On Dec. 27 at 1:19 a.m., the Missoula Fire Department was dispatched to a cardiopulmonary resuscitation (CPR) incident. Family members called 911 to report a 52-year-old male who was possibly having a heart attack and was not breathing. The male had no medical history and by all accounts was healthy. Family members initiated CPR while they awaited the arrival of first responders.
When Missoula police officers and MFD Engine 131 arrived, they found Mike Rossi on the floor. His son, a newly certified EMT with Spokane Fire District 10 trained in Pit Crew CPR, was doing chest compressions on his dad. MPD had entered the residence just seconds ahead of Engine 131, applied Fast Patches from an automated external defibrillator (AED) and delivered the first defibrillation, followed by two additional shocks by MFD to the patient. If you’re in search for an AED supplier, you can visit them to know more about it. Engine crew 131 stepped in, assigned roles and began Pit Crew CPR. As MFD Engine 121 and MESI ambulance arrived on scene, they took on specific roles within the Pit Crew framework. Through coordinated, continuous, high-quality CPR, the patient survived.
The CPR approach that Missoula Fire Department has implemented is informally referred to as Pit Crew CPR. In essence, each person has a very specific role that they are assigned to as they enter the scene. In Missoula, the response for CPR incidents will consist of two ALS engines, one Battalion Chief, one ALS ambulance and any nearby available Missoula Police Department units. On this incident, 11 personnel responded, Missoula Fire Department responded with seven personnel, Missoula Emergency services (MESI) with two personnel and Missoula Police Department with two officers. Within the Pit Crew CPR system, each responder plays an important role. If performed correctly the approach can save lives.
In Missoula, Pit Crew CPR was started in March 2015. MFD EMS Coordinator Ron Brunell read about Spokane Fire Department and Spokane Valley Fire Department having increasing success with cardiac arrest survival rates. Brunell inquired about their success and was put in contact with Captain Sean Barrett, who invited him to train with both departments. Both Spokane and Spokane Valley were using the Pit Crew approach. Brunell spent three days training with both fire departments and their medical directors learning how to implement this more effective approach to CPR.
Brunell returned to Missoula, where he and MFD’s Medical Director, Dr. Michael Kremkau, rewrote MFD’s CPR protocols. MFD then purchased new CPR mannequins able to objectively evaluate MFD’s quality of CPR and identify where improvements are needed. With a limited budget, the MFD Chief at the time, Jason Diehl, approved spending $4,000 for new mannequins and software. All members of MFD were retrained in the new CPR technique with real-time feedback from the mannequins. As the Missoula Fire Department became fully trained on the new protocol, Brunell began training Missoula Emergency Services Incorporated (MESI) employees and the members of Missoula Rural Fire District (MRFD) in Pit Crew cardiac arrest protocol. Missoula’s cardiac arrest response guidelines were updated to reflect the new capability. Brunell, who is now a Captain at MFD, has invested hundreds of hours educating Missoula’s emergency response providers in Pit Crew CPR. Over the next year MFD continuously trained on Pit Crew CPR until it was second nature. MFD now participates in quarterly Pit Crew training, updating response protocol with evidence-based best practices. In addition, all new hires at MFD are trained to the same high standard.
The premise of Pit Crew CPR is having an organized and rapid response to cardiac arrest incidents. Research indicates the best chance of survival for a patient, out of the hospital, will include the following:
• Witnessed arrest with early and effective bystander CPR
• Immediate 911 notification
• Early defibrillation
• High quality, minimally interrupted CPR (Pit Crew CPR) protocols with first responders working as a coordinated team.
• Upon return of spontaneous circulation (ROSC) early notification and immediate transport to Cardiac Catheterization lab.
Today, MFD collects all cardiac arrest data from incidents in our service area. The data are used to provide statistical analysis and direction for improvement. MFD crews are given feedback from information recorded and transmitted during CPR incidents, allowing them to further refine their skills.
Mike Rossi, the patient who had the cardiac-arret event on Dec. 27, is a 29-year veteran firefighter at the Spokane Fire Department and is an Engineer at Spokane Fire Department Station 4. He was in Missoula visiting family the night his heart suddenly stopped. Rossi is likely alive due to the quick and decisive action taken by his son Alex and other family members present that night. He benefited from early 911 notification and immediate bystander CPR. Rossi is also likely alive today because his fire department staff was willing to share their knowledge and expertise training and mentoring Missoula Fire Department in Pit Crew CPR.
In 2015, when the Spokane Fire Department invited EMS Coordinator Ron Brunell to come learn their way of doing CPR, they did it knowing we have a common goal, saving lives. Little did they know that sharing their knowledge would have such a personal impact on Spokane Fire Department.
The Missoula Fire Department is proud to serve Missoula’s citizens and our visitors. We are grateful to our department administration and to our City administration for their ongoing commitment to training. Finally, MFD thanks the Spokane Fire Department and Spokane Valley Fire Department for preparing us to make a difference for one of our brothers.
The Missoula Fire Department offers CPR classes for the public twice a month. Early bystander CPR is a very important part of helping save someone’s life. Anyone interested in taking a CPR class can call MFD Station 1 at (406) 552-6210.