CPR Changes.. have you changed?

[JonathanGennick]

[rant]

You know what? I'm sick of this "Have you been trained" or "We'll switch when everyone gets trained" BS.

[snippage]

If you truly believe that protocols are guidelines, then take charge during an arrest and do what the evidence currently shows to work. If you don't, then all the talk on this board about "guidelines" and "evidence based medicine" is a sham! [/end rant]

I'm not sure it's all that simple. Were I a physician, then sure, I could look at the evidence and change my treatment. But I'm not a physician. Rather, I answer to one. Where I am, we've been told to stick with the method that we're certified for until we can schedule a new training session. (And we are planning to schedule training soon) This order comes, I believe, from our medical director. I agree that the CPR changes are fairly simple, but I would not want to ever find myself on the stand in a courtroom trying to explain why I chose to go with a procedure on which I had not been trained, for which I had not been certified, and which I'd been told explicitly not to implement until such time as I became certified. I don't believe that "because I read it on the Internet" would be all that good of a defense.

I will say though, I would like to get the traning done so that I can move up to the current best practice.

p.s. I'm a basic. Perhaps if I were a medic, I'd feel differently. Seems like what I said above would still apply though.

[JPINFV]

I'm not sure it's all that simple. Were I a physician, then sure, I could look at the evidence and change my treatment. But I'm not a physician. Rather, I answer to one. Where I am, we've been told to stick with the method that we're certified for until we can schedule a new training session. (And we are planning to schedule training soon) This order comes, I believe, from our medical director. I agree that the CPR changes are fairly simple, but I would not want to ever find myself on the stand in a courtroom trying to explain why I chose to go with a procedure on which I had not been trained, for which I had not been certified, and which I'd been told explicitly not to implement until such time as I became certified. I don't believe that "because I read it on the Internet" would be all that good of a defense.

I will say though, I would like to get the training done so that I can move up to the current best practice.

p.s. I'm a basic. Perhaps if I were a medic, I'd feel differently. Seems like what I said above would still apply though.

Simply put, there has been a lot of discussion on this board about "the book" and patients who have never read "the book." Thus, there have been several discussions (almost always at the ALS level) about protocols being more guidelines then rules. The change isn't based on one study, but on several of them. This is why AHA is changing how they train people to do CPR.

As for the source, just because it is on the internet doesn't mean it can't be trusted. This isn't Joe Blow's CPR and First Aid Wackerdom or a page that just anyone can change (Wikipedia), but the American Heart Association's website. If you can trust their instructors and their literature, then you should be able to trust their website. If you can't just because it is on the internet for free instead of a $10 book at a $50 course then every discussion here that uses a study off of pubmed is just as pointless as calling protocols guidelines or claiming to care about evidence based medicine. After all, apparently nothing on the internet can be trusted, right?

While I see you're point at being explicitly told to wait till your retrained, but I find this equally annoying. Basically your med control doctor is saying that the EMT (B, and most likely P too) are too stupid to look for information on the own and have to have it force fed to them or else they'll manage some way to screw it up. From what I've seen of EMS at the BLS level, it probably isn't too far from the truth (not an indictment against anyone here)

[JonathanGennick]

As for the source, just because it is on the internet doesn't mean it can't be trusted. This isn't Joe Blow's CPR and First Aid Wackerdom or a page that just anyone can change (Wikipedia), but the American Heart Association's website. If you can trust their instructors and their literature, then you should be able to trust their website.

Of course. You're absolutely correct here. We can trust the AHA website.

While I see you're point at being explicitly told to wait till your retrained, but I find this equally annoying. Basically your med control doctor is saying that the EMT (B, and most likely P too) are too stupid to look for information on the own

You've motivated me to go look :-). I found an issue of the AHA magazine "Currents" that describes the delta between the old and new guidelines. I've only given the document a quick review so far, but there's enough in there that I'd be reluctant to implement the new guidelines by simply telling everyone in our system to just go read them. The result would probably be a coordination nightmare. I can envision a clusterf--k on scene as we debated whether to go with 30:2 or 15:2 compressions to breaths, whether to give two minutes of CPR before shocking, etc. And that's not to mention that not all would read up on the new guidelines at the same time, and so everyone on scene might be in a different "place" knowledge-wise.

The guidelines themselves seem to be presented in an issue of the journal "Circulation" (Vol 112, Issue 24 Supplement; December 13, 2005). There's quite a bit of reading to be done there. Putting on my management hat for a moment, would I expect our group of mostly EMT-Basic volunteers to sort everything out for themselves? I would not. Some training and coordination is needed, because, when the stuff hits the fan, everyone on the team needs to be working from the same playbook, know what to expect from each other, know they can depend on each other.

Changing the way that a large group of people operate can be teeth-grindingly difficult :-). I do see the wisdom in planning and then training. (and I'm eager to get on with the training).

Hey, JPINFV, at least you've motivated me to get off my butt and download the new guidelines. I've got a nice small pile of bedtime reading now. Thanks for that. I'm still not going to implement the new guidelines unilaterally in my system, but I will read up on them, to get a head-start in preparing.

[JPINFV]

That's one of the great things about AHA. If you think it's too much reading, there are always the webcasts (including a set made specifically for EMS).

http://americanheart.org/presenter.jhtml?i...ier=3037720#ems

Some training and coordination is needed, because, when the stuff hits the fan, everyone on the team needs to be working from the same playbook, know what to expect from each other, know they can depend on each other.

This is another problem about EMT education, and one that I'm currently trying to fix in myself. Yes, the EMS team needs to work from the same play book, but there also needs to be a team leader. Generally the leader is very easy to identify, in hospital it is the doctor, prehospital, it is usually a paramedic. Because of the limited scope for basics, generally there is no need for a basic to work as a team (i.e. you can take v/s, start O2, etc on a medical patient without too much difficulty as a solo player). In the ALS world (hospital or prehospital), there are several actions that can't be done at the same time as others (IV starts, establishing base contact, drawing up medications, etc, hx, physical, etc). For example, during a code in a hospital, the doctor actually does very little. A tech will do compressions, a tech or RN bags, a RN will administer the medications, an RN will generally run the defib. I've seen 5-6 code brought in by ALS(not exactly a great number, but anyways). Except for the one time that the MD had to remove a combi and intubate, the MD stood there with his hand on the femoral artery and directed the show. During my ride along (911 company) and over the past year that I've worked (IFT), it seems that most basics tend to not stand up and take charge. We either stand there like deer in the head lights (cluster fucks), or do most of the stuff by ourselves.

During a code, one basic should take charge prior to ALS arrival. This person should be the one making sure that a constant ratio is maintained, proper compression depth is achieved and proper forced is used for the bagging. Now it's not about being on the same page in terms of 2000 or 2005 guidelines, but everyone is on the same page as the leader.

[JonathanGennick]

This is another problem about EMT education, and one that I'm currently trying to fix in myself. Yes, the EMS team needs to work from the same play book, but there also needs to be a team leader. ... Because of the limited scope for basics, generally there is no need for a basic to work as a team (i.e. you can take v/s, start O2, etc on a medical patient without too much difficulty as a solo player). .... During my ride along (911 company) and over the past year that I've worked (IFT), it seems that most basics tend to not stand up and take charge. We either stand there like deer in the head lights (cluster fucks), or do most of the stuff by ourselves.

During a code, one basic should take charge prior to ALS arrival.

(JPINFV, the ellipses (...) show where I've elided some of your post that I'm quoting. Just FYI on that.)

Amen! I couldn't agree w/you more. I'll only add that I wouldn't limit what you've just said to codes. If there's more than one responder on a call, then one needs to be in charge and the others need to be good followers.

[shan_77]

we are slowly implementing the change ... MICA have started to use the "new" guidelines and we will use them if working with MICA who have been trained ... paramedics are being introduced to the changes during our training days so this will be a slow process taking probably 6-8 months to have every paramedic in the service using the new guidelines

to be honest in order for these guidelines to be effective we need better defibrillators .. our current ones take too long to charge and don't permit any compressions/ventilations during the charging (supposedly) ... very annoying

the second thing is the number of paramedics attending an arrest .. starts off with 2 which is a very busy time ... someone on airway and someone doing compressions - doesn't really allow for IV's to be established/drugs drawn up/fluids to be established .. then when MICA arrive that usually brings another 2 crew ... MICA are usually so intent on intubating and getting lines that the medics first on scene are still compressing without a break ... it will be interesting to see how the service implements these changes and how they are adaptated by crews

[Oilersfan1]

We are currently implementing the new standards. With all the present research we have chose to purchase the Zoll AutoPulse to perform CPR. Which free's up a person, increases responder safety and is more efficent.

Cheers

[dahlio]

Have any deadlines been set for when services should have all personnel retrained? Has anyone heard of deadlines set by state, region, service, etc?

I also wasn't able to find any information on whether or not the Red Cross would make similar changes for their standards. Does anyone know?

I know the local Central Jersey Chapter of ARC is changing all courses to the new CPR routine in Jan. 07

[ffemt819]

i have done two critical care transfers in last two weeks both rosc from emergency clinics to hospitals both have had decorticate posturing enroute to hosp. something tells me we are doing too good of a job of cpr and bring false hope to these families.

[Asysin2leads]

Had CME on the new improved CPR last night, new protocols are out governing cardiac arrest procedures and will be implemented January 2001. I was designing some gameplans tonight for running codes with the new protocols in effect. It will be interesting to see how they work.