The Sudden Cardiac Arrest “Pit Crew” Procedure

Statistics do not lie, and the generally poor sudden cardiac arrest survival rate statistics in particular are difficult come to terms with.  The good news is that there is much room for improvement, and the potential for many lives to be saved.  There have been vast improvements in survival rate statistics and there is much to be learned from what communities from (Seattle, WA, Rochester, NY Collier, FL, Austin, TX, several communities in North Carolina) have done to achieve the improvements that they have made.

Communities that are improving their SCA survival statistics do not necessarily have better trained or more experienced EMTs.  They are examining their processes and applying some very basic strategies to achieve positive and drastic statistical gains.   The unconventional, but highly effective pit crew approach originated at the University of Arizona’s Sarver Heart Center, and has progressed from a small trial group in 2004 to a refined country-wide standard of care.   The necessity of efficient, fast acting medical care is required during a sudden cardiac arrest because the victim has only about 5 minutes to receive the care and defibrillation that is required to save their life.

In 1990, the American Heart Association developed the Chain of Survival. This protocol addresses the fact that most SCA episodes occur outside of a hospital, with death occurring within minutes of onset. For the Chain to be effective, quick execution of each and every link is critical. With each minute that passes, the likelihood of survival decreases 7-10%. 

If you are a NASCAR fan, or even if you’re not, you have witnessed the pit crew team taking care of the race car as it comes in for a pit stop.  The pit crew is a finely tuned, well oiled, beautifully choreographed machine.  Each person in the pit crew is focused on doing their job expertly and efficiently.  The team depends on each person’s successful and timely completion of their particular job to ensure that their race car is back on the track in the fewest number of seconds possible.   The analogies are clear.  The difference is that when the NASCAR Pit Crew process is applied to a sudden cardiac arrest, it may well save a life.  For both NASCAR pit crew training and Sudden Cardiac Arrest pit crew training, essential actions are used in every single training evolution and on actual calls.  The results are that all EMS responders on a call, regardless of the individuals present, have standard expectations of what needs to be done and how to accomplish it.  This standardization allows for more efficient patient care, and contributes to fewer medical errors during a medical crisis.

Seattle, WA and surrounding King County has over a 50% sudden cardiac arrest survival rate.  They have worked hard over the past decade to dramatically improve this statistic and they serve as a model for other communities.   The Pit Crew process is utilized effectively there, as well a Structured and Supported Debriefing after each code to learn.  G-A-S is the Gather-Analyze-Summarize process after an arrest.  The entire team goes over the arrest and based on particular pieces of data, information, and outcome discusses their performance in the “pit”, and how they can improve it next time they are called for a sudden cardiac arrest.

Another community that has implemented the Pit Crew process is Collier County, FL.  Dr. Robert Boyd Tober is a 30 year veteran in medical direction for Collier County.  He has been involved in many innovative changes over the years in Florida that have resulted in dramatically improved sudden cardiac arrest survival rate statistics for Collier County.  He initiated the use of the Zoll Auto Pulse, which he believes is 400 percent more effective than manual compressions and reaches coronary and cerebral blood flows of close to 100 percent of normal.  In 2005, he adapted the renowned Pit Crew concept to cardiac arrest response.  This process is becoming the standard that has delivered improved survival rates to many communities that have adopted it.

There will and should be an ongoing learning process to find and share ways that improve survival rates in sudden cardiac arrest.  The Pit Crew and Structured and Supported Debriefing are the newest tools that have proven successful.  For more information on adapting the Pit Crew Strategy to improve sudden cardiac arrest survival rate in your community: http://atcomdce.org/wp-content/uploads/2010/09/CPR-Pit-Crew.pdf