Memorial Hermann and HFD Partner to Equip Ambulances
by: Laurie Johnson, May 24, 2007 5:05:00 am
An estimated 5 million people in the U.S. have congestive heart failure. In the advanced stages of the disease, the patient's lungs fill up with fluid, making it increasingly difficult to breathe. Houston Emergency Medical Services Physician Director Dr. David Persse says until now, EMS technicians had to intubate patients to keep them alive until they arrived at the emergency room.
"Which can be technically difficult because the patient isn't unconscious, they're just in very severe respiratory distress to the point where they may not really know what's going on, they're very confused. Their oxygen level has gotten so low, but they're still breathing and they're sometimes able to fight. So trying to intubate a patient in that condition can be dangerous -- just the process of intubating can be dangerous. Intubation is putting a device into the mouth to get the tongue out of the way and then sliding a tube into the windpipe. And when somebody's kind of fighting that, there's obviously a chance for hazard."
Now every HFD ambulance is equipped with a CPAP machine. CPAP stands for Continuous Positive Airway Pressure. Dr. James McCarthy is the Emergency Center Medical Director at Memorial Hermann Hospital and an assistant professor of Emergency Medicine at UT Medical School. He says the CPAP is a much safer, non-invasive way to get oxygen to the patient.
"What actually happens is we put a soft mask over the patient's face and this provides a continuous positive pressure of air through their trachea, down into their lungs and opens their lungs up, pushing the fluid back into the soft tissue, allowing gas exchange to flow better. Effectively clearly some of the liquid out of their lungs, improving their oxygenation and basically simplifies their ability to take a breath -- they can't get air in and this allows them to take a large deep breath that they're not able to do otherwise."
Patients who are intubated are more likely to be admitted to the intensive care unit and more likely to develop complications.
"If we can keep these patients off the ventilator, their outcomes are going to be much better. They're going to get out of the hospital faster, their risk for hospital-acquired problems -- whether that's pneumonia, whether that is all the other complications that can happen, other types of infections, line infections etc -- are all minimized by minimizing their time in the ICU, minimizing their time in the hospital."
Memorial Hermann has donated 51 CPAP machines to the city. The hospital provided training to EMS technicians on how to use the devices. They're also donating machines to Montgomery County and are currently traing technicians in Humble and Atascocita. Laurie Johnson, Houston Public Radio News.