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August 4, 2011

Fire department paramedics tout breathing aids in Calif.

By Sarah Burge
The Press Enterprise

RIVERSIDE COUNTY, Calif. — A device used to treat sleep apnea is helping Riverside County paramedics with patients who are struggling to breathe and, in some cases, it is preventing lengthy hospital stays.

Since April, all paramedics in Riverside County have been using continuous positive airway pressure devices, known as CPAP, on patients who have signs of congestive heart failure. The condition can cause patients' lungs to become congested with fluid, making it difficult for them to breathe.

The CPAP device being used in Riverside County consists of a mask that straps snugly to the patient's face, creating a seal around the mouth and nose, attached to an oxygen tank that pushes air into the patient's lungs.

These types of devices originally were used to help people with sleep apnea, Riverside County Fire Department officials said. The condition involves pauses in breathing while a person sleeps.

Now, CPAP is used in hospital intensive care units and emergency departments, in addition to its use by paramedics, they said.

Battalion Chief Phil Rawlings said the devices his department is using cost about $60 apiece and must be replaced after each use. Outfitting all 96 stations — including initial startup expenses — cost about $39,000, Rawlings said.

From April through early July, Rawlings said, paramedics from his department used the devices on 48 patients. All benefited from the procedure, some dramatically, Rawlings said.

"We're really, really pleased with it," he said.

The new equipment was mandated for all Riverside County paramedics by the Riverside County EMS Agency, which designs, implements and oversees the county's emergency medical services system, Director Bruce Barton said.

Elsewhere, CPAP has gained widespread use among paramedics in the past three years, he said.

Some San Bernardino County agencies began using the device in 2007 and it was mandated for all paramedics there in 2009, said Dr. Reza Vaezazizi, medical director for the Inland Counties Emergency Medical Agency, which also oversees Inyo and Mono counties.

"CPAP has been one of our biggest successes," Vaezazizi said.

Vaezazizi said paramedics there are authorized to use CPAP on any patient who is awake and suffering from shortness of breath, including asthma patients.

While most patients who receive CPAP are suffering from heart failure or chronic obstructive pulmonary disease, Vaezazizi said, the agency decided to allow use on a broader range of conditions because it is difficult for paramedics in the field to pinpoint the cause of a patient's breathing troubles.

The key, Vaezazizi said, is that patients be awake so they can let paramedics know how well the device is working.

Vaezazizi said nearly 80 percent of patients report improvement to paramedics. Those who do not, he said, might have a more extreme problem or underlying condition, or they might be having trouble accepting the device because they are under stress.

During a recent demonstration at Cal Fire/Riverside County Fire Station No. 84 in Temecula, paramedic Capt. Hans Bolowich said the roar of the oxygen tank can be intimidating to patients at first, but once they put on the mask, patients see quick results.

"The goal is to get the patient to breathe better with the least amount of treatment," he said.

Without this tool, paramedics, or doctors later at the hospital, might have to insert a breathing tube, which is more traumatic for the patient, Bolowich and the other EMS officials said.

That procedure, used for critically ill patients, involves using a metal scope to help guide a flexible tube down the throat and into the trachea - the airway to the lungs.

Once a breathing tube has been inserted, the patient must be weaned off a ventilator in a hospital, a process that can take days, they said.

"In some cases, these patients never get weaned off, especially if they're older patients," Barton said.

With CPAP, Bolowich said, "You can walk in the room, you can put it on in 30 seconds and they're good to go."

Bolowich said his ailing mother was a recent beneficiary of the new device.

She was suffering from congestive heart failure and didn't know it, he said.

Paramedics were called to help her and used the device.

At the hospital, he said, "she was up on the floor within three hours. And she was home the next day."

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