Want to Know What Wake EMS and NASCAR Have in Common?

While I can think of a number of things a NASCAR team and Wake EMS have in common, like speed, winning, professionalism, and working with tools, the real common denominator is the pit crew. Oh yes and what they don’t have in common is beer, food concessions, and swag trailers. Although a trailer selling Wake EMS gear might be an idea. Hum.

Now don’t get any crazy ideas that pit crew paramedics are changing ambulance tires in fifteen seconds or less. The Wake EMS pit crew is an approach the EMS service takes when someone is having a heart attack.

When a call comes in to 911 that sounds like someone has just coded and is having a heart attack, the nearest EMS unit is dispatched with the calvary. Loads of people come running.

The pit crew approach protocol says that in the case of a cardiac arrest situation, three EMS units are to be dispatched. The second unit dispatched is an Advanced Practice Paramedic (APP) or EMS District Chief. The third unit is going to be the next nearest resource and that might mean an APP, EMS District Chief, or ambulance. They call that third unit, the “it,” meaning whatever the nearest “it” is. And the nearest fire department engine will be on the way as well.

It’s no wonder Wake County has such a marvelous record of saving lives from heart attacks. With an all-hands approach there are enough people on hand to watch monitors, provide advice, get meds, administer CPR, and do whatever else needs to be done.

When it comes to cardiac arrest, Wake EMS says an important factor in survival is that CPR/chest compressions are administered hard, fast, and constant. Interrupted chest compressions are not as beneficial to the patient. This is why it is important for all people to know how to do hands only CPR so chest compressions can begin even before the first responders arrive. For more on how to do hands only CPR, watch the video below.

During a cardiac arrest call there are a lot of things happening all at the same time. The fire department crew that may arrive first and will begin compressions and attach the AED (Automated External Defibrillator) to the patient.

The firefighters will stay focused on the patient and not stop compressions even when switching between firefighters.

Not the kind of EKG display you want to let linger if you want the patient to survive.
Not the kind of EKG display you want to let linger if you want the patient to survive. Booooooooooooooooooooooooo.

When the paramedics arrive they will unplug the AED and plug the patient applied pads to their more comprehensive equipment. The goal is to watch for an inviting shockable heart rhythm to restore it to a normal heart beat.

So loads of stuff is happening at the start of the cardiac event and more manpower is much better to the survival rate of the patient. I believe in Wake County they will kick your ass if you die on their watch. Wake EMS and first responders take these situations personally, seriously, and professionally.

Chris Gherardi and his Medic 93 car with all the gear he carries to save lives.
Chris Gherardi and his Medic 93 car with all the gear he carries to save lives.

As manpower starts rolling in with the pit crew approach there are more hands and eyes to monitor vital signs, administer oxygen, switch off doing compressions, determining what medications are indicated, maybe even starting the cold fluid IVs that are just above freezing which the Advanced Practice Paramedics carry in the little refrigerator in the back of their cars. The administration of cold IVs has proven to be beneficial in cardiac arrests. I wonder if they have yogurt in there as well? I would but then again that’s why I’m not a paramedic.

The way you want your EKG to look if you want to live. This is what the Wake EMS pit crew is looking to give you.
The way you want your EKG to look if you want to live. This is what the Wake EMS pit crew is looking to give you.

One of the professionals at the scene will be appointed as a “Code Commander” and is responsible for calling out instructions to the care team pushing on the patient’s chest. But while that person has the cool sounding title and should be wearing a cape at the scene, all people there play an important role to agree, disagree, and/or offer an alternate point of view on how treatment is going. The goal is to work as a team, be in agreement, and work collectively to provide the best quality care.

One of the paramedic team members as part of the pit crew will be responsible for drilling a small hole into the bone below your knee so a large amount of fluids can be dumped into your bone marrow via an IO needle. Definitely sounds like a process you should not try yourself. Let’s leave that to the professionals. Much better than, “Hey honey, can you get the drill from the garage and that straw from my sweet tea?”

All of this pit crew protocol is geared to watch for your heart to play ball and be ready to get rebooted with an electrical shock. When the heart isn’t playing nice like in V-Fib (ventricular fibrillation) the heart is beating to its own crazy mixed up beat. Kind of like how I dance at wedding receptions.

The electrical shock is intended to depolarize the heart and get everything beating on the same electrical cycle. If we had CTL-ALT-DEL keys on our bodies they could used those instead.

What ventricular fibrillation looks like.
What ventricular fibrillation looks like.

Some members of the cardiac pit crew may also be responsible at this point for getting medications ready to help the heart, mixing medications from the ambulances, or just being the “go for” the next thing needed. No, not coffee.

While all of this is going on, anxious and excited friends or family members who may be there witnessing the event and will have one of the pit crew team members trying to keep them informed about what is happening. This includes an explanation why moving the patient immediately is not the best thing to do.

Wake EMS will set up shop wherever the patient falls and stay there for the duration of the event. Even after the heart is restored to a normal rhythm the patient and paramedics will hang out for another ten minutes before scooping up the patient and heading for the hospital. This ten minute period is important to watch for any cardiac rearrest. If the patient would need to be shocked again after returning to ROSC “return of spontaneous circulation” then the ten minute clock will start over again.

It would not be unexpected for the pit crew members to be helping a patient on the floor of the mens room at the mall for an hour or more till the patient has maintained ROSC for more than ten minutes.

When it comes to having a heart attack, it sure sounds like the Wake EMS pit crew approach is a great thing to have in place to save lives.

It you happen to live in an area that does not have this life saving NASCARish cardiac policy in place, please accept my condolences.

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