On the plane ride back from a Emergency Medical Services conference in Seattle, three years ago, Howard County Department of Fire and Rescue Services Capt. Dale Becker turned to the department's medical director, Dr. Kevin Seaman, with an idea.
"I told him, 'We can do this. We can change the culture and the way we manage cardiac arrest responses in Howard County,' " said Becker, a 40-year-old Carroll County native and resident of York, Pa.
On March 10, Becker, who employed the techniques he learned at The Resuscitation Academy conference, was honored as one of the Top 10 EMS innovators in the country by the Journal of Emergency Medical Services at its EMS Today conference — punctuating that Becker followed through on his vow.
The new method, dubbed the "CPR dance" by department employees, has resulted in a spike in the percentage of resuscitations by department responders since Becker, one of the departments six EMS supervisors, began implementing it with his 'B' shift crew at Station 8 in Ellicott City.
According to Seaman, who nominated Becker for the national award, department personnel resuscitated 54 percent of the cardiac arrest calls that were witnessed by an observer and capable of being revived in 2011, the first full year the CPR dance was implemented.
Between 2001-10, the department resuscitated only 19 percent of those same calls.
Starting in 2010, the department began tracking the number of resuscitated people who survived with normal cognitive functionality.
According to Seaman, 37 percent of those resuscitated in 2010 and 2011 survived.
For Becker, the improvements, which were first used in King County, Wash., hinge on one thing: chest compressions.
"We are maximizing the time we are doing chest compressions. That's going to make a difference if someone survives or not," said Becker, a 19-year veteran of the department.
According to Seamen, the new way of doing things is about getting back to basics.
"The two most important things that affect survival is CPR and time to defibrillation. Those are the two things that make the biggest difference," Seamen said. "They are the base of the pyramid. If you don't have the base, the other things we do aren't as effective."
Previously, Becker said the responders, who are capable of CPR and defribrillation, were focused on transporting the victim to the hospital as quickly as possible. While a good strategy for most EMS calls, cardiac arrests are different.
"You never want to delay taking the patient to definitive care (normally a doctor)," Becker said. "But in the case of cardiac arrest, definitive care is EMS. What we do to resuscitate someone is basically the same thing they do at the hospital."
In order to properly maximize chest compressions, every move the responders make must be coordinated and timed — just like a dance.
"We have assigned predetermined responsibilities before we run a cardiac arrest," Becker said. "In the past, for the most part, until the paramedic divided out responses, things didn't just happen spontaneously."
The fluidity and order of what was previously a chaotic scene has led to the universal nickname.
"One of the things it was called in Seattle was the dance, and I never said anything when I came back here, but that's what these guys decided to call it," Becker said. " Its like well-choreographed ball room dancing, everyone is communicating, we are flowing, its like a dance. When they see me come in with the manikin they say 'It's time for dance practice.' "
Learning how to dance
While Becker had the numbers from King County to support the new method, getting a dance partner was a bit of a struggle at first.
"Firefighters and paramedics are prideful people. Everyone has the 'we do it better than they do' attitude," Becker said. "If we tried to push this thing from the top down, it's not going to work. That's the wrong way to do it; so we built it from the ground up using the firefighters and paramedics who have to use it every day."
Becker began teaching the dance, which relies on timed rotation of roles, to his crew at Station 8. After 10 hours of practice and modification, the dance was ready for prime time.
According to Becker, Crew 8B resuscitated it's next five cardiac arrest calls. Although only one of those five patients survived, it was clear progress was being made.
The crew's success caught the eye of Chief William Goddard, who came out to see the dance for himself.
"It took on a life of its own," Goddard said. "The great thing about the fire service is stations are very competitive, and they want to outdo each other. People started to realize what was happening and said, 'We'd like to give it a try.' Then it went viral within the department."
While the executive order formalizing the method wasn't issued until 2012, Becker said it was standard practice one year after he began teaching it to Crew 8B.
'Worthy of an award'
On Monday, March 18, Becker was given a proclamation on behalf of the County Council for his work with the program.
"This is an outstanding example of the commitment to innovation and excellence that our firefighters and paramedics continually aspire to," said County Executive Ken Ulman in a statement. "On behalf of the entire county, I applaud Dale's contributions in moving the EMS profession forward."
While Becker is honored to be recognized, he knows that the transformation was a team effort.
"It's nice to be recognized, I'm not going to deny that, but it's not why I do the job," Becker said. "It's a little embarrassing actually. There are 400 people plus all the volunteers; they are making their best efforts, too."
It was partly Becker's team-first attitude that moved Seaman, unbeknownst to Becker, to nominate him for the award.
"He took this on with no extra compensation or gain, did it out of his dedication to patient care. Those kind of things are worthy of an award," Seaman said.
Becker said rubbing elbows with the other award-winners, most of whom are medical doctors conducting reserach, at the presentation March 10 in Washington, D.C, was an interesting experience.
"It's been kind of crazy, but it's going to settle down in a minute. My 15 minutes of fame is just about up," Becker said.
While Becker's fame may be fleeting, the impact his efforts have made on the department are here to stay.