Sponsored by Bound Tree Medical
By Tim Nowak for EMS1 BrandFocus
It’s CPR renewal time. You walk into a room with a floor (or tables) lined with manikins and a screen in the front of the room already frozen at the starting point of the video series.
Sounds like every renewal course you’ve ever been through, right?
While the focus of CPR renewal courses isn’t necessarily to create a comprehensive and dynamic environment of critical thinking, they are designed to hone and solidify your compression skills in the moment. But CPR training doesn’t have to be limited to biannual refreshers.
Having access to – and utilizing – CPR feedback devices in your training scenarios can provide your agency and individual crew members data that can reshape practices, validate hypotheses and provide quality oversight comfort in knowing that everyone is capable of effective CPR.
In fact, there’s value in using CPR feedback devices throughout every stage of your career, from a physical ability testing scenario during the hiring process to continued education training labs and even to skills validation and credentialing sessions with your agency’s medical director.
Resuscitation as we know it, however, isn’t always so cut-and-dried, or even the same across all situations.
Should you focus on continuous chest compressions and passive oxygenation while on scene, or an immediate load-and-go situation with compressions attempted in your moving ambulance? Many protocols throughout the country place these two situations in entirely different buckets when it comes to purpose, practicality and protocol procedures.
Incorporating training around these situations, therefore, is imperative, and an area where CPR feedback can shine within your training environment.
Scenario A: Compressions On Scene
You are dispatched to a possible cardiac arrest call at a residence. You arrive to find a 62-year-old male patient unresponsive and on the floor and his wife performing chest compressions. His wife states that she heard her husband fall and rushed to his aid, finding him unresponsive.
This situation places our crew in “ideal” conditions, kneeling beside the patient in a spacious area like a living room (if your patient is found in a hallway or a bathroom, there’s nothing saying that you can’t move them to the living room where you will have more space to work). Compressions may follow a continuous pattern for two minutes or be based on another 30 compressions-to-two ventilations format.
In either protocol, conditions are “ideal” to perform chest compressions. The results that your crews provide here may be drastically different than the upcoming scenarios, and real-time feedback will help you measure the difference.
Scenario B: In Transport
You arrive on the scene of a motorcycle-versus-pickup truck crash and find the motorcyclist ejected and lying away from the crash scene, unresponsive. You check for a pulse and believe you still feel one. Spinal motion restriction is maintained, you scoop your patient onto a scoop stretcher or longboard and secure him to your cot, quickly wheeling him to your ambulance. In your ambulance, you no longer feel a pulse, so you begin chest compressions and tell your partner to step on it!
Performing chest compressions in the back of a moving ambulance is no longer recommended as the “normal” practice in many EMS systems, at least for medical-related cardiac arrests. For traumatic arrests, however, this may be the patient’s only saving grace before reaching the closest emergency department. As such, it’s still important for us to train for situations involving the practice of performing chest compressions in a moving ambulance.
Place your CPR training equipment in the back of one of your available ambulances and drive around a vacant parking lot for 10 or more minutes, monitoring chest compression effectiveness as you accelerate, decelerate, stop and turn (again, it’s recommended that you do this in a vacant parking lot, not on an active roadway).
Try performing chest compressions with only one hand while the other is holding onto a grab bar above. Compare those results to two hands, or to the prior scenario.
SCENARIO C: During Patient Transfer
You arrive at the hospital with your STEMI patient – who is now also a cardiac arrest patient, and you have been performing chest compressions for the past two minutes. There are monitor and defibrillator cords everywhere, IV lines, oxygen tubing – and the patient’s arms that aren’t even secured to their body just yet.
You’ve got to get your patient from point A to point B safely, and while effectively performing chest compressions. But how?
If you think that jumping on the cot and straddling your patient your patient is a good idea, think again. Even worse, stepping on the side rails of the cot and “riding along” as you lean over to compress is hardly as effective as it looks. Instead, you should remove the cot from the back of your ambulance, lower it to about one-third the loading height and slowly walk alongside the cot as you and your partner wheel it into the emergency department bay (while also providing supplemental ventilations).
Using feedback while you practice for this complicated scenario will help you deliver effective care in the moment. In fact, CPR feedback provided while training for each of these scenarios will help you to validate which method truly is an evidence-based best practice.
Perform this training early and often to make your crews more efficient, effective and prepared each and every time – even when the unusual situations arise.
For more information on training and patient care devices that provide real-time CPR feedback, visit Bound Tree Medical.
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