interventions and don’t have to question the quality of chest compressions. We don’t have any randomized controlled trials to show it, but our patients have been getting better overall care because the medics have an extra set of hands to support their ALS needs.

We have been using mCPR for 8 years in the field, and I was one of the instructors that started training the fire departments and other first responders. I also trained the new emergency medical technicians that would come aboard with our company.

The second change is using LMAs, which are supraglottic airway devices. Medics are able to perform rapid sequence intubation, but if you can’t get an endotracheal tube in place, you can easily place an LMA to secure the airway.

Do you see your role as having an impact on improving patients’ survival?

For overall resuscitation, most definitely. Without EMS, we would lose a lot of people before they could get to a hospital. For peri-arrest patients — in cases of myocardial infarction, congestive heart failure, failed pacemakers, sepsis, etc. — we’re resuscitating them early to support them before they go into cardiac arrest. Cardiac arrest resuscitation is more challenging because many of our patients are asystolic by the time we arrive, but at least we can give them a fighting chance.

Reflecting on the past — and looking to the future — of resuscitation response

What is some advice you would give your younger self that you didn’t know then, but know now?

I would have become a nurse earlier in my career and trained to become a flight nurse, with a focus on critical care. As a medic, we don’t get much critical care experience in the field. We manage the acute patient scenario and drop them off at the hospital, but we don’t get to manage these situations through time. I would love to support these patients even 12 to 24 hours after an event. It would give a better global perspective of the patient and would complement my emergency response care for my current patient population.

How do you see resuscitation response changing in the future?

For pre-hospital providers, I see us carrying red blood cells (RBCs) for trauma patients in that “golden hour” with long extrication times. When we can’t get them to a ground hospital quick enough, and we don’t have the option for helicopter EMS due to timing or location, we can give them RBCs to start supporting resuscitation right there. We can start infusing blood products into these patients early on. Also, I see an increase in the use of tranexamic acid to slow down the bleeds in trauma patients who are exsanguinating when we don’t have blood products available.

 Hospitals are also creating surgical first teams that work with medics to create an “operating room” in the field for some victims. For example, in a remote area where we can’t have a flight crew for some reason (weather-related or it’s just not available), the hospital may send a surgeon for a first surgical assist team to emergently amputate in the field. I’ve also heard that in the European Union they do a resuscitative endovascular balloon occlusion of the aorta (REBOA) for a ruptured abdominal aortic aneurysm in the field. I think advances in trauma care are going to impact cardiac resuscitation in the future.