More firefighters to be deployed to save cardiac arrest victims during emergencies

SINGAPORE - More firefighters will now be deployed to revive victims of cardiac arrest, given that they are usually the first to arrive at the scene of an emergency.

More than 300 firefighters have been certified as emergency medical technicians after learning high performance cardiopulmonary resuscitation (CPR), on top of their basic first aid training.

For the first time, fire trucks will be immediately deployed to attend to cardiac arrest cases, besides an ambulance carrying paramedics.

It is among several new measures to improve the emergency treatment of cardiac arrest victims that will begin in January 2018. Other steps to be taken include quicker assessment on the need for defibrillation to make the most of every second.

The Singapore Civil Defence Force (SCDF) and Singapore General Hospital (SGH) will be implementing the new measures over a four-year period.

The move to rope in more firefighters to respond in medical emergencies comes after it was reported in 2013 that selected firefighters were beginning to be trained as emergency medical technicians.

Currently, an ambulance takes an average of 11 minutes to reach the scene. In comparison, a fire bike usually gets to the destination in half the time. Meanwhile, fire trucks are estimated to reach the scene within eight minutes.

Speed is paramount in cardiac arrest cases as the highest chance of survival occurs in the first 10 minutes. Last year, there were more than 2,500 cases of cardiac arrest in Singapore, with 21.3 per cent surviving the episode.

With firefighters performing high performance CPR, every minute could be used efficiently. "Resuscitation is a team sport," said Professor Marcus Ong, a senior consultant at the department of emergency medicine at SGH.

Usually, a firefighter on a motorbike is deployed to the scene of emergency followed by an ambulance. Under new protocol, they will be joined by a fire truck with four firefighters also trained in high-performance team CPR.

This will allow them to assist the first firefighter on the scene by carrying out high performance CPR together - to enhance life-saving efforts. Together with the paramedics who usually arrive shortly after to attend to the ailing person, all the respondents will now be the "Formula One team that works together to ensure everything is done in less time", said Prof Ong.

Another change is to rely less on computers to assess whether a person requires defibrillation, in which a machine is used to deliver a dose of electric current. Instead, paramedics will now do a manual assessment, which is quicker.

Prof Ong noted that computers take 10 to 20 seconds to determine this, while trained paramedics could make the decision in two seconds. "It will mean more training for our paramedics but in these situations, every second counts," he added.

There will also be a device introduced to enhance the heart's ability to pump blood around the body. This "impedance threshold" device will be attached to regular ventilating systems and it works by creating a negative air pressure.

Lastly, a new type of injection to correct life-threatening heart rhythm will also be introduced in ambulances. Both of these interventions will be carried out by paramedics.

While the rate of cardiac arrest survival has risen from 2.5 per cent in 2001 to 21.3 per cent in 2015, Prof Ong hopes the four new interventions will push this figure up to 30 per cent.

Various combinations of these interventions have been successfully used in the United States and Europe, with Seattle using manual defibrillation and high-performance CPR for more than 10 years, he said.

SCDF chief medical officer Ng Yih Yng said the interventions are being introduced in Singapore now because the Republic's ageing population and incidence of cardiac arrest have increased over the past 10 years.

Mr Zane Ang, 28, an advanced care paramedic with the SCDF, said that the new measures should help to improve survival rates further. "Although there is new pressure on the paramedics, it is doable. But there are precautions we will take," said Mr Ang, who has been working as a paramedic for five years.

Dr Ng said that there are around 250 paramedics who will be trained in the new interventions and more than 300 firefighters trained in high-performance CPR that will now play a more active role in cases of cardiac arrest.

He added: "If untreated in a cardiac arrest emergency, there is a 98 per cent chance you will die. These interventions require more skills to train but it's to tackle a difficult problem."