Urology Pearls: NASCAR doc: Saving lives at pit-stop

Shahar Madjar, MD

George fell to the ground at once, and without any warning. He and his wife, Jane, were on a trip to San Francisco. They were walking along the beach. Jane was facing the ocean, pointing at the Golden Gate Bridge and at a seagull that was hovering in the skies, and when she turned around, she saw George on the ground, his face red, his eyes rolled back, foaming at the corners of his mouth. People gathered around them. Someone called 911. Nobody knew what to do.

It looked like an eternity to Jane, but the EMS crew came in less than 6 minutes. And once on site, they worked like a pit-stop team at NASCAR.

Yes! I am talking NASCAR, like in auto racing.

Car races run hundreds of miles at outrageous speeds. The cars require frequent stops to replace tires, refill the 18-gallon fuel tank, and make quick repairs.

In a typical pit-stop, the car pulls off the oval road, and enters into the pit lane. Six mechanics, ready with tires, air guns and fuel jump onto the scene. They dance around the car in a coordinated ballet. They move with vigor, and clear direction. The car is jacked up in the air, one side at a time. The team removes the lug nuts, and puts new wheels on. They change oil. A well-trained pit-stop team will take 12 seconds to complete the mission. A single mistake, a split of a second longer might cost them the competition.

George had a cardiac arrest – his heart suddenly stopped working. George’s heart didn’t pump any blood to his brain. And George suddenly collapsed.

In North America, approximately 400,000 people experience cardiac arrest each year. Cardiac arrest is deadly: only 9-15 percent of the victims survive the event. And among those who survive, many develop brain injury.

Prior to implementation of the pit-stop approach, EMS teams would arrive at the scene as fast as they could, but once there, chaos overcame good intentions.

Learning from the work of pit-stop crews, EMS team members and doctors developed an approach similar to that used at race car pit-stops. And so, when the EMS team arrived on the scene where George fell, each member knew exactly what he, or she needed to do. Their positions were assigned before the team arrived. They were all equipped with the necessary tools to perform their individual tasks. One member of the team positioned herself next to George’s head, established an airway, and started to puff air into his lungs. Two other members took their positions, one on each side of George’s chest. Guided by a metronome that gave them the appropriate rhythm, they started to perform chest-compressions at a high rate (120 per minute), with little or no interruption. Another team member searched for a vein in George’s arm, and started to infuse fluids and inject him with medications according to a simplified algorithm. Instead of chaos, the team worked like a well oiled-machine. Or, I would say, as a NASCAR pit-stop team.

Dr. Christy L. Hopkins and her colleagues from the Division of Emergency Medicine at the University of Utah School of Medicine reported in the Journal of the American Heart Association, in 2016, that the pit-crew approach has improved patient survival and neurological outcomes: the percentage of patients that survived their cardiac arrest without any neurological damage rose from 8 to 16 percent. And those who were treated according to the pit-crew protocol had better neurological outcomes.

As to George, he is a fictional character. In one or two sentences, I can decide his fictional fate. And since I am in a good mood today, his story will end like that: equipped with the knowledge they gained from the NASCAR pit-crew, the EMS crew that treated George have saved his life. He returned to his home in Ann Arbor in good health. To celebrate his good fortune, he took his wife out for dinner at Zingerman’s Deli.

I ask myself: if learning from NASCAR pit-crews can increase the survival of patients with cardiac arrest, what else can doctors learn from other professionals? Should the orthopedic surgeon draw from the experience of carpenters, a urologist from that of a plumber? In my next column, I will tell you about what doctors have learned from musicians, what I have learned from a visit to Zingerman’s Deli, and what I think you should learn from the way effective doctors work.

Editor’s note: Dr. Shahar Madjar is a urologist working in several locations in the Upper Peninsula. Contact him at smadjar@yahoo.com or at DrMadjar.com.