Thanks to a partnership with Nationwide Children's Hospital, the Westerville Division of Fire has equipped all three of its medic vehicles with pediatric continuous-positive-airway-pressure equipment, commonly known as CPAP.
Westerville's fire division is among the first emergency-medical-service providers to carry the equipment full time to treat infants and children in respiratory distress, avoiding the invasive procedure of intubation with better long-term outcomes, said Brian Miller, Westerville fire chief.
Intubation, a medical procedure to help people who cannot breathe on their own, involves placement of a plastic tube into the trachea to maintain an open airway.
"We've been carrying the equipment on all three medic vehicles since late 2019," Miller said.
The custom device was designed by Westerville Fire paramedics and emergency medical specialists who are experienced to help the youngest patients overcome breathing obstructions and/or facilitate rest from the work of breathing caused by a medical issue, Miller said.
He said medics worked with manufacturers to develop a tubing piece that facilitates the airflow needed for small patients.
Miller said Nationwide Children's Hospital helped Westerville develop the protocol in the field to deploy the CPAP.
"Also, we had to build the different parts of the CPAP machine to use in EMS machines. (The partnership) is more for protocol and development pieces."
He said the city has a Nationwide Children's Close To Home Center at 433 N. Cleveland Ave.
"We want to use CPAP en route to the hospital instead of intubation when possible," said Dr. Frank Orth, medical director for Westerville Division of Fire. "Intubation is an invasive procedure, and the goal is to avoid having to admit these children for long-term health care if we can eliminate the work of breathing through CPAP. What we see in CPAP use is that it helps us prevent further deterioration and the difficulty of weaning off ventilation if intubated."
CPAP in adults is a standard intervention for emergency care, Miller said.
"We're excited to be one of the pioneers in this and know it will have a major impact in EMS," he said. "Westerville Fire was in front of this for use in adults, and pediatric CPAP is now part of our protocol if we have a child in respiratory distress."
Part of the innovation will be in monitoring the data to push for the manufacturing of a full kit for pediatric use, Miller said.
The pediatric kits, which cost about $100, include tubes, ports and masks.
Each medic unit is equipped with four one-time-use kits for paramedics responding to medical emergencies in and around Westerville.
"There's some healthy discussion right now about how to study this and how to move forward with manufacturing," Miller said.
"The innovation is in the design and retrofitting of equipment to work for this purpose. But it doesn't exist yet as an entire kit, and we're eager to share our success with manufacturers so that EMS providers everywhere have access," he said.
Westerville and Nationwide Children's Hospital plan to monitor results and future cases to study the intervention of patients who start on CPAP and continue treatment in the emergency department.
The Westerville Division of Fire also plans to offer demonstrations and gather central Ohio-area departments interested in implementing the strategy.
"This is a good opportunity to capture some of the good work and start the momentum to learn in the field," Orth said.
"Other departments are right behind us on this because it makes sense."
The division provides fire protection and emergency medical services to approximately 48,000 residents in the city of Westerville and Blendon Township. The division has more than 100 full- and part-time employees.
More information is available at nationwidechildrens.org.