FLAGSTAFF, Arizona -- There's a call for service from 2022 that stands out to Officer Zachary Knoepfel of the Flagstaff police. It's one he's unlikely to forget. That year, he helped save a life.
"I observed a male who was on their back and just actively not breathing at all," Knoepfel recounted. "I see a family member who has been performing CPR. I take over and perform one round of chest compressions until medics can make their way up the driveway and get the necessary medical equipment to continue life-saving measures."
The man had been enjoying drinks on his patio on an October evening when he collapsed, eyes rolling back in his head. His companions called 911 and started CPR. Knoepfel took over when he arrived and ultimately helped continue chest compressions while a medic delivered shocks via an automated external defibrillator (AED).
Knoepfel was there when fire and emergency medical personnel detected the man's pulse. He checked on him later at Flagstaff Medical Center, finding the patient in serious but stable condition.
Knoepfel's actions, in hopping in to take over CPR compressions, helped save the man's life.
"I think as colleagues of his and supervisors of him, we are proud that he was able to save someone's life and make sure people are around for the holidays. It doesn't always end successfully," Lt. Charles Hernandez of the Flagstaff Police Department said.
It's not uncommon for police to make it to the scene of a medical emergency before firefighters or EMTs arrive, and it's one of the reasons why Brandon Griffith, a cardiac arrest survivor and sworn law enforcement officer, founded Griffith Blue Heart.
The nonprofit provides specialized training for law enforcement that dives deeper than a standard CPR course and prepares them to handle cardiac emergencies.
"Why don't we have the proper equipment and training?" Griffith asked, remembering how he felt after going into cardiac arrest in his den when he was just 26 years old. "We're not here to make these guys EMTs, we just want to keep [the patients] alive long enough for the experts to come on and do their job."
In Knoepfel's case, medics arrived around the same time he did. They needed time to unload equipment, and the officer knew seconds mattered for the patient who wasn't breathing.
"The training kind of kicked in, and it felt like, 'Hey, this is what it is. I need to do this. This is what I need to do until we can get more resources,'" Knoepfel said.
The officer felt prepared, but he said practicing emergency medical response and actually doing compressions when in the field are a little bit different.
"When we do training, they're staged scenarios. You don't know what to expect, but you know it's not real, so it's hard to create an atmosphere or a training scenario where your blood pressure is elevated, and you're trying to think and work through processes," said Hernandez.
Thanks in part to a nearly $100,000 grant from Health First Foundation Northern Arizona, Griffith Blue Heart was able to start training FPD officers, using their in-depth method in the summer.
"The Griffith group, with their instructors, created scenarios that were real-life based. They got your blood pressure up. They made you think. Their instructors were giving you changes in scenarios, to just implement your tactics and your knowledge, too, that you had just learned through the class from putting on tourniquets to CPR with AEDs," Hernandez said.
We all know the saying "practice makes perfect," but the Griffith Blue Heart advanced cardiac response training is about more than just practice. It's about striving toward mastery. If you asked Griffith, he might be more likely to espouse that adage's twin of "perfect practice makes perfect," as his course takes aim at removing what he calls "training scars."
"You've got clicker mannequins, for example," Griffith said. "You've got guys that'll wait to hit their depth. They'll push as hard as they can till they get that click, but they'll be waiting for that. You'll see them in the field, and when they start doing CPR on a real person, all of a sudden they start pressing down and, well, people don't click. They might have cartilage pop, like when you crack your knuckles, or ribs break but they're looking for that and they start missing their metronome; they start missing that 100 to 120 beats per minute on an adult. You can see that training scar is there because they got so used to doing it on a clicker mannequin, and people don't do that." .
The training pulls ideas and strategies from other kinds of police-specific skills training.
"Law enforcement is very good at reality-based training when it comes to things like force on force. When it comes to hostage rescue, active shooters, barricade situations, we train and train and train on that, right? When it comes to cardiac emergencies, we're not focusing on high performance. We're not focusing on keeping the brain profuse the entire time," Griffith said. "The reality is there were 1,100 fatal police shootings last year and 690,000 Americans died of heart disease. What are we more likely to run across? Not to mention, law enforcement is at a 70-times higher risk for heart disease than the general public we serve. We're at the higher risk for going down. We obviously want to protect and serve the people in our communities, but we want to protect ourselves and our families as well."
Inside the crowded auditorium at the Flagstaff Police Department Friday, a trainer posed as a bystander and said, "Are you sure you know what you're doing?" practically breathing down the neck of a newly hired police officer, doing CPR on a feedback manikin.
The new guy is one of 11 recruits and four lateral transfers who joined the force this month.
He was wearing his complete duty uniform — a gun, a vest, a headset, a radio and a taser. His clothing was bulky, and his gun dug into his side. Still, he was being tested at every second while administering CPR on a state-of-the-art mannequin. If he pressed too hard, the mannequin recorded it. If the brain of a real patient would have started to be affected by lack of blood flow, if the officer's compressions were too fast or too slow, the sensors in the dummy detected it and transferred that information onto an iPad monitored by an instructor nearby.
It's not the same as being in the field, but it helps officers get closer.
"There was one scenario that we went through where a patient is passed out behind the wheel of a car. Dragging a 150- or 180-pound mannequin out of a vehicle yourself, having to undo the seat belt, and get them on the ground," said Hernandez, "I mean, when I went to the class it was summer. The pavement was hot. So you need to consider burns on patients. My knees were burning from being down and doing CPR. So, you need to work through all the challenges that the environment may pose as well."
Guardian captain paramedic Josh Wilson, as both a fellow first responder and community member, is happy to see police officers getting reality-based, measurable training for cardiac emergencies
"Seeing it from the police perspective is really cool and it's really cool to see the officers really engaged in the training, because it's really life-saving stuff. It's important for me, to be on the medical side of stuff and to see these guys be able to do it faster than I can do out there," Wilson said. "I grew up here in Flagstaff; my whole family is here. I've got dozens of cousins and aunts and uncles, and I've been on a lot of cardiac arrests, I've been on quite a few saves. Being able to see our survival rate go up is just so important for me for my community. We've got a better chance of people being able to get back to their families, back to their homes, back to a normal life that they wouldn't be able to normally. I'm really excited to start seeing it deployed in the community and used to save lives."
The training for new recruits that took place Friday is one of three Advanced Police Resuscitation Academies that have taken place at FPD since the summer.
More than CPR
CPR alone is not the focus of the specialized academy.
"Defibrillation is what saves lives from cardiac arrest," Griffith said. "It's not like what you see in the movies where they're compressing away on somebody and suddenly they wake up. You can't start a dead battery with compressions; you need AEDs. Only about 20% of law enforcement agencies have AEDs in the field in Arizona.
Griffith added: "We have a lot of work to do in order to get cops properly equipped."
FPD currently has four AEDs in rotation, but the grant has allowed them to purchase more. The new AEDs were delayed by supply chain backlogs, Griffith said.
"We have a fleet of 45 [patrol vehicles]. Working with Brandon and the Health First Foundation Northern Arizona, we were able to obtain an additional 50 for deployment in the field — which means we will be able to outfit every patrol vehicle with an AED. ... But we wanted to make sure we had training prior to implementing the device in the field," Hernandez said.
The training, even before the equipment's arrival, had the opportunity to pay dividends.
"When you get the opportunity to save a life, it's the highest honor that you can have in this profession. I think that that's the best feeling in the world," Hernandez said. "This class definitely set a baseline foundation for them to not only re-enforce the skills they get at the academy but to also re-enforce their confidence to say, 'Hey, I'm a police officer. I'm going to be called to save a life, and I can do it without fear of being unprepared.'"
Griffith said it's not enough to just throw an AED in the back of a car and hope for the best, so there are plans in place to monitor the long-term impact of the course and the condition of AEDs, with the help of Guardian Medical.
"After we do this course, we come back six months to a year later and make sure that their skills are still up to par. We're doing a study right now to see how well officers perform resuscitation skills," Griffith said. "Most of the time when we go into courses, our overall resuscitation scores are between 35 and 60%. By the time we're leaving, these guys are in the high 90s. The lowest score we've ever gotten on a final evaluation was 98.35%. But we're going back six months to a year later and they're still in the low 90s and high 80s. They're retaining the information. Because it's not, throughout the day, here's five minutes of CPR. They're doing it throughout the day under stress, and they're doing about an hour of compressions throughout the entire day. They're building that muscle memory and that skill set and keeping it."
When AEDs are delivered and used, Guardian will help maintain the devices. They'll also report back on the AED usage, to help with Griffith's independent study and keep records for Arizona Shares.
In the end, every person who is saved by CPR training or the deployment of an AED is more than a number. They are people having drinks on their patio, or standing in their den when their health takes a sudden turn for the worst. The hope is that in understanding how training can better prepare officers like Knoepfel, law enforcement officers everywhere will have the chance to tell more stories like his.
Sierra Ferguson can be reached at [email protected].
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