Coaching effective CPR

[fiznat]

I worked a code a few shifts ago where I noticed that the firefighters performing CPR were doing a really poor job with the compressions. There was very little movement of the chest, no time for proper recoil, and the rate was wrong. I also noticed that the end-tidal CO2 outputs were very low (single digits) with the firefighter CPR, and much higher (in the low 20's) with me or other providers.

With all of the focus recently on the importance of proper CPR, I thought it was worth my time to coach these providers on how to do it right. I told them that they needed to work "deeper and faster," showed them myself a few times, and gave feedback (both positive and negative) as they were working at it. I thought I was respectful and took the time to briefly explain why I was making such a big deal about the compressions.

Still, I didn't get a very good response. Most of the time these firefighters listened to me and agreed, but then continued doing it exactly the way they were doing it before. It didn't seem like they were really getting how important this was, or understanding my instructions on how to do it better.

I work in a system where we frequently serve as the only paramedic on a scene otherwise dominated by firefighters/other non-EMS providers. It isn't a situation where I can simply tell these people to go away and do the CPR myself.

I thought we could share some of our experiences on coaching proper CPR. What kinds of explanations or demonstrations have you found to give the greatest "teaching" effect? How do you get around negative attitudes that invariably arise when providers are told they're doing things wrong?

[reaper]

I have had plenty of times where I had to have them reposition their hands or tell them to push deeer or faster. Most of the time They will do it right away. Most were never taught the proper way. Most are happy to learn the correct way.

If I have one that refuses to do it right. I have gone to their cheif with it. I have had one dept. that made every FF retake their BLS class on their own time. Guess who got to teach them!

[Quakefire]

The song "Stayin Alive" has a good effect on rate, if you listen to the tempo of the song.

[reaper]

So does "Another one bites the dust"! It may be more appropriate!! :shock:

[AnthonyM83]

Tell them to look at the CO2 reading and the range to keep it between. Tell them to do it deeper, harder, faster until that number gets within range.

[firedoc5]

I've had to do that many times also. Sometimes they were First Responders or a Rescue Squad from a rural station. When you get there they would barely be compressing the chest, either not taught right or afraid of breaking bones. And poor airway management. I know I stepped on a few toes, OK, I stepped on a lot of toes.

More or less as soon as we got there I'd tube the guy quickly, just to get a good airway going. Deal with the one who didn't know how to open and maintain an airway later. After tubing them I'd usually have someone I knew that I could trust with managing the tube, if at all possible.

But I would slide up next to whoever was doing compression and show them how to do it right. If family is around you explain to them in a very low voice that you need to do it harder. You are going to break bones. Keep an even rhythm. I'd do a few compressions for them to see. The first compression...crack. A rib or two would pop.

I'd be doing this BLS "cover" while trying to get my monitor and paddles in there somewhere. But hopefully, in a perfect world I'd have at least two EMT-I's with me. I'd have one of them do all the BLS corrections and the other getting my line started, drug box opened, etc.....

You know, now that I'm remembering what all the crap that would be going on and I had to put up with...it's a wonder I lasted I long as I did. But then again, most of the time we were pretty much a well greased machine. But when things were difficult, they were BAD.

[fiznat]

Thats pretty much my point. As the lone paramedic on scene I really need the BLS to be done well without requiring constant correction from me. I've got enough to do and if things go wrong (or in a code: if they go right!) I've got even MORE to do. I don't have all the time in the world to constantly correct poor BLS. ...Hence the need for an effective and efficient way to coach CPR.

[Arizonaffcep]

Tell them to look at the CO2 reading and the range to keep it between. Tell them to do it deeper, harder, faster until that number gets within range.

That's what my wife said! :oops: