Horizon, Host: Ted Simons

May 18, 2006


Host: Michael Grant

New CPR


  • It's Emergency Medical Services Week and Horizon introduces us to the new CPR called the Cardiocerebral Resuscitation and Arizona is the first state to adopt it. A survivor who was treated with the new Cardiocerebral Resuscitation will share his experience and Dr. Ben Bobrow, Medical Doctor of the Arizona DPH, Bureau of Emergency Medical Services will talk with Michael Grant about Arizona's effort to educate the public on the new CPR.
Guests:
  • Dr. Jason Linder - Medical director, emergency department, Mercy Gilbert Medical Center
  • Dr. Ben Bobrow - Emergency physician, Mayo Clinic Hospital in Phoenix and medical director, Bureau of Emergency Medical Services, Arizona Department of Health Services


View Transcript
Michael Grant:
Tonight on "Horizon," there's a new hospital in the east valley. We'll tell you about it and discuss health care facilities in the valley. Speaking of health care, there's a new way to revive a person, and it eliminates the need for mouth-to-mouth contact. Learn more about the new C.P.R. That's coming up next on "Horizon."

Announcer:
Horizon is made possible by contributions from the friends of 8, members of your Arizona PBS station. Thank you.

Michael Grant:
Good evening, welcome to "Horizon." I'm Michael Grant. Before we get to those issues, here's what's happening today. President Bush was in Yuma today to visit the nation's busiest illegal alien smuggling hotspot. Greeting president bush was Governor Janet Napolitano, along with the Yuma mayor and four border patrol agents. The president's visit coming three days after he talked to the nation about his immigration plan, which includes sending 6,000 National Guard troops to the border in support roles. During the visit, the president said it makes sense to build a fence along parts of the border. Accompanying the president on the trip were Arizona representatives John Kolbe, Jeff Flake, and John Shadegg. Although the president was in town today, his wife is going to be here a month from now. Laura Bush will help Senator Jon Kyl in a fund-raiser. The First Lady will appear at a $500-a-plate luncheon in Scottsdale June 16 for Kyl, who is being challenged by democrat Jim Pederson. As Arizona's population grows, so does the need for health care services around the state. A new 300,000-square-foot, $152 million hospital is opening soon in the east valley. In a moment we'll talk about efforts by that health care organization and others to meet the need for more hospitals and health care workers across the valley and the state. First, Merry Lucero shows some of the features of the new hospital.

Merry Lucero:
It's a town where fields of corn are being plowed into tracts of new homes. Gilbert is a rapidly growing community, and along with new grocery stores, banks, and other services, there has been a great need for a new hospital. Now they have one: Mercy Gilbert Medical Center.

Laurie Eberst:
We are the first full-fledged acute care hospital for Gilbert. The population is now over 180,000 people, and so there's just such a tremendous need for health care provider in this area. Currently people are having to travel 30 to 45 minutes to get to the nearest hospital, so on opening date of June 5 we know that we're going to be very busy from the beginning, meeting that need.

Merry Lucero:
Cutting edge equipment and technology are key amenities at the hospital. Patients and visitors will have a remote control and a wireless keyboard at their bed. With it they can control their T.V. and get on the internet, and hospital staff can communicate with the patient and even find out if they are happy with their stay.

David Schofield:
This allows the hospital to launch a survey during the patient's stay. A lot of times most hospitals would do surveys post-discharge. If there's a problem during their stay, there's nothing they can do about the issue because they're already gone. So we have a way to compliment that survey by doing a real-time survey piece.

Merry Lucero:
Another new technology, the hospital will be filmless, with all digital radiology imaging.

Rudy Apodaco:
And those procedures are at the click- one mouse click away from physicians. Within a matter of seconds they can make a determination, make a diagnosis for the patients so they can be treated.

Merry Lucero:
State of the art labor and delivery rooms include a special place for baby.

Laurie Eberst:
Once the baby is born, you open up this cabinet over here and there's a cabinet, it pulls down and there's a cabinet in there for the baby to be warmed up and cleaned up and just pretty sophisticated.

Merry Lucero:
In contrast, the hospital also features a warm comforting, and spiritual environment. Art and photography centered on the local community decorate the floor where surgery is done, and intensive and critical care is given.

Laurie Eberst:
We know the families and patients that are on this floor are generally a little bit sicker or going through a more stressful time. So we did a few extra features.

Merry Lucero:
On June 5, Mercy Gilbert Medical Center will initially open to the public with 88 beds and will have the ability to expand to more than 400.

Michael Grant:
Joining me now to talk more about the Mercy Gilbert Hospital and the need for more like it and workforce to staff it is Dr. Jason Linder, medical director of the emergency department at Mercy Gilbert Medical Center. It's good to see you. That just looks like a terrific facility, particularly the filmless X-ray feature. I would think that would be just really a terrific innovation.

Dr. Jason Linder:
It gives a huge help in my medical career. I started with film, obviously as medical students one of our jobs is to track that down, and that was sometimes-- getting it from the film library and there's issues of returning it, so it speeds us up beyond what we would think. It's one of those innovation that's changes how you do things day-to-day.

Michael Grant:
Yeah and you were telling me before we went on the air that, for example, particularly on-call people, those kinds of things can access that data if they have the right sort of computer links from their homes.

Dr. Jason Linder:
That's right, we view witness our specialist frequently, just over the phone. This will probably be improved over that.

Michael Grant:
You can do a consult over the phone. They can make a decision about how urgent or not it is to come in, those kinds of things?

Dr. Jason Linder:
Correct. And a follow-up is defined by that, and maybe a one-day return, or two weeks, to wait for the swelling to go away. It benefits a patient an enormous amount of time.

Michael Grant:
How much does Mercy Gilbert relieve-- we talk about growth all the time, and we-- many of us, including myself, don't think about all the things that have to go along with that, including but not limited to hospitals. Pretty heavy demand down in the east valley, is there not?

Dr. Jason Linder:
Tremendous demand and our administrative people spent a lot of time trying to predict how many people need health care services in the east valley and where they will come from. I spent a-- spend a lot of time trying to predict our daily census. It's difficult. The honest answer is we're not sure what is going to happen. We don't know the growth is so expansive; it's hard to predict how many people will show up.

Michael Grant:
Is it still somewhat seasonal? I know it's not as-- .

Dr. Jason Linder:
Yeah.

Michael Grant:
It's not as seasonal as it used to be.

Dr. Jason Linder:
Certainly the Phoenix history was the summertime people could take vacations in health care. Certainly that's gone away. We do see trends of maybe a 10-15\% drop that occurred in February and March, and now it's back up to census levels that again are stressing the resources. Such that people are fearful of that predictable nature. Certainly other value hospitals have experienced that, that the dip in the summer has-- is smaller each year, and that trend continues.

Michael Grant:
What about staffing issues for you? We've been hearing an awful lot about in particular emergency room staffing.

Dr. Jason Linder:
Emergency room staffing, there's two problems. One is nursing, a lot of-- it's a struggle to find nurses, retain them, it's a high demand market. That professional has changed based on that. We have been lucky to hire a lot of experienced nurse and have a full complement, but that's not always the experience at all hospitals, certainly with the fear of a new one. Medical staff, easy to get the hospital-based medical staff, emergency department positions, general surgeons who rely upon it. Far more difficult to get the specialists who primarily operate out of outpatient centers, like plastic surgeons, hand surgeons, sometimes gastroenterology, a number of others that are difficult to obtain call coverage for.

Michael Grant:
These are the on-call guys?

Dr. Jason Linder:
That's correct. Those are the people, for example, we would consult about a complicated facial laceration, or orthopedics can be a problem. It's not in our hospital, but open fractures that need stabilization and treatment within four to six hours. A laundry list of things, mostly all subspecialty based.

Michael Grant:
One of the issues we talked about recently was the coordination in particular among emergency rooms, again, dealing with the overcrowding and those kinds of system. Pretty good communication net between hospitals, is there not?

Dr. Jason Linder:
There is--

Michael Grant:
Other safety support, public safety kind of--

Dr. Jason Linder:
Well, the struggle with the expansive growth now, even our community resources are stretched. In the past you could see hospital resource get stretched, but it's one hospital for about 180,000 people in Gilbert. And that ratio with 88 in-patient beds is not enough. The whole hospital is under-- the whole valley here is under bedded per thousand population we're far under national averages. So the whole system is strained, and when one hospital is overloaded typically all of them are in the east valley, it's pretty legendary for that so far.

Michael Grant:
Now you mentioned 88. Mercy Gilbert's going to get bigger, right?

Dr. Jason Linder:
Yes, and that's already in the works. Health Care west has already put it into place, the drawing process, the construction process will start shortly, and I'm told in 12 to 16 months, we'll have another win which will put us at about 200 beds.

Michael Grant:
Okay. And then ultimately I think growing to 400?

Dr. Jason Linder:
Ultimately the plan-- yeah, since it's-- space is already purchased in terms of the earth, we can go to 400.

Michael Grant:
All right. Dr. Linder, we appreciate you joining us. The public opening is this Saturday?

Dr. Jason Linder:
Saturday from 10:00 to 2:00.

Michael Grant:
You'll have cookies, coffee--

Dr. Jason Linder:
They can come and tour the hospital, come through the emergency department, and get all kinds of medical knowledge and see the place, everybody is very proud of it. It is a very nice facility.

Michael Grant:
It looks terrific. Jason, thanks again.

Dr. Jason Linder:
Thank you.

Michael Grant:
Tucson is the first city in America to adopt a new C.P.R. method. It's a procedure to resuscitate cardiac arrest victims, even though the new procedure has not been officially endorsed by the American Heart Association. Pam White reports that the head of the University of Arizona's Sarver Heart Center says the latest research is too compelling to wait for a new set of guidelines.

Pam White:
The head of the U of A heart center Dr. Gordon A. Ewy began campaigning for a new C.P.R. in the early ‘90s when research showed most people wouldn't perform C.P.R. on a stranger because they didn't want to do mouth-to-mouth resuscitation.

Dr. Gordon A. Ewy:
And we actually sent out a survey to almost 1,000 people and found out that only 15 to 20\% of people would do C.P.R. if they had to do chest compression and respiration, and almost all of them would do it if all they had to do was chest compression only.

Pam White:
In 2000, the American Heart Association took those findings into consideration and revised its guidelines, saying if you're unable to do mouth-to-mouth resuscitation; it's ok to only do chest compressions.

Dr. Gordon A. Ewy:
You know, that was the best information we had, and we of course wanted them to emphasize that a little bit more.

Pam White:
Now Dr. Ewy's crusade for new C.P.R. standards is becoming even more urgent based on two recent studies. One found that for the layperson, traditional C.P.R. is difficult to remember. Researchers also found precious time was lost when chest compression were interrupted to do mouth-to-mouth resuscitation.

Dr. Gordon A. Ewy:
So then we went back and said, ok, let's do it the way it's really done. We compared doing nothing, to doing chest compression only, to doing C.P.R. where you did 15 breaths and 15 compressions and 16 seconds to do the two breaths. In other words, you're only pressing on the chest at the time. The survival in that group was 13\%. The survival in the chest compression only was 70\%.

Pam White:
Doctor Ewy, this is the new C.P.R., not new to you, since you were advocating it in the early ‘90s.

Dr. Gordon A. Ewy:
Yeah, the research group has been advocating this since 1993 because we have shown that doing chest compression only was dramatically better than doing nothing. What has changed recently, in the last two to three years, is we've shown that doing chest compression only is better than doing the old standard way, where you interrupted each 15 compressions for two breaths. Because the two breaths take so much time that you're not pressing on the chest. Notice she is-- put the heel of the bottom hand right in the center of the chest, usually between the nipples, locks the elbows, and she's using her weight to compress. No one is strong enough to use their muscles. And she's doing a sue push job. Notice that she's doing it at about 100 per minute, and this is absolutely ideal. The point of the news conference today is to announce a new initiative in cardiopulmonary resuscitation that will begin today in Tucson.

Pam White:
And in 2003, the Tucson Fire Department, with the help of the U of A heart center, began using the new C.P.R., making Tucson the first city in the country to use the procedure.

Joe Eulotta:
The first thing we had to do is be convinced it would not harm the community, and Dr. Ewy and the heart center spent about six months with us going through a lot of their research and background, convinced the fire chief and our medical director, and in turn we convinced the people in the field, the paramedics and the E.M.T.'s that it would work.

Pam White:
Joe Gulotta is a deputy chief with the Tucson Fire Department. It's too early to give the results, but they found feedback from paramedics-- based on feedback from paramedics, the new C.P.R. is having a significant impact.

Joe Eulotta:
It's not as complicated as what American Heart Association has us go through, and anecdotally the paramedics are responding back saying that they're seeing more response from the patients, that they're seeing-- that their defibrillations are more effective because we have increased the circulation in the heart and oxygenated the heart.

Pam White:
Now in the current issue of "Circulation" magazine, a major publication in the cardiology world, is an article by Dr. Ewy outlining the protocols for the new C.P.R. and how it's being used here in Tucson.

Dr. Gordon A. Ewy:
Not only the layperson, but th-- what the paramedics need to do, what the professionals need to do as well to improve it. Because it's not just one thing, it's an entire series of changes. But it relates to the fact that you've got to continue pressing on the chest, because when you're pressing on the chest, you're moving blood to the brain, and when you stop, you're not.

Pam White:
The American Heart Association comes out with its updated guidelines at this December. So far it has not endorsed the new C.P.R. One concern, the new technique does not help cases of respiratory failure.

Dr. Gordon A. Ewy:
We're not talking about a drug overdose, an alcoholic that took too much whatever and stopped breathing. Those are arrests, and you need to breathe for that patient to get them to-- we recognize that. And we think lay people can recognize that. What we're talking about is unexpected, sudden collapse in an adult. And it-- an adult has a sudden unexpected collapse that is 99\% heart attack.

Pam White:
Paramedics in two other cities are using the new C.P.R. One in Wisconsin, the other in Illinois. With this article Dr. Ewy says more places will follow, even if the American Heart Association does not update its guidelines.

Dr. Gordon A. Ewy:
I think it's going to be a groundswell that the A.H.A., it's going to have to change. Because people are going to change without them.

Michael Grant:
Earlier this week I talked to a local expert about that new C.P.R. procedure. He is Dr. Ben Bobrow, an emergency physician at the Mayo Clinic Hospital in Phoenix and the medical director of the Bureau of Emergency Medical Services for the Arizona Department of Health Services. I also talked to cardiac arrest survivor John Coules. Dr. Bobrow, cardiocerebral recitation, the procedural calls for chest compressions only. Explain that to me.

Dr. Ben Bobrow:
Basically the way we've conventionally taught C.P.R. is a combination of chest compressions and ventilations. That's the way it's been taught for the last 40 years or so. And the last several years we've-- a lot of research has shown the chest compression component is the key part, and that really resuscitating the brain, cardiocerebral resuscitation is the key component as opposed to cardiopulmonary resuscitation. The lungs can go a long while without oxygen, but the brain needs continuous supply of oxygen.

Michael Grant:
The feeling being here is this is also more user-friendly, that people who are doing the administration more likely just to do the chest compressions than the combination technique?

Dr. Ben Bobrow:
Exactly. When we asked people to do chest compression and ventilations together, it's difficult. It's a difficult task, difficult to remember, difficult to teach, and also people are very hesitant to do mouth-to-mouth breathing on bystanders if they collapse. And what we found out is that when we teach people to do chest compression only, number one, it's much easier for them to learn, much quicker for them to learn, they can remember it, and they'll do it in an emergency.

Michael Grant:
Now John, tell us your story. Pretty amazing.

John Coules:
Well, like I said, I grew up in-- I should say I am living in Gold Canyon, Arizona, working out on a daily-- fairly daily basis, and I went out and this was Christmas of 2001, and a couple of days after the holiday, working out in the gym, did a normal workout, which I normally do every day, and got on the treadmill, bicycle, stretching, that type of thing. And got off the machine, cooled down, as you're supposed to do, went out talking to a lady, walked out to the restroom. I stopped in the restroom, she evidently stopped outside. When I went into the restroom I had a cardiac arrest. Without any warning at all. Just hit the ground.

Michael Grant:
Now at this point in time she hears that, thank goodness.

John Coules:
And she didn't want to go in the restroom, ran back immediately, got her husband who was in the gym, he happened to be the trainer, and had had experience with C.P.R. He had been a highway patrol officer for years. And had to actually resuscitate two people prior to me. He started with me with C.P.R., it didn't work, he tried again, it didn't work. He yelled to somebody to grab the defibrillator off the wall which was about fifteen feet away, and he put that on me, stood back, which it instructs you to do, and it didn't work. So he did it one more time, and it did work, and he knew it worked, because the blood was pouring out of my head.

Michael Grant:
Dr. Bobrow, you had a circumstance where traditional C.P.R. did not seem to work, thank goodness that a defibrillator was very handy, because that's fairly rare in a circumstance outside of a hospital or an emergency room.

Dr. Ben Bobrow:
Yeah. We're trying to increase the numbers of those devices available in public places, like gyms and golf courses and schools and things like that. And more and more they are available, and we have several thousand of them across the state. But we have to increase awareness in people's ability to use them. The thing that was key in Mr. Coules case was that somebody did immediate bystander C.P.R. that kept him going until they could get the A.E.D. to him.

Michael Grant:
Now the argument here, though, being that the less complicated procedure with the chest compressions only hopefully encouraging more people to administer first aid. Does that make sense to you?

John Coules:
Yes, it does. Having gone through the procedure.

Dr. Ben Bobrow:
It's a little confusing. The gentleman that rescued Mr. Coules was an off-duty police officer who was trained in this. So he wasn't really a layperson. Now he had had medical training. We find that quite frequently, that if there's an off-duty medical person, they can respond and they often are the ones that do respond. But we're trying to develop a system where we have responders who are non-medically trained, non-formally medically trained, and they can respond as well.

Michael Grant:
American Heart Association says chest compressions only may not be enough because the person may be suffering from a respiratory problem and lay people wouldn't understand the difference. What do you think?

Dr. Ben Bobrow:
This is a key component. A key point. In that we're only talking about adults first. Kids usually have a respiratory component. So we're talking about this continuous chest compression, C.P.R. for people older than 8 years of age. And also we're really talking about the sudden unexpected collapse. Not someone that has had respiratory problems or asthma, or--

Michael Grant:
Gasping.

Dr. Ben Bobrow:
Gasping, yeah, that's different. Those people still-- you need to breathe for them. And also people that have an overdose of some sort or drowning, we need to ventilate them with the conventional way. But for the case that happened like Mr. Coules who had a sudden unexpected collapse, that really is a case where we need to perform immediate chest compressions until we can get an A.E.D.

Michael Grant:
John, I'm curious, were you schooled in C.P.R. prior to your--

John Coules:
C.P.R. Yes, I knew about C.P.R. Of course I didn't know about the defibrillator. The defibrillators in our building were only installed about three or four months before this happened to me. And they were installed largely due to that same police officer.

Michael Grant:
Now, as I understand it, you're now wandering around with one.

John Coules:
I have my own. I'm playing golf and working out like I did before. I was very fortunate.

Michael Grant:
Dr. Bobrow, how are you promoting this new technique?

Dr. Ben Bobrow:
We developed a program, I work also for the Department of Health Services, the Bureau of E.M.S., and we have a program called the SHARE program, which is an acronym for Save Hearts and Arizona Registry and Education. And basically what we're trying to do is promote bystander C.P.R. and A.E.D. use through public education and public awareness and training. And on the website, www.azshare.gov, if you visit that website you can learn about this.

Michael Grant:
Okay and let's go back. All right, we just threw it up on the screen. So more information on this, give us the website one more time?

Dr. Ben Bobrow:
www.azshare.gov.

Michael Grant:
All right. Dr. Ben Bobrow, thank you very much for joining us. Appreciate the information. Jim Kolbe, thanks to you. John Coules, thanks to you as well. Happy you made it.

John Coules:
I am too.

Michael Grant:
If you would like information about upcoming shows or about past shows, please visit the web site at www.azpbs.org. Once you get there, click on the word "Horizon" to get to the show's home page.

Mike Sauceda:
President Bush visits the border at Yuma three days after his speech on immigration. While there, he says a border fence might not be a bad idea. The governor calls on the legislature to hold off on its immigration plan. And 2\% of the class of 2006 won't be graduating because they failed the AIMS test. The Journalists' Roundtable Friday at 7:00 on "Horizon."

Michael Grant:
And next on 8 is "Horizonte." Thank you very much for joining us on "Horizon." I'm Michael Grant. Have a great one. Good night.

New Hospital


  • As Arizona’s population grows so does the need for health care services across the state. HORIZON profiles one new 300-thousand square-foot, $152-million dollar hospital opening in the East Valley and ongoing efforts to meet the need for more health care facilities.
Guests:
  • Dr. Jason Linder - Medical director, emergency department, Mercy Gilbert Medical Center
  • Dr. Ben Bobrow - Emergency physician, Mayo Clinic Hospital in Phoenix and medical director, Bureau of Emergency Medical Services, Arizona Department of Health Services


View Transcript
Michael Grant:
Tonight on "Horizon," there's a new hospital in the east valley. We'll tell you about it and discuss health care facilities in the valley. Speaking of health care, there's a new way to revive a person, and it eliminates the need for mouth-to-mouth contact. Learn more about the new C.P.R. That's coming up next on "Horizon."

Announcer:
Horizon is made possible by contributions from the friends of 8, members of your Arizona PBS station. Thank you.

Michael Grant:
Good evening, welcome to "Horizon." I'm Michael Grant. Before we get to those issues, here's what's happening today. President Bush was in Yuma today to visit the nation's busiest illegal alien smuggling hotspot. Greeting president bush was Governor Janet Napolitano, along with the Yuma mayor and four border patrol agents. The president's visit coming three days after he talked to the nation about his immigration plan, which includes sending 6,000 National Guard troops to the border in support roles. During the visit, the president said it makes sense to build a fence along parts of the border. Accompanying the president on the trip were Arizona representatives John Kolbe, Jeff Flake, and John Shadegg. Although the president was in town today, his wife is going to be here a month from now. Laura Bush will help Senator Jon Kyl in a fund-raiser. The First Lady will appear at a $500-a-plate luncheon in Scottsdale June 16 for Kyl, who is being challenged by democrat Jim Pederson. As Arizona's population grows, so does the need for health care services around the state. A new 300,000-square-foot, $152 million hospital is opening soon in the east valley. In a moment we'll talk about efforts by that health care organization and others to meet the need for more hospitals and health care workers across the valley and the state. First, Merry Lucero shows some of the features of the new hospital.

Merry Lucero:
It's a town where fields of corn are being plowed into tracts of new homes. Gilbert is a rapidly growing community, and along with new grocery stores, banks, and other services, there has been a great need for a new hospital. Now they have one: Mercy Gilbert Medical Center.

Laurie Eberst:
We are the first full-fledged acute care hospital for Gilbert. The population is now over 180,000 people, and so there's just such a tremendous need for health care provider in this area. Currently people are having to travel 30 to 45 minutes to get to the nearest hospital, so on opening date of June 5 we know that we're going to be very busy from the beginning, meeting that need.

Merry Lucero:
Cutting edge equipment and technology are key amenities at the hospital. Patients and visitors will have a remote control and a wireless keyboard at their bed. With it they can control their T.V. and get on the internet, and hospital staff can communicate with the patient and even find out if they are happy with their stay.

David Schofield:
This allows the hospital to launch a survey during the patient's stay. A lot of times most hospitals would do surveys post-discharge. If there's a problem during their stay, there's nothing they can do about the issue because they're already gone. So we have a way to compliment that survey by doing a real-time survey piece.

Merry Lucero:
Another new technology, the hospital will be filmless, with all digital radiology imaging.

Rudy Apodaco:
And those procedures are at the click- one mouse click away from physicians. Within a matter of seconds they can make a determination, make a diagnosis for the patients so they can be treated.

Merry Lucero:
State of the art labor and delivery rooms include a special place for baby.

Laurie Eberst:
Once the baby is born, you open up this cabinet over here and there's a cabinet, it pulls down and there's a cabinet in there for the baby to be warmed up and cleaned up and just pretty sophisticated.

Merry Lucero:
In contrast, the hospital also features a warm comforting, and spiritual environment. Art and photography centered on the local community decorate the floor where surgery is done, and intensive and critical care is given.

Laurie Eberst:
We know the families and patients that are on this floor are generally a little bit sicker or going through a more stressful time. So we did a few extra features.

Merry Lucero:
On June 5, Mercy Gilbert Medical Center will initially open to the public with 88 beds and will have the ability to expand to more than 400.

Michael Grant:
Joining me now to talk more about the Mercy Gilbert Hospital and the need for more like it and workforce to staff it is Dr. Jason Linder, medical director of the emergency department at Mercy Gilbert Medical Center. It's good to see you. That just looks like a terrific facility, particularly the filmless X-ray feature. I would think that would be just really a terrific innovation.

Dr. Jason Linder:
It gives a huge help in my medical career. I started with film, obviously as medical students one of our jobs is to track that down, and that was sometimes-- getting it from the film library and there's issues of returning it, so it speeds us up beyond what we would think. It's one of those innovation that's changes how you do things day-to-day.

Michael Grant:
Yeah and you were telling me before we went on the air that, for example, particularly on-call people, those kinds of things can access that data if they have the right sort of computer links from their homes.

Dr. Jason Linder:
That's right, we view witness our specialist frequently, just over the phone. This will probably be improved over that.

Michael Grant:
You can do a consult over the phone. They can make a decision about how urgent or not it is to come in, those kinds of things?

Dr. Jason Linder:
Correct. And a follow-up is defined by that, and maybe a one-day return, or two weeks, to wait for the swelling to go away. It benefits a patient an enormous amount of time.

Michael Grant:
How much does Mercy Gilbert relieve-- we talk about growth all the time, and we-- many of us, including myself, don't think about all the things that have to go along with that, including but not limited to hospitals. Pretty heavy demand down in the east valley, is there not?

Dr. Jason Linder:
Tremendous demand and our administrative people spent a lot of time trying to predict how many people need health care services in the east valley and where they will come from. I spent a-- spend a lot of time trying to predict our daily census. It's difficult. The honest answer is we're not sure what is going to happen. We don't know the growth is so expansive; it's hard to predict how many people will show up.

Michael Grant:
Is it still somewhat seasonal? I know it's not as-- .

Dr. Jason Linder:
Yeah.

Michael Grant:
It's not as seasonal as it used to be.

Dr. Jason Linder:
Certainly the Phoenix history was the summertime people could take vacations in health care. Certainly that's gone away. We do see trends of maybe a 10-15\% drop that occurred in February and March, and now it's back up to census levels that again are stressing the resources. Such that people are fearful of that predictable nature. Certainly other value hospitals have experienced that, that the dip in the summer has-- is smaller each year, and that trend continues.

Michael Grant:
What about staffing issues for you? We've been hearing an awful lot about in particular emergency room staffing.

Dr. Jason Linder:
Emergency room staffing, there's two problems. One is nursing, a lot of-- it's a struggle to find nurses, retain them, it's a high demand market. That professional has changed based on that. We have been lucky to hire a lot of experienced nurse and have a full complement, but that's not always the experience at all hospitals, certainly with the fear of a new one. Medical staff, easy to get the hospital-based medical staff, emergency department positions, general surgeons who rely upon it. Far more difficult to get the specialists who primarily operate out of outpatient centers, like plastic surgeons, hand surgeons, sometimes gastroenterology, a number of others that are difficult to obtain call coverage for.

Michael Grant:
These are the on-call guys?

Dr. Jason Linder:
That's correct. Those are the people, for example, we would consult about a complicated facial laceration, or orthopedics can be a problem. It's not in our hospital, but open fractures that need stabilization and treatment within four to six hours. A laundry list of things, mostly all subspecialty based.

Michael Grant:
One of the issues we talked about recently was the coordination in particular among emergency rooms, again, dealing with the overcrowding and those kinds of system. Pretty good communication net between hospitals, is there not?

Dr. Jason Linder:
There is--

Michael Grant:
Other safety support, public safety kind of--

Dr. Jason Linder:
Well, the struggle with the expansive growth now, even our community resources are stretched. In the past you could see hospital resource get stretched, but it's one hospital for about 180,000 people in Gilbert. And that ratio with 88 in-patient beds is not enough. The whole hospital is under-- the whole valley here is under bedded per thousand population we're far under national averages. So the whole system is strained, and when one hospital is overloaded typically all of them are in the east valley, it's pretty legendary for that so far.

Michael Grant:
Now you mentioned 88. Mercy Gilbert's going to get bigger, right?

Dr. Jason Linder:
Yes, and that's already in the works. Health Care west has already put it into place, the drawing process, the construction process will start shortly, and I'm told in 12 to 16 months, we'll have another win which will put us at about 200 beds.

Michael Grant:
Okay. And then ultimately I think growing to 400?

Dr. Jason Linder:
Ultimately the plan-- yeah, since it's-- space is already purchased in terms of the earth, we can go to 400.

Michael Grant:
All right. Dr. Linder, we appreciate you joining us. The public opening is this Saturday?

Dr. Jason Linder:
Saturday from 10:00 to 2:00.

Michael Grant:
You'll have cookies, coffee--

Dr. Jason Linder:
They can come and tour the hospital, come through the emergency department, and get all kinds of medical knowledge and see the place, everybody is very proud of it. It is a very nice facility.

Michael Grant:
It looks terrific. Jason, thanks again.

Dr. Jason Linder:
Thank you.

Michael Grant:
Tucson is the first city in America to adopt a new C.P.R. method. It's a procedure to resuscitate cardiac arrest victims, even though the new procedure has not been officially endorsed by the American Heart Association. Pam White reports that the head of the University of Arizona's Sarver Heart Center says the latest research is too compelling to wait for a new set of guidelines.

Pam White:
The head of the U of A heart center Dr. Gordon A. Ewy began campaigning for a new C.P.R. in the early ‘90s when research showed most people wouldn't perform C.P.R. on a stranger because they didn't want to do mouth-to-mouth resuscitation.

Dr. Gordon A. Ewy:
And we actually sent out a survey to almost 1,000 people and found out that only 15 to 20\% of people would do C.P.R. if they had to do chest compression and respiration, and almost all of them would do it if all they had to do was chest compression only.

Pam White:
In 2000, the American Heart Association took those findings into consideration and revised its guidelines, saying if you're unable to do mouth-to-mouth resuscitation; it's ok to only do chest compressions.

Dr. Gordon A. Ewy:
You know, that was the best information we had, and we of course wanted them to emphasize that a little bit more.

Pam White:
Now Dr. Ewy's crusade for new C.P.R. standards is becoming even more urgent based on two recent studies. One found that for the layperson, traditional C.P.R. is difficult to remember. Researchers also found precious time was lost when chest compression were interrupted to do mouth-to-mouth resuscitation.

Dr. Gordon A. Ewy:
So then we went back and said, ok, let's do it the way it's really done. We compared doing nothing, to doing chest compression only, to doing C.P.R. where you did 15 breaths and 15 compressions and 16 seconds to do the two breaths. In other words, you're only pressing on the chest at the time. The survival in that group was 13\%. The survival in the chest compression only was 70\%.

Pam White:
Doctor Ewy, this is the new C.P.R., not new to you, since you were advocating it in the early ‘90s.

Dr. Gordon A. Ewy:
Yeah, the research group has been advocating this since 1993 because we have shown that doing chest compression only was dramatically better than doing nothing. What has changed recently, in the last two to three years, is we've shown that doing chest compression only is better than doing the old standard way, where you interrupted each 15 compressions for two breaths. Because the two breaths take so much time that you're not pressing on the chest. Notice she is-- put the heel of the bottom hand right in the center of the chest, usually between the nipples, locks the elbows, and she's using her weight to compress. No one is strong enough to use their muscles. And she's doing a sue push job. Notice that she's doing it at about 100 per minute, and this is absolutely ideal. The point of the news conference today is to announce a new initiative in cardiopulmonary resuscitation that will begin today in Tucson.

Pam White:
And in 2003, the Tucson Fire Department, with the help of the U of A heart center, began using the new C.P.R., making Tucson the first city in the country to use the procedure.

Joe Eulotta:
The first thing we had to do is be convinced it would not harm the community, and Dr. Ewy and the heart center spent about six months with us going through a lot of their research and background, convinced the fire chief and our medical director, and in turn we convinced the people in the field, the paramedics and the E.M.T.'s that it would work.

Pam White:
Joe Gulotta is a deputy chief with the Tucson Fire Department. It's too early to give the results, but they found feedback from paramedics-- based on feedback from paramedics, the new C.P.R. is having a significant impact.

Joe Eulotta:
It's not as complicated as what American Heart Association has us go through, and anecdotally the paramedics are responding back saying that they're seeing more response from the patients, that they're seeing-- that their defibrillations are more effective because we have increased the circulation in the heart and oxygenated the heart.

Pam White:
Now in the current issue of "Circulation" magazine, a major publication in the cardiology world, is an article by Dr. Ewy outlining the protocols for the new C.P.R. and how it's being used here in Tucson.

Dr. Gordon A. Ewy:
Not only the layperson, but th-- what the paramedics need to do, what the professionals need to do as well to improve it. Because it's not just one thing, it's an entire series of changes. But it relates to the fact that you've got to continue pressing on the chest, because when you're pressing on the chest, you're moving blood to the brain, and when you stop, you're not.

Pam White:
The American Heart Association comes out with its updated guidelines at this December. So far it has not endorsed the new C.P.R. One concern, the new technique does not help cases of respiratory failure.

Dr. Gordon A. Ewy:
We're not talking about a drug overdose, an alcoholic that took too much whatever and stopped breathing. Those are arrests, and you need to breathe for that patient to get them to-- we recognize that. And we think lay people can recognize that. What we're talking about is unexpected, sudden collapse in an adult. And it-- an adult has a sudden unexpected collapse that is 99\% heart attack.

Pam White:
Paramedics in two other cities are using the new C.P.R. One in Wisconsin, the other in Illinois. With this article Dr. Ewy says more places will follow, even if the American Heart Association does not update its guidelines.

Dr. Gordon A. Ewy:
I think it's going to be a groundswell that the A.H.A., it's going to have to change. Because people are going to change without them.

Michael Grant:
Earlier this week I talked to a local expert about that new C.P.R. procedure. He is Dr. Ben Bobrow, an emergency physician at the Mayo Clinic Hospital in Phoenix and the medical director of the Bureau of Emergency Medical Services for the Arizona Department of Health Services. I also talked to cardiac arrest survivor John Coules. Dr. Bobrow, cardiocerebral recitation, the procedural calls for chest compressions only. Explain that to me.

Dr. Ben Bobrow:
Basically the way we've conventionally taught C.P.R. is a combination of chest compressions and ventilations. That's the way it's been taught for the last 40 years or so. And the last several years we've-- a lot of research has shown the chest compression component is the key part, and that really resuscitating the brain, cardiocerebral resuscitation is the key component as opposed to cardiopulmonary resuscitation. The lungs can go a long while without oxygen, but the brain needs continuous supply of oxygen.

Michael Grant:
The feeling being here is this is also more user-friendly, that people who are doing the administration more likely just to do the chest compressions than the combination technique?

Dr. Ben Bobrow:
Exactly. When we asked people to do chest compression and ventilations together, it's difficult. It's a difficult task, difficult to remember, difficult to teach, and also people are very hesitant to do mouth-to-mouth breathing on bystanders if they collapse. And what we found out is that when we teach people to do chest compression only, number one, it's much easier for them to learn, much quicker for them to learn, they can remember it, and they'll do it in an emergency.

Michael Grant:
Now John, tell us your story. Pretty amazing.

John Coules:
Well, like I said, I grew up in-- I should say I am living in Gold Canyon, Arizona, working out on a daily-- fairly daily basis, and I went out and this was Christmas of 2001, and a couple of days after the holiday, working out in the gym, did a normal workout, which I normally do every day, and got on the treadmill, bicycle, stretching, that type of thing. And got off the machine, cooled down, as you're supposed to do, went out talking to a lady, walked out to the restroom. I stopped in the restroom, she evidently stopped outside. When I went into the restroom I had a cardiac arrest. Without any warning at all. Just hit the ground.

Michael Grant:
Now at this point in time she hears that, thank goodness.

John Coules:
And she didn't want to go in the restroom, ran back immediately, got her husband who was in the gym, he happened to be the trainer, and had had experience with C.P.R. He had been a highway patrol officer for years. And had to actually resuscitate two people prior to me. He started with me with C.P.R., it didn't work, he tried again, it didn't work. He yelled to somebody to grab the defibrillator off the wall which was about fifteen feet away, and he put that on me, stood back, which it instructs you to do, and it didn't work. So he did it one more time, and it did work, and he knew it worked, because the blood was pouring out of my head.

Michael Grant:
Dr. Bobrow, you had a circumstance where traditional C.P.R. did not seem to work, thank goodness that a defibrillator was very handy, because that's fairly rare in a circumstance outside of a hospital or an emergency room.

Dr. Ben Bobrow:
Yeah. We're trying to increase the numbers of those devices available in public places, like gyms and golf courses and schools and things like that. And more and more they are available, and we have several thousand of them across the state. But we have to increase awareness in people's ability to use them. The thing that was key in Mr. Coules case was that somebody did immediate bystander C.P.R. that kept him going until they could get the A.E.D. to him.

Michael Grant:
Now the argument here, though, being that the less complicated procedure with the chest compressions only hopefully encouraging more people to administer first aid. Does that make sense to you?

John Coules:
Yes, it does. Having gone through the procedure.

Dr. Ben Bobrow:
It's a little confusing. The gentleman that rescued Mr. Coules was an off-duty police officer who was trained in this. So he wasn't really a layperson. Now he had had medical training. We find that quite frequently, that if there's an off-duty medical person, they can respond and they often are the ones that do respond. But we're trying to develop a system where we have responders who are non-medically trained, non-formally medically trained, and they can respond as well.

Michael Grant:
American Heart Association says chest compressions only may not be enough because the person may be suffering from a respiratory problem and lay people wouldn't understand the difference. What do you think?

Dr. Ben Bobrow:
This is a key component. A key point. In that we're only talking about adults first. Kids usually have a respiratory component. So we're talking about this continuous chest compression, C.P.R. for people older than 8 years of age. And also we're really talking about the sudden unexpected collapse. Not someone that has had respiratory problems or asthma, or--

Michael Grant:
Gasping.

Dr. Ben Bobrow:
Gasping, yeah, that's different. Those people still-- you need to breathe for them. And also people that have an overdose of some sort or drowning, we need to ventilate them with the conventional way. But for the case that happened like Mr. Coules who had a sudden unexpected collapse, that really is a case where we need to perform immediate chest compressions until we can get an A.E.D.

Michael Grant:
John, I'm curious, were you schooled in C.P.R. prior to your--

John Coules:
C.P.R. Yes, I knew about C.P.R. Of course I didn't know about the defibrillator. The defibrillators in our building were only installed about three or four months before this happened to me. And they were installed largely due to that same police officer.

Michael Grant:
Now, as I understand it, you're now wandering around with one.

John Coules:
I have my own. I'm playing golf and working out like I did before. I was very fortunate.

Michael Grant:
Dr. Bobrow, how are you promoting this new technique?

Dr. Ben Bobrow:
We developed a program, I work also for the Department of Health Services, the Bureau of E.M.S., and we have a program called the SHARE program, which is an acronym for Save Hearts and Arizona Registry and Education. And basically what we're trying to do is promote bystander C.P.R. and A.E.D. use through public education and public awareness and training. And on the website, www.azshare.gov, if you visit that website you can learn about this.

Michael Grant:
Okay and let's go back. All right, we just threw it up on the screen. So more information on this, give us the website one more time?

Dr. Ben Bobrow:
www.azshare.gov.

Michael Grant:
All right. Dr. Ben Bobrow, thank you very much for joining us. Appreciate the information. Jim Kolbe, thanks to you. John Coules, thanks to you as well. Happy you made it.

John Coules:
I am too.

Michael Grant:
If you would like information about upcoming shows or about past shows, please visit the web site at www.azpbs.org. Once you get there, click on the word "Horizon" to get to the show's home page.

Mike Sauceda:
President Bush visits the border at Yuma three days after his speech on immigration. While there, he says a border fence might not be a bad idea. The governor calls on the legislature to hold off on its immigration plan. And 2\% of the class of 2006 won't be graduating because they failed the AIMS test. The Journalists' Roundtable Friday at 7:00 on "Horizon."

Michael Grant:
And next on 8 is "Horizonte." Thank you very much for joining us on "Horizon." I'm Michael Grant. Have a great one. Good night.


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