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Home > Topics > Survivability
February 13, 2014
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Everyday EMS
by Greg Friese

Resuscitation training ups survival rates

More than 150 attendees took part in the half-day Resuscitation Academy presented at EMS Today

By Greg Friese

More than 150 attendees took part in the half-day Resuscitation Academy presented at EMS Today. Physicians and paramedics from Seattle Medic One and Howard County (Md.) Fire and Rescue Services taught attendees the science and skills to make witnessed ventricular fibrillation a survivable event in every community.

Dr. Mickey Eisenberg started with a presentation on why some communities have a high survival rate for cardiac arrest, why some communities have a low survival rate, and that unfortunately many communities have no idea what their survival rate is. He shared many mantras about building a system that uses cardiac arrest survival as the best metric of performance.

“Everybody survives needs to become a mindset for witnessed v-fib,” he said, and that needs to be embraced at all levels of fire and EMS organizations.

Eisenberg’s lecture ended with a vision of the future. When a community commits itself to making cardiac arrest survivable it means:

  • 100 percent of patients receive high performance CPR
  • 75 percent of patients receive bystander CPR (often because of telecommunicator recognition of cardiac arrest and caller instructions)
  • 50 percent of patients will have an AED applied in less than six minutes
  • 60 percent of patients with witnessed ventricular fibrillation will survive

Full recoil

Dr. Peter Kudenchuk talked about the science behind the hands that perform chest compressions. Two points in his presentation really captured my attention.

First was his explanation that chest compressions compress every blood-containing vessel in the chest. CPR instructional videos put the focus on the compression of the heart, but in reality chest compressions also compress and move blood in the major vessels, as well as the coronary and pulmonary vasculature.

Second was his explanation of the systole and diastole of compressions. In ACLS and BLS courses there is emphasis on compression and recoil, but Kudenchuk gave me the final ‘aha moment’ that I needed. During compression (systole) the brain is perfused. During recoil (diastole) the heart is perfused. Thus, it is important to allow the patient’s chest to fully recoil and not lean on the chest between compressions.

Practice, practice and more practice

The meat of the workshop was nearly two hours of small group instruction and practice. Medic One and Howard County paramedics worked with groups of four to five attendees. With the assistance of Laerdal and Physio-Control every group had a CPR feedback manikin, AED or cardiac monitor, and a bag valve mask.

We followed a watch then practice, practice, and more practice format. The Howard County EMS captain assigned to our group provided immediate and useful feedback to help us improve our skills in these four areas of high performance CPR:

  • 100 to 120 compressions per minute
  • Compress the chest at least 2 inches
  • Maintain a compression fraction greater than 80 percent
  • Allow full chest recoil with no leaning

With the assistance of the captain, real-time compression rate and depth feedback, and teamwork our group increased its high performance CPR skills throughout the workshop. As I neared the end of one of my two-minute chest compression cycles, I realized, a bit sheepishly, that sweat was dripping off my brow and onto the manikin. It was a great reminder that high performance CPR is hard work and rescuers need to switch position every two minutes.

I highly recommend the half-day Resuscitation Academy for future EMS conferences. I came out of the session more knowledgeable in the science of CPR, more assured of my skills, and excited to contribute to efforts in my community to improve survival from sudden cardiac arrest.

About the author

Greg Friese is the Director of Education for CentreLearn Solutions, LLC. He is also an e-learning designer, writer, podcaster, presenter, paramedic, and marathon runner. Read more from him at the EverydayEMSTips.com blog. Ask questions or submit tip ideas to Greg by e-mailing him at greg.friese@ems1.com.
Comments
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Michael Fraley Michael Fraley Friday, February 14, 2014 6:43:41 AM Dr. Eisenberg's Resuscitation Academy is not only an awesome example of a successful system giving back to the EMS community but IT WORKS. Another thing I heard when I attended the Academy in Seattle a few years ago was that "it isn't complicated but it isn't easy." And that is true too. Communities have to work at it but it can be done. Our area has a 42.4% survival rate thanks much to the program and there is nothing more motivating than to shake the hand of a survivor.
Christal Spivey Christal Spivey Sunday, February 16, 2014 7:57:07 PM Wonderful everyone needs a refresher.
Jimmy Bryant Jimmy Bryant Thursday, February 20, 2014 10:15:22 AM That's great as long as you can find them !! Calling 911 in California? Don't Use Your Cellphone Unless You Have To —By Dana Liebelson | Tue Aug. 13, 2013 8:46 AM GMT Sean Paul/Flickr A new study released Monday suggests that many, and perhaps most, 911 emergency calls made on cellphones do not include accurate location data. More than half of cellphone 911 calls in the California-focused study—and over 80 percent of those in San Francisco—failed to transmit the caller's address, according to the report, which was compiled by the California Chapter of the National Emergency Number Association (CALNENA). That's bad news: In emergencies, it's crucial that responders automatically receive accurate location information in case a victim is lost, passes out, doesn't speak English, or is otherwise incapacitated. According to the Federal Communications Commission, 70 percent of 911 calls are placed on cellphones, and that number is growing. When 911 calls are made on land lines, location data is transmitted to a dispatch center using the same system phone companies use to determine how much to charge for long-distance calls. But cellphone companies have to contend with loss of coverage in rural areas and increasingly, inside high rises. CALNENA, which advocates on behalf of California emergency dispatchers, looked at millions of 911 calls made in five geographic areas in California—Bakersfield, Pasadena, San Francisco, San Jose, and Ventura County—and found that accurate transmission of location data has been steadily declining since 2008. It also found that certain carriers performed better than others: In January 2008, AT&T was sending location data on 92 percent of calls, a percentage that dropped to 31 percent by December 2012, according to the report. T-Mobile's coverage dropped from 47 percent to 19 percent in the same time period, and a spokesperson for the company told the Los Angeles Times that the company was reviewing the report. Verizon and Sprint are getting slightly better at finding 911 callers, with Verizon sending accurate location data 57 percent of the time in late 2012. "This is a serious public safety concern and a significant stress on our public safety assets, both the dispatchers and first responders who have to spend considerable time obtaining the location of wireless 911 callers," wrote CALNENA president Danita Crombach in a letter sent yesterday to the FCC. "Lives are at stake." The CALNENA study only looked at California—but as our recent investigation into the failure of 911 computer system shows, when one city is having life-threatening problems with its emergency equipment, other cities often have similar problems. That's likely the case here: Last month in New York City, it took emergency responders nearly eight hours to track down a stroke victim who called 911 but was unable to say her address. The only information rescuers had was the location of the nearest cellphone tower.

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