Thanks for your participation for this month’s C & C!
Red Shift HPCPR is coming along nicely with your help!!!
We started out our session with Curt giving us some insight into behind the scenes effort St John is making to perfect the details of HPCPR Australasia*.
Here is some points that can be implemented before the “Official Launch”.
*HPCPR Australasia is getting developed so paramedics in Australia and New Zealand will speak the same language, and work on the same principles. I thinks this is a really cool initiative and pretty excited to be practicing some elements at this stage.
Please note some of the points listed here are subject to change depending on the final consensus amongst multiple services across the Tasman.
- HPCPR (not PCCPR) – High-performance CPR is the term we use now.
- Silent resus – I take it as similar to the sterile cockpit concept of CRM where verbal communication is minimised to keep the scene calm and under control. Use shoulder tapping, universal succcict commands/response (closing the loop).
- Phone app metronome – Defib’s metronome are set to 100bpm and cannot be changed. Use phone apps such as CPR Tempo instead and set the rate to 110~120bpm. (ventilate every 11 or 12 beats when LMA or ETT is placed.)
- Deemphasising over the head chest compression – to further improve the quality of chest compression.
- Use LMA early (Initially even as an airway adjunct without connecting and ventilating via BVM.)
- Practice practice practice to increase the chest compression fraction, i.e. hovering hands during the changeover.
“Every pause, justified or not, represented a decrease in the chance for survival.”
Fraction time for King County responders was in the 40-50% range; today, performance measures now show they’re in the mid-80% to low 90% – all because they were trained to eliminate pauses.
Pit Crew CPR vs High-Performance CPR
While we’ve used the terms PCCPR and HPCPR anonymously in the past, HPCPR better describes the true intention that is to focus on the performance rather than merely a protocolised team = pit crew approach.
HPCPR is also the whole package where St John is working hard for the improved tCPR (Telephone CPR), feedback device, data collection/analyse, dispatch system etc etc.
Resuscitation Academy describes the difference as following.
“The concept of a highly trained and choreographed crew is a powerful, relatable analogy for the work of an EMS team. Pit crew CPR training focuses on highly defined roles that aid in the organization of a chaotic scene.”
“In comparison, HP-CPR is much more than instinctively knowing where to go and what to do. It’s about routine measurement of performance and understanding how to increase that performance, which requires an incredible commitment to monitoring, remediation and retraining.”
Check out the blog titled “The Evolution of Quality CPR: What Exactly IS High-Performance, Anyway?” for more details.
OK so where to from now?
We’ve figured trying to put everything together straight away is slightly too ambitious so we’ve so far put some emphasis on the following points to remember and keep practicing it.
Set the scene!
In the majority of cases, there is no rush to defibrillate. This is due to the fact we can only reach our patients when they are in the circulatory or metabolic phase of cardiac arrest (3 phase theory). In that case, make sure to set the scene well, 360-degree access, gear placements, crew positioning, resus on Stryker etc, as it will make a huge difference for the total performance.
But if you witness the arrest, DON’T PISS AROUND and DEFIBRILLATE @ 360J!
Know your role and responsibilities!
In many cases, you’ll be assigned to more than one role, and we need to avoid swapping the roles during the resus so the initial role allocation is an important skill to master.
Airway/Ventilation = Initial ABC, confirm CPA (cardiopulmonary arrest), start chest compression while defib person sets the scene and be ready to defibrillate. Once first shock is delivered (or non-shockable), focus on the quality of the basic then advanced airway management to achieve effective ventilation. ICP may not be available hence we want all staff to be good at basic airway skills + LMA. Please review our previous posts for the airway skills.
Defibrillation = When only two of you initially, you need to place some gears while your partner starts chest compression. Spend extra few seconds to unpack airway, IV modules etc and place and prepare the modules (This needs some practices). Instruct fire crew when they arrive and get them to help setting up the scene.
Attach defib pads then get your phone app out and you are in charge of the timing and eventing (scribing). Use simple words to advise such as “Charging in 10 secs”, and use shoulder/hand tapping indicating when to start chest compression. EMT is ideal for this role but please make sure to get Para/ICP to check for the rhythm.
Drugs = Gain IV but don’t delay IO (ask ICP to step in). Consult clinical leader and administer drugs in the timely manner.
Chest compression = You are in charge of the quality control for the most important skill. Not only the quality ie depth, speed, recoil, fatigue etc, but also to do everything to improve chest compression fraction. While it’s important, this role may be more a conceptional role that often doubled up with other role and it’s about being a good coach for those (i.e. Fire crew) administering the chest compression.
Clinical Leader = While practical aspects such as timing can be lead by EMT or Para, St John clearly requests ICP (when available) to be responsible for the clinical decisions and be the clinical leader.
When ICP is not available, most experienced and highest qualified staff need to be clearly identified as the clinical leader.
This leadership is one of the key factors for HPCPR.
OK, that’s enough this month…phew…but just before you go, please check out the following BLS demonstration.
* I like the silent scene, hand tapping to indicate the start of chest compression, but in reality, would like to see more CRM such as role assign, quality control using closed-loop communication.
I’m also still in favour of 2 hands BVM technique or move onto LMA/ETT for many patients 🙂
We are going to plan another session in a couple of months but please have a mini sims or have discussions about roles would be hugely beneficial for the team.