Northern Arizona Healthcare’s medevac service, Guardian Air has changed its policy for trauma-related cardiac arrest incidents with help from Sedona Fire District.
In the past, Guardian Air has not used its cardiac arrest compression tool, Auto-Pulse, on trauma-related patients.
But that all changed on Dec. 1, when Guardian Air responded to a shooting off of Beaverhead Flat Road, along with Sedona Fire District crews and Yavapai County Sheriff’s Office deputies.
“It was like a cascade of things that worked in [the patient’s] favor,” Guardian Air flight paramedic Dean Hoffman said. “From the law enforcement responding to Sedona Fire and us being familiar with the device and willing to try something.”
Although the Auto-Pulse machines have been in use at both Guardian Air and SFD for a few years now, this was the first time that Hoffman and his team used the Auto-Pulse machine on a trauma related incident, specifically for multiple gunshot wounds.
“Traditionally and for the manufacturer, the device has been recommended for medically induced cardiac arrest, so a heart attack or some other medical reason that the heart is stopped effectively working,” Hoffman said. “They do not endorse it on a trauma patient that is in cardiac arrest and I’m not really sure why.”
Hoffman said that Guardian Air has reached out to the manufacturer in the past and received no definite answer on why they believe the Auto-Pulse is not intended for trauma-related cardiac arrest.
In 2019, Hoffman’s study, funded by an NAH research grant, on the ineffectiveness of chest compressions in a medevac helicopter helped change the discussion about cardiac arrest for the region’s air medical industry.
This research resulted in Guardian Air’s seven helicopters and one airplane being outfitted with Auto-Pulse technology after two years of trials.
SFD currently has two Auto-Pulse machines in the field that were purchased during last fiscal year. These machines are located at West Sedona’s Station 1 and Village of Oak Creek’s Station 3.
According to Sedona Fire District Chief Jon Trautwein, the district purposefully spread them out in order to get to patients sooner.
“He had extensive blood loss from multiple injuries to his person. We made contact with the patient shortly after Sedona Fire did. Just a few minutes after our contact, he went into cardiac arrest,” Hoffman said. “And that’s where things changed from the normal protocol, if you will.
“Sedona Fire, since they have the machine too, suggested putting this patient on the Auto-Pulse. And based on that conversation we’ve had with our medical director a month or two earlier, we’re like, ‘let’s try it.’”
According to Hoffman, trauma-related patients that go into cardiac arrest are usually pronounced dead on scene and therefore are not called to be airlifted out.
Earlier that month, Hoffman and his team had talked with their medical director to potentially look into research for using Auto-Pulse on trauma patients. So at Beaverhead Flat Road that night, SFD and Guardian Air took a risk for the patient.
“Capt. [Donny] Arwine said we need to use this machine and they did, still why the patient was in full arrest [on the ground],” Trautwein said. “It was the helicopter pilot that said, ‘no we don’t transport, take him by ground or call it,’” i.e., declare the patient to have died.
“But then [Arwine] said ‘let’s leave the machine on and transport.’ They agreed and took him to Flagstaff to save his life.”
By the time Hoffman and his team got the patient to Flagstaff Medical Center, the patient’s heart had been stopped for a total of 45 minutes. But through SFD, Guardian Air having the Auto-Pulse machine pulsing for him, Flagstaff Medical Center was able to bring the patient into emergency surgery and his life saved.
SFD Shift A from Station 3 responded to the call. The unit is headed by Arwine and engineer Ryan Fischer, along with four other firefighters. They all received the 2021 unit citation award from the district for their response to this specific call.
“Now it just so happened, Guardian looked at that and they changed her policy so now they will,” transport trauma-related cardiac arrest patients, Trautwein said at the last SFD board meeting as he presented the award. “That’s why that unit citation was not only important with the performance of the crew, but the unusual situation and decision means that downstream there’s probably going to be an impact. They could save another life like that which would not have been saved, so that was a great crew effort and great leadership.”
None of the team expected the patient to survive, let alone return into a normal cognitive state. According to Hoffman, when he transported the patient down to Phoenix three weeks ago, he was completely alert and responsive.
The Auto-Pulse machine is the chosen chest compression equipment for much of Northern Arizona. According to Hoffman, Guardian Air is the only company in Arizona that has a fully equipped fleet with the machine.
