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Authors: Sanjay Gupta
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sprawling dairy farms of southern
Wisconsin. Soon after, he flew to Tucson, accompanied by three other EMS directors from Wisconsin. This small group of unknown
physicians was launching a major challenge to the field of emergency medicine.
While not a prestigious academic center, Mercy Health System is the dominant medical provider in Rock and Walworth counties,
about an hour south of Madison. Its sixty-three facilities handle more than 85,000 patients a year. 14 Kellum’s ambulance squads have a lot of ground to cover. Even with sirens blaring full tilt, it takes an ambulance twenty
minutes to get from Mercy’s main hospital in Janesville to the far western edge of Rock County. 15
In the three years prior to Kellum’s experiment, emergency teams had responded to ninety-two cases of witnessed cardiac arrest.
Of those patients, only nineteen survived—and only fourteen without serious brain damage. It was, as Kellum’s team wrote in
a subsequent paper, an awful record—but no worse, probably better in fact, than the results from the rest of the country.
Put bluntly, under the accepted standard of care, the vast majority of patients died. 16
Once home Kellum and the other EMS directors made a radical decision to change the way they responded to cardiac emergencies.
They would try the resuscitation method that had formally been tested, at that point, only on pigs. They would teach it to
their paramedics, firefighters and police officers—everyone who was part of the counties’ 911 emergency response system. The
single focus would be ensuring circulation to the brain. Every effort would focus on chest compressions, and interruptions
would be kept to a minimum. When they first came to a patient who had stopped breathing, they would immediately begin by giving
not fifteen, not thirty, but two hundred hard and fast compressions to the chest. Emergency responders would follow that with
a single shock from a defibrillator rather than the multiple shocks that were considered standard medical procedure.
Defibrillation is a powerful lifesaving tool, but Kellum knew that each shock takes precious time. So after each single shock,
emergency responders would give another two hundred chest compressions. Rescue breaths were eliminated entirely. A small device
would be inserted into the mouth to pump in additional oxygen, but no breathing tube would be inserted until the patient had
a pulse or until he or she had received three rounds of shocks and compressions—six hundred chest compressions in all.
All through 2004, Kellum called down to Tucson with updates. Everything was going great; it was obvious the new technique
was working. Paramedics were getting saves they had never gotten before. Ewy was thrilled, but it wasn’t enough. He needed
other people to know about the results, so every time he got Kellum on the phone, he would harangue him to submit them to
an academic journal. Bouncing in his seat across from me, Ewy reenacted the phone calls. “I’d say, ‘Mike, you gotta get some
data!’ After he’d called me up several times, I’d be screaming at him, ‘You gotta get some data!’ He’d say, ‘I’m just an ER
doc; I can’t do that.’ But eventually I just wore him down,” said Ewy.
In the fall of 2006, when Kellum finally published his article (Ewy was a coauthor) in the
American Journal of Medicine
, the results were astounding. In the previous three years, of ninety-two people in Rock and Walworth counties who suffered
out-of-hospital cardiac arrest, only 15 percent had survived with intact brain function. After the new protocol was implemented,
that rate more than tripled. In thirty-three cases of sudden cardiac arrest, nineteen people survived and sixteen of them—48
percent—walked out of the hospital, more or less as good as new. Ewy recalls, “We had a dickens of a time getting it published.
People thought this was just too good to believe.” But a
Wisconsin. Soon after, he flew to Tucson, accompanied by three other EMS directors from Wisconsin. This small group of unknown
physicians was launching a major challenge to the field of emergency medicine.
While not a prestigious academic center, Mercy Health System is the dominant medical provider in Rock and Walworth counties,
about an hour south of Madison. Its sixty-three facilities handle more than 85,000 patients a year. 14 Kellum’s ambulance squads have a lot of ground to cover. Even with sirens blaring full tilt, it takes an ambulance twenty
minutes to get from Mercy’s main hospital in Janesville to the far western edge of Rock County. 15
In the three years prior to Kellum’s experiment, emergency teams had responded to ninety-two cases of witnessed cardiac arrest.
Of those patients, only nineteen survived—and only fourteen without serious brain damage. It was, as Kellum’s team wrote in
a subsequent paper, an awful record—but no worse, probably better in fact, than the results from the rest of the country.
Put bluntly, under the accepted standard of care, the vast majority of patients died. 16
Once home Kellum and the other EMS directors made a radical decision to change the way they responded to cardiac emergencies.
They would try the resuscitation method that had formally been tested, at that point, only on pigs. They would teach it to
their paramedics, firefighters and police officers—everyone who was part of the counties’ 911 emergency response system. The
single focus would be ensuring circulation to the brain. Every effort would focus on chest compressions, and interruptions
would be kept to a minimum. When they first came to a patient who had stopped breathing, they would immediately begin by giving
not fifteen, not thirty, but two hundred hard and fast compressions to the chest. Emergency responders would follow that with
a single shock from a defibrillator rather than the multiple shocks that were considered standard medical procedure.
Defibrillation is a powerful lifesaving tool, but Kellum knew that each shock takes precious time. So after each single shock,
emergency responders would give another two hundred chest compressions. Rescue breaths were eliminated entirely. A small device
would be inserted into the mouth to pump in additional oxygen, but no breathing tube would be inserted until the patient had
a pulse or until he or she had received three rounds of shocks and compressions—six hundred chest compressions in all.
All through 2004, Kellum called down to Tucson with updates. Everything was going great; it was obvious the new technique
was working. Paramedics were getting saves they had never gotten before. Ewy was thrilled, but it wasn’t enough. He needed
other people to know about the results, so every time he got Kellum on the phone, he would harangue him to submit them to
an academic journal. Bouncing in his seat across from me, Ewy reenacted the phone calls. “I’d say, ‘Mike, you gotta get some
data!’ After he’d called me up several times, I’d be screaming at him, ‘You gotta get some data!’ He’d say, ‘I’m just an ER
doc; I can’t do that.’ But eventually I just wore him down,” said Ewy.
In the fall of 2006, when Kellum finally published his article (Ewy was a coauthor) in the
American Journal of Medicine
, the results were astounding. In the previous three years, of ninety-two people in Rock and Walworth counties who suffered
out-of-hospital cardiac arrest, only 15 percent had survived with intact brain function. After the new protocol was implemented,
that rate more than tripled. In thirty-three cases of sudden cardiac arrest, nineteen people survived and sixteen of them—48
percent—walked out of the hospital, more or less as good as new. Ewy recalls, “We had a dickens of a time getting it published.
People thought this was just too good to believe.” But a
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