Kim Ring
Telegram & Gazette, Worcester, Mass.
WORCESTER, Mass. — A single piece of legislation, if passed, could save as many as 500 lives a year in Massachusetts, according to a UMass Memorial Medical Center doctor.
Joseph Sabato, a emergency medicine doctor, said that when a heart attack happens, it’s critical to start cardiopulmonary resuscitation within 90 seconds. As time marches on, so do the victim’s chances for survival, he said.
But in Massachusetts, sometimes a 911 caller can wait as long as six minutes before an emergency dispatcher starts instructing them on how to perform the lifesaving technique, Sabato said.
“It’s too late,” he said.
The U.S. city with the best survival rate for heart attacks is Seattle, where 60% of those who experience a cardiac arrest survive. In Massachusetts, the number of survivors is much, much lower.
“It’s 3 ½%,” Sabato said. “That is horrible. The national average is 10%.”
What’s different is that in Seattle, most residents know how to do CPR and if they don’t, 911 dispatchers are trained to quickly help them learn in real time when someone is having a heart attack, Sabato said.
In Florida, where Sabato worked before coming to Massachusetts, 911 dispatchers were trained, in person, how to do CPR and practiced with simulated 911 calls from civilian rescuers. That training helped them see the incidents from both sides and made them better at handling the calls, he said. Protocols for answering such calls were aligned so all dispatchers knew the best methods for keeping a patient alive until emergency medical service arrived.
While changes to the Massachusetts 911 system a few years ago eliminated the state police middleman from 911 calls made from cellular telephones, not all emergency calls end up being routed to emergency services in the town where they originate, Sabato said.
He experienced this himself while out for a job recently and coming across a bicyclist who’d crashed. The 911 call went first to state police, then to a local dispatcher. Sometimes the call is again transferred from a police dispatcher to one who handles the EMS calls.
Spencer Police Chief David B. Darrin said those changes in 2017 and 2018 did increase call volume to the community’s dispatch center by about 100 a month and occasionally of those calls are meant to go to adjacent towns.
Darrin said a dispatcher immediately asks where the calling party is and if they’re not in Spencer, the press of a button sends the call to the correct town in seconds.
“It’s very fast,” Darrin said.
While that’s good news, Sabato said some calls can be transferred three times and with each new dispatcher, a caller might have to answer five questions before CPR instructions are given.
He’d like Massachusetts to implement the “No, no, go,” system recommended by the American Heart Association, where a dispatcher asks if the victim is conscious and if they are breathing. Two no’s means CPR instructions are given immediately.
Fewer than 30% of patients are getting CPR before the ambulance arrives as opposed to Seattle, where between 70 and 80% are already receiving lifesaving treatment from bystanders, Sabato said.
While too few people know how to perform CPR, others are uncomfortable because of the rescue breathing portion. But, Sabato said, mouth-to-mouth resuscitation is no longer used in most cases and rescuers need only pump a victim’s chest to keep blood flowing and increase the chances for survival.
Massachusetts also has laws protecting Good Samaritans. Sabato said it’s worse when people do nothing and CPR isn’t likely to hurt a patient if they’re not really in cardiac arrest.
“We have a sign in the dispatch center that says, ‘The only bad CPR is no CPR,’ ” Sabato said. “And that’s true.”
Sabato said he’s been collaborating with Worcester EMS Deputy Chief Michael Hunter Michael Shanley, the city’s acting Director of Emergency Communications and Management, to find ways to deliver CPR more quickly to more patients. The doctor said he’s pleased with how far Worcester has come in working to make the heart on city signs and in the Worcester logo mean something more.
In Worcester, lives have been already been saved by the hospital’s Prescription CPR program, in which doctors use data to determine which patients are at high risk for cardiac arrest. The family members of those folks are then trained in CPR and can spring confidently into action as they call 911 and start CPR while they await the arrival of paramedics.
The legislation would require, “All 911 telecommunicators that provide dispatch for emergency medical conditions shall be required to be trained, utilizing the most current nationally recognized emergency cardiovascular care guidelines, in high-quality Telephone-CPR. The instruction shall incorporate recognition protocols for out of hospital cardiac arrest, compression-only CPR instructions for callers, and continuous education.”
It was filed by Michael D. Moore, D-Millbury, and supported by other Worcester-area legislators after Sabato collaborated with the American Heart Association to champion the legislation. Sabato said the bill is moving along and he’s hopeful because it’s sensible and would help many people in Massachusetts.
While it won’t solve some of the other issues with prehospital cardiac care and the 911 system in Massachusetts, the simple step will be one in the right direction if the the House and Senate agree and Gov. Charlie Baker signs the legislation into law, Sabato said.
“The dispatchers can save so many lives,” he said.
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