- Experience
This is the single most crucial aspect of an instructor. Everybody can read a handbook on CPR and start firing away instructions to the students. But CPR training is more than that. Only an experienced instructor can reveal the nuances of a real-world CPR situation. A paramedic, nurse, EMT, lifeguard, and other similar professionals are the people who deal with such emergencies on a regular basis and will have dozens of stories to tell the students. This will give the class a holistic idea of what is expected of them in such situations.
- Passion and Procedural Knowledge
The instructor should believe in the importance of the job. A passionate instructor captivates the mind of the students like nothing else can. A teacher`s excitement easily penetrates into the students` minds and gets them to learn and understand the things at hand with more zeal. Such an instructor never lets a class become boring and compromise the learning of students.
An instructor should be motivated enough to keep oneself updated with the latest developments in the field of CPR. The guidelines are updated regularly and the instructor should be aware of the most recent guidelines. This will inspire the students to do the same.
- Knowledge of Human Anatomy and Physiology
A badly administered CPR may result in broken ribs, heart or lung contusions, hemothorax and other complications. The instructor should be able to make the students aware of the positions of the human organs and the correct ways of administering a CPR without causing damage to the internal organs.
- Communications Skills
The instructor should lead the class and facilitate learning. CPR is a serious subject and could be quite intimidating for the first time learners. An instructor with a good sense of humor can make the class fun, while managing to get the students to learn. Just telling stories will not cut it, an instructor should involve the students and make them understand how the lifesaving skill came handy in saving the lives of people on multiple occasions
- Technological Proficiency
A number of technological tools can be used to teach a class. Presentations on a projector are a very effective way of communicating with students. Internet could also be a great resource for learning, if properly utilized. The instructor can simply open CPR videos on YouTube and point out the common misconceptions about the procedure. The instructor should be familiar with such tools to connect with the audience in a more effective manner.
]]>I want to get a certification. That’s it!
Well, a large number of people want to enroll for CPR classes only for the sake of a certification. Most hospitals and healthcare organizations require their employees to have basic knowledge regarding First-Aid, CPR and AED. A person looking for a certification to just get employment in such organizations, has endless options of classes to choose from.
A simple “CPR class” search on Google will fetch a long list of agencies and a variety of training classes for enrollment. However an overwhelming majority of these online agencies have absolutely no standards in granting a certification. They are there to just make money. These agencies may provide a handbook on CPR and conduct an online test before granting a certification. As a matter of fact, a large number of them just hand over a certification for simply registering for the course and paying the fees.
Nonetheless, whether the employing organization will accept the certification from a particular online agency or not is completely at their discretion. Therefore, it is better to know which certifications they accept beforehand, if possible.
I want to learn to administer CPR
It is impossible to learn CPR without some actual practice in the presence of an instructor. The actual practice is done on a mannequin in a CPR class. Only some agencies go to the lengths of providing a mannequin and an experienced instructor to train the students. When I say experienced instructor, he should be someone who has had hands-on experience of administering a CPR. Having someone who has worked as a paramedic or a nurse is the best bet. Likewise, the classes which require their students to demonstrate competence in CPR administration, for awarding a certification are trustworthy.
Various hospitals and EMS providers conduct weekend CPR classes, which are, more often than not, quite good too. But, generally they do not offer certifications for attending their classes.
Remember to ask these questions before enrolling for a CPR class.
- Is hands-on training available?
- Is there a mannequin available on which you can perform chest compressions? Will each student get one to practice?
- Is the instructor experienced?
- What was the nature of his previous job? Did he have the opportunity to perform CPR?
- How rigorous is the training?
- Are there any tests for awarding the certification at the end of the training?
I want to learn as well as get a CPR certification
The certifications awarded by various CPR classes are not valid universally. Whether a certification is considered valid is purely at the discretion of the person and/or the organization asking for it. Overall, there are only 2 organizations whose certifications are widely, if not universally, accepted. They are American Heart Association and American Red Cross. These organizations are known for their excellent training programs. On the other hand, depending on your location, they may not have year-round classes. It is therefore recommended to check for their class schedules in advance.
]]>- No practical Exposure
Let me be blunt about this. You are not competent enough to administer a CPR unless you have practiced it on a mannequin in a live class with an instructor monitoring your actions. Despite of this, the online agencies offer nothing more than some reading material on CPR and a test for awarding a certification. As a matter of fact, most agencies do not even conduct the test and when they do, it is only a formality and has no bearing on your being awarded a certification. There is absolutely no learning involved in the online CPR certifications that would help you in a real-life situation.
- Absence of a Regulatory Norm
There is no dedicated government body to oversee the operations and certifications awarded by the various CPR training agencies. All the agencies, whether online or traditional, have their own approaches. They have their own course material and practice guidelines. Although American Heart Association releases updated CPR guidelines, it is up to the agencies whether to adapt the latest guidelines or continue with the older procedure. American Heart Association and American Red Cross are two of the most trusted agencies which offer reliable online certification programs. Granted, these organizations have online training programs, but they too mandate in-person skills assessment to award the certification.
- Certification Acceptance issues
If you are looking to get an easy certification to fulfill a job requirement, be wary of the online certifications. The acceptance of a certification from a particular agency is solely at the discretion of the employer. If the employer feels the online agency is not qualified or credible enough to grant a certification, then the certification has no weight to it. This is especially true in case of obscure online agencies with no practical training involved.
- Complications of CPR
About 330,000 cardiac arrests happen every year in U.S. alone. A majority of them are at home. That is to say that, an overwhelming majority of people suffer cardiac arrests at home in the presence of other people. The people present at the location during such an emergency, could be the only hope of survival for the victim. A good CPR can considerably improve the chances of the patient’s survival. If the person giving CPR is not well versed with the technique and only knows theoretical concepts from the course material provided by an online certification agency, the victim`s chances of survival are greatly reduced. A badly administered CPR may leave the patient with broken ribs, lung contusion, heart contusion or other injuries.
Whether you wish to learn a lifesaving skill or get the certification to land a job, it is paramount that you enroll for a traditional classroom CPR training class.
]]>1. Am I allowed to do a CPR if I have do not have a certification or never attended any CPR class?
Yes. CPR certification or class training is not mandatory for you to spring to action and extend your valuable help to save a fellow human being`s life. However, some country laws require you to ask for victim`s permission before you perform a CPR on them. CPR classes make you aware of such legal obligations to be mindful of, in the event of such emergencies.
2. Am I obligated to perform a CPR on a victim in emergency, if I am CPR certified?
Except in the state of Vermont, there is no legal obligation in the U.S. for a fellow-citizen to administer a CPR on an emergency victim. The state of Vermont has the Good Samaritan Law (Duty to Aid the Endangered Act), which puts an obligation to a fellow-citizen present in an emergency to extend all the reasonable help that could be provided to the victim. This includes a CPR as well. However, the case is different for professional rescuers such as a firefighters, EMS’s, lifeguards and so on, for whom it is a duty to perform CPR on the victim, if required.
3. Is it better to join a traditional classroom CPR class or an online CPR class?
There is no better way to learn the lifesaving skills than practicing them live on a mannequin. The experience of practicing while being continuously monitored and advised by an instructor is the best method to learn the procedure. Online classes neither offer the depth of knowledge nor the experience that is characteristic of traditional CPR classes.
4. How often do I need to take CPR classes to remain competent in administering a CPR?
With advances in medical science, our understanding of CPR and its effects improve continuously. The CPR guidelines are updated regularly to reflect these changes. In order to keep yourself updated to the latest guidelines and to have enough practice on a regular basis, it is generally recommended to retake the certification every 12 months or less.
5. Are online CPR certifications valid?
Since there is no national level regulatory body to monitor the activities of various CPR training agencies, a number of online CPR certification agencies have cropped up. Their standards for awarding a certification are very low and therefore, it is entirely up to the employer to consider or reject the certification from an online agency.
6. Are the CPR classes different for amateurs and professionals?
Yes. A professional agency such as the American Heart Association has customized training programs for amateurs learning to become capable of saving a loved one in emergency and for professionals such as a daycare provider or a nurse. On a broad level, the CPR classes train students in administering CPR on adults, children and infants. While amateurs are generally trained to provide CPR to adults, the professionals are trained based on their professional requirements.
7. Do I need to pass an examination or a test to get a CPR certification?
All good CPR training agencies require their students to pass a skills test, during which they are required to demonstrate their CPR administration skills in practice. Depending on their performance in the test, they are awarded a certification. Even the well-known CPR training agencies which offer online programs, require the students to perform a physical skills demonstration to award a certification. Nevertheless, many agencies give away certifications without conducting any test and when the tests are conducted, the students are hardly rejected.
]]>- Legal Implications:
An emergency requiring CPR is naturally a life and death situation. Consequently, the legal implications of the actions by various parties during the situation are also serious. Although it is the duty of a CPR professional to act and tend to such an emergency, considerations such as consent, scope of practice, confidentiality, documentation and so on are equally important. The classes train participants on the legal considerations and proper behavior to be followed with the victim.
- Protection against pathogens
The professionals are trained on the various methods of preventing the spreading of blood-borne pathogens from the victim. It is possible that an emergency victim is a patient of blood-borne diseases such as Hepatitis B, Hepatitis C and HIV. Therefore a professional should be well versed with precautions to be taken against exposure to such pathogens and also know the steps to be taken if an exposure occurs.
- Primary Assessment
One of the first things a professional is required to do in an emergency is to assess the conditions of the victim. Unconsciousness, breathing, pulse and bleeding are to be checked. The accuracy of the assessment is critical, for the correct administration of life-saving techniques to the victim. Classes discuss in depth, the steps to be taken during assessment of victims in various emergencies such as spinal injuries, drowning, vomiting and so on.
- Respiratory Distress Situations
In the pandemonium that ensues an emergency, it is difficult to notice important clues on the conditions of the victim such as Hypoxia, Choking or slow breathing. Professionals are trained to look for a dozen symptoms of respiratory distress in a victim and the assistances they can extend the victim.
- Cardiac Emergencies
This could be a tricky subject for a non-professional since the symptoms of cardiac emergencies are easily confused with muscle spasms or indigestion. A late response in identification of and response to a heart attack could mean death to the victim. CPR Professionals are trained to recognize the various causes and symptoms of a heart attack so that they can tend to the victims.
- Administration of CPR
CPR is a fairly complex technique and requires considerable skill on part of a professional. Factors such as hand position, chest compression rate, ventilations and others, have to be properly monitored while administering a CPR. These factors also depend on the age of the victim.
- Two-Rescuer CPR
In this method, one of the rescuers gives chest compressions, while the other administers ventilations in a synchronized manner. Since those few precious moments of emergency can be a deciding factor between life and death for the victim, an extra pair of hands is an advantage. The CPR classes train the participants on how to administer a two-rescuer CPR in sync with each other.
8. Automated External Defibrillator (AED)
Most classes on AED may not cover the topic of AEDs for the simple reason that it is not something that is readily available to everybody in an emergency. They are available mostly with the Advanced Medical Personnel. However, some classes do cover AEDs in varying depths of detail. Typical knowledge explored in AED sessions include using an AED on adult, child and infant, precautions to be taken with AED and so on.
Most of the information on CPR is easily obtained online. But it is a fairly complex task and requires considerable skill on part of you to administering it. Therefore, it is your duty, as a responsible fellow human, to practice these skills in person in classes. What`s more, as someone with such life-skills, the people around you can depend on you to tend to them during an emergency.
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A doctor who presented research on the importance of CPR during the American Heart Association’s resuscitation conference in Chicago proved her point hours later, saving a man who collapsed in a hotel lobby.
Monique Anderson, M.D., was talking with another doctor about the importance of fast response to cardiac emergencies while leaving a reception Sunday night when they saw a middle-age man face down on the ground.
Anderson and three other doctors ran to him, rolled him over and saw that his face was ashen. He was not breathing and had no pulse.
Anderson – who had never performed CPR outside a hospital setting – quickly yelled out instructions to one of the doctors to call 9-1-1 and started chest compressions. After a few rounds, the man sat up and said, “I’m OK, I’m OK,” Anderson said.
Anderson said her first thought when they saw him was, “Is this real?” The second thought was, “Take action.”
“We knew we had to get to him,” she said. “We assessed, we called for help and initiated what we learned.”
As she was giving CPR, one of the other doctors cheered her on, yelling, “Keep pushing! Keep pushing!”
“It was a team effort,” Anderson said.
As of Monday afternoon, the man had undergone tests at a hospital and was doing well.
The doctor who called 9-1-1 was Eric Peterson, M.D., M.P.H., a longtime volunteer with the American Heart Association and director of cardiovascular medicine for the Duke Clinical Research Institute in Durham, North Carolina, where Anderson also works as a medical instructor.
“Panic quickly sets in to even the best of us, but really having somebody there who knew what they were doing, doing CPR, was really key to keeping this organized and running well,” Peterson said. “And once it was all done, what an amazing feeling. This is sort of what we all do and talk about in research, now coming to life.”
Anderson, who is also an active volunteer with the American Heart Association, focuses exclusively on cardiac arrest research and has trained thousands of people in CPR at Duke and throughout North Carolina.
She has pursued resuscitation as a career ever since she treated a patient in the cardiac critical care unit. She was so inspired by that patient that she made a short documentary about it called, “Surviving Cardiac Arrest, A Family’s Perspective on a Second Chance at Life.”
“It’s amazing to see that there’s been a lot of research in the area and it’s growing, but survival has not changed to the point that we’re happy about,” she said.
Only 10 percent of people who suffer out-of-hospital cardiac arrests survive, and the majority don’t get the immediate help they need from bystanders. High-quality CPR can double or triple a victim’s chance of survival.
As a volunteer for the AHA, Anderson serves on the Emergency Cardiovascular Care Committee. She also serves on the planning committee for the Resuscitation Science Symposium, held Saturday and Sunday in Chicago.
In addition to presenting research on the importance of high quality in-hospital CPR this year, Anderson also led a first-of its kind study showing where CPR training is happening across the United States.
Her lifesaving experience Sunday reinforced the importance of her work.
“I want to reiterate how important it is for people to act fast in emergency situations and remind everyone to learn CPR,” she said.
]]>The frantic situation occurred Wednesday inside a store in High Ridge, Missouri. Surveillance video showed the mother desperately trying to revive her baby.
The store’s manager called 911.
Abby Snodgrass, 17, heard the commotion from aisles away and ran to help, performing CPR. She had recently learned the procedure in her health class at Hillsboro High School in Hillsboro, Missouri.
“The one thought that crossed my mind was, ‘What if this doesn’t work?’ And I just had to push it out of my mind and keep going because I knew that’s what I had to do,” Snodgrass said.
Eventually the baby started breathing again.
“I can’t explain how happy I was when she started to breathe,” Snodgrass said. “It was a huge relief.”
Without the teen’s swift action, the infant may have died, emergency responders said.
Authorities said that the mother and child were doing well.
The baby’s family released a statement to ABC News acknowledging Snodgrass’s efforts.
“We are exceedingly grateful to the young woman who helped our daughter,” the statement read. “Our daughter is home and healthy, and we couldn’t be more thankful.”
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As you’ll read in multiple other sections of this supplement, we continue to discern insights into more effective treatment approaches to out-of-hospital sudden cardiac arrest. In reality, we’ve collectively learned more in just the last decade than ever before about the pathophysiology of cardiac arrest.
With considerations about cooling (therapeutic hypothermia), chest compression continuity and alternative ventilation strategies, is there really much to talk about when it comes to something as simple as the rate of chest compressions?
“So, Dr. G, what’s your interest in chest compression rate? The American Heart Association (AHA) says to compress the cardiac arrest victim’s chest at least 100 times a minute. That’s all there is to it, right?”
That’s a good place to start and an understandable question. For purposes of this particular conversation, let’s discuss victims who are of adult age. You’re correct in your interpretation of the AHA guidelines released in late 2010.1 How the 2015 guidelines on chest compression rate will change, if at all, is unknown.
There’s been some interesting science published regarding chest compression rates since those 2010 guidelines.2,3 I’m quite sure the clinicians and scientists charged with formulating those 2015 guidelines will certainly take such discoveries into account. The fact is — no surprise here, I think — nothing is very simple when it comes to a condition as dynamic, dramatic and challenging as cardiac arrest.
Key among the latest scientific papers on chest compression rate is work done by Dr. Ahamed Idris and his colleagues in the Resuscitation Outcomes Consortium. In short, Dr. Idris and the research team found that exactly 100 chest compressions per minute didn’t produce the highest number of survivors among the large group of cardiac arrest victims who were treated by systems that participate in the ROC.4
The “sweet spot” of chest compression rate in that review, published in 2012, was much nearer to 120 chest compressions per minute.4 So, you might say that the AHA is still right because 120 compressions per minute fits the definition of “at least 100 times a minute,” although so does 140 compressions per minute, correct?
“The patients (and their families) we treat often think more is better, and if we want to be honest, many EMTs and paramedics subscribe to that belief about a lot of interventions. That said, I bet you’re getting ready to burst that bubble and tell us 140 compressions per minute may not be better?”
Actually, I’m not going to say 140 compressions per minute may not be better than a rate of 120. Instead, I’m going to say, based upon the Idris paper, that 140 compressions per minute are definitely not better for survival than 120. In that report, a very compelling graph is presented that I choose to describe as a “wave of survival per compression rates.”
The reason I call it a “wave” is that a curve implies an even rise and fall and this isn’t that. The scientific term for the actual curvilinear shape is a cubic spline model, but that’s hard for a guy like me to immediately grasp. I can visualize a wave that rises and then fades out, and I think most people can as well.
So back to that study, it’s not too hard to imagine that survival proved lower at rates less than 100 compressions per minute and then there is a slow increase to a peak in survival near 120 compressions per minute.
Here’s my key point: After 125 and towards 140 and beyond, the survival line drops off! That’s why this study is so important in my opinion, and I trust the researchers, their method of study, plus the number of patients involved was large. This is science you and I can use in our quest to produce more neurologically intact survivors from out of hospital sudden cardiac arrest.
“Why do you think 140 isn’t better than 120? Besides, are people in real life compressing at 140 anyway? That seems pretty fast and not what’s taught in the first place.”
Let me break that up into two answers. First, we have to think about this amazing organism that is the human body. What happens when you and I decide we’re going to get our particular organisms in better shape and do some aerobic conditioning or weightlifting? Why does our heart rate rise and breathing increase? We are doing the “Magic C” as I call it — compensating!
That workout-induced tachycardia and tachypnea is getting greater-than-usual oxygen-enriched blood flow to muscles that require it to perform what we’re asking of them. As long as we are pulsatile, and your patient is pulsatile, our human bodies will stretch compensation to impressive levels. But, what happens when pulsatile becomes pulseless? Compensation ceases, at least the intrinsic compensation.
So what’s the extrinsic compensation during CPR? You. Me. Your partner(s). Bystander(s). CPR is, in one word, compensation.
What percent of compensation do you and I have to attain for a person when we do CPR? 100%! Sobering, huh? We don’t even get to outsource 1%; that 100% needs to be the very best it can be, at least according to the best understanding of what works today.
As important as each compression is, the decompression phase is just as important because that’s when intrathoracic pressure drops and blood flow can return to the heart to be available for flow from the heart on the next compression. Think about the last sick patient you had in a true tachydysrhythmia with a pulse? Why were they so weak, hypotensive and likely even hypoxic? The rapidity of their pulse prevented good cardiac output and perfusion, both to central and peripheral circulation.
We may not be so worried about peripheral perfusion in cardiac arrest, but if our compressions are going to produce helpful cerebral and coronary perfusion pressures, we have to let enough decompression time occur. That doesn’t happen if we compress at 140 times a minute.
So do professionally trained EMTs and paramedics compress that fast anyway? Actually, yes, a lot do. Good – hearted, enthusiastic police officers, firefighters, EMTs and paramedics perform too many compressions. How do I know this? Back in 2011, we discovered in the process of reviewing chest compression fundamentals with each and every EMT and paramedic in the EMS System for Metropolitan Oklahoma City and Tulsa, that without a metronome to guide compressions, nearly 90% of these incredibly well-trained men and women were compressing somewhere between 135–145 times per minute!
That really opened my eyes. It affirmed to me several things: 1) We have EMS professionals in our system who really care about — and work hard at — treating cardiac arrest. Even in training scenarios, their adrenaline kicks in and they go after it! I had honestly thought if we did start using metronomes set at 120 beeps per minute, directly influenced by that ROC study we’ve been talking about, those metronomes would be needed to speed up the rates. But, I was wrong. The reverse was true; we were compressing too fast and the metronomes would help us to slow down.
It became crystal clear to me we needed to begin using metronomes to change natural compression rate tendencies. This turned out to not just be a positive for the patients, but our crews also, because we were actually able to reduce the physical work necessary in performing optimal manual chest compressions.
“Cool, Dr. G. So just compress at 120 a minute in adults, use metronomes set to that and that’s all there is to it?”
Even with what we’ve discussed so far, there’s more to it. To prove the point, I’ll share with you now that we recently changed our compression rate guideline, and metronomes, to 110 compressions per minute in rate.
“What?!?! How does that make sense based upon what we’ve been talking about?”
Back to the “nothing is really simple when it comes to cardiac arrest” mindset. In our particular system, we currently don’t use mechanical chest compression devices like the Physio-Control LUCAS 2 chest compression system or ZOLL AutoPulse non-invasive cardiac support pump. We use a team dynamic plan for coordinated resuscitation (aka the “pit crew” approach). The most common resuscitation in metro Oklahoma City or Tulsa has 5–8 EMS professionals on scene within 4–10 minutes.
In addition, one of the devices we choose to use in our airway management and cardiac arrest care is the ResQPOD impedance threshold device (ITD) for its capability of reducing intrathoracic pressure during decompression — another important factor in cardiac arrest resuscitation.
Further, because of the emphasis we’ve been placing on the continuity of chest compressions and getting quick feedback to our colleagues about how consistent in rates and continuity that their compressions were or were not in individual resuscitations, we’ve seen our chest compression fraction (time of resuscitation in which chest compressions are occurring) move from a typical 85% to more than 95%.
Without getting too far down in the weeds of science, it’s important to point out that use of mechanical chest compressors and/or the impedance threshold device can influence the basic physiology of hemodynamics produced by compressions.
Through very in-depth conversations that I’ve had over the past few years with the clinical scientists who developed the impedance threshold device, it appears that the ideal compression rate for CPR without an ITD, as reported in the Idris paper, differs from what’s ideal if an impedance threshold device is used in-line in the airway circuit.
It seems the best rate when using an impedance threshold device is much closer to the 100 compression rate per minute; in fact, in subsequent data analysis, the best overall survival in the ROC study occurred in patients who received an active ITD with chest compression rates close to 100/min. So, we’re slowing down to 110 for now, primarily based upon both this specific data analysis and our system-specific chest compression fraction and effective compressions per minute. We’ll continue to follow our survival outcomes and adjust our chest compressions rates as further observation and science dictates.
To illustrate how complex this can get, if active compression – decompression CPR with an ITD finds its way to the streets of the United States, that ideal chest compression rate may be as low as 80/min according to a recent U.S. study!
It does make sense when you appreciate that all of these things produce different compression types and intrathoracic pressure and, thus, different compression types and adjuncts, like the ResQPOD ITD and mechanical compression devices, will produce different optimal rates.
Just remember, it still is all about survival and there are a lot of “fine tuning” knobs to turn back and forth as science gives us updates to our user’s manual for resuscitation.
“Wait, Dr. G. So you’re talking a lot about rate, but not so much specifically about metronomes. Seems like those are more important than you first thought and if anything, they’re getting even more important. Why don’t the monitor/defibrillators have metronomes adjustable from 100 per minute? Should we ignore those? And, what metronomes should we be buying?”
First, you’re right. Metronomes are far more important than I first thought. In fact, credit goes to paramedics in our system who pushed the concept. I’ll claim to be smart — smart enough to listen to what proved to be their great idea.
Those early metronomes came about because not all the responding companies (fire-based) had manual monitor/defibrillators and not all of our monitor/defibrillators had built-in metronomes at the time. And, for my manufacturing colleagues reading this article, I’ll admit some frustration at the lack of their built-in metronomes being changeable in rate. But, I’ll also admit that I understand the frustration that these manufacturers have themselves because they can’t put a “dial the rate up or down” knob or touchscreen on their devices without a time-intensive and costly journey through the Food and Drug Administration review and approval process.
Should you ignore those metronomes that come with the cardiac monitor/defibrillators? Not if your local medical oversight physician(s) want you to use them. If they do, please use them per your system-specific treatment guidelines.
In our system, we’ve purchased musical metronomes that do allow for rate changes. This made it possible to start at 120 beeps per minute, change to our current 110 beeps per minute, and still allow for future changes. I’m pretty sure these music industry companies have no idea what paramedics are doing ordering dozens of metronomes. They probably think we’ve got some great garage bands in urban Oklahoma!
Many options exist in the marketplace. I recommend you try to find something that’s easy to activate and see or hear, with the durability of the proverbial EMS steel ball, something that allows for rate changes (but doesn’t allow crews to change it to undesired rates or allow unintended changes in rates), and something sized to promote ready accessibility.
There are a lot of smartphone apps with audible and visual metronomes that are adjustable as well. We considered use of smartphone apps, but didn’t want to ask our EMS professionals to use their personally owned devices in the provision of resuscitation.
Many of the agencies in our EMS system have found great ways to physically attach metronomes to the outside of their AEDs or manual monitor/defibrillators so initial arrival EMTs and paramedics don’t have to go fishing in a pocket or compartment to find it in the early and chaotic first minutes of resuscitation. Easy access always promotes consistency in early use.
“So, Dr. G.: What kind of improvement have you seen in resuscitation practices in the EMS System for Metropolitan Oklahoma City and Tulsa since your crews started using these metronomes during cardiac arrest resuscitations?”
We made an assumption when the pit crew protocol was finalized and initially implemented, that the medics were providing 120 compressions per minute per our protocol. All of the involved agencies had metronomes at that time and there was nothing to lead us to believe this rate was in question.
When we participated in a cardiac arrest resuscitation analytics annotation pilot project sponsored by one of our industry partners in February and March of 2014, we found that the compression rates on some cases were alarmingly high while others were at or near 120. So we added a field to the data we collect and the CPR rates have been continuously tracked since that time.
One of the things we found early on was that some of the smaller sized metronomes were not being used for various reasons. In some cases, it was simply because the crews forgot to use them, though in others it was because the Velcro that had been used to attach them to the monitors had become worn and the metronomes either fell off and were lost, or they were simply placed in the monitor case where EMTs and paramedics didn’t know they were relocated. Like they say, out of sight can equal out of mind!
We also learned that environmental noise can cover the sound of the metronome, so, whatever metronome you use, it has to be capable of being heard and/or seen. The metronomes built into the cardiac monitor/defibrillators do seem to solve that problem, but I want to caution that I personally don’t think 100 compressions per minute for all cardiac arrest patients, in all resuscitation practices is the optimal rate as we know it today.
In all of the cases in our specific system when the metronome wasn’t used, the compression rate was certainly faster than the 120/min we desired. Interestingly, when the ambulance would go en route to the hospital, rates often jumped almost immediately from around 120 to 130 and above.
After we mounted a concerted effort to have the providers utilize the metronomes and began revealing the patterns in compression rates at our monthly CQI meetings and additionally in emails to the education departments in our system agencies, we found almost immediate elimination of extreme compression rate deviations (e.g., greater than 160/min).
Our typical rate is now 123/min. Keep in mind we’re still rolling out the change to 110/min. This is down from 129/min. It doesn’t sound like much, but there are nearly 100 workable arrests every month in our system and that’s a great achievement by our fire and EMS crews in focusing on hitting that compression “sweet spot” of compressions per minute. We believe it has strongly contributed in increasing our successful resuscitations.
“Thanks, Dr. G. Do you have any parting thoughts?”
It’s an exciting time in EMS resuscitation. It takes work on everyone’s part to keep pace with the findings we’re putting into practice. Thanks for your commitment to excellence in out-of-hospital EMS medicine by reading this article. Together we’re finding better answers to challenges like cardiac arrest, answers that truly make a life or death difference to people we serve, and when they need those answers most. Keep reading and asking questions because scientific discoveries are happening in EMS medicine now more than ever.
References
1. Field JM, Hazinski MF, Sayre MR, et al. Part 1: Executive summary: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2010;122(suppl 3):S640–S656.
2. Field RA, Soar J, Davies RP, et al. The impact of chest compression rates on quality of chest compressions: A manikin study. Resuscitation. 2012;83(3):360–364.
3. Jäntti H, Silfvast T, Turpeinen A, et al. Influence of chest compression rate guidance on the quality of cardiopulmonary resuscitation performed on manikins. Resuscitation. 2009;80(4):453–457.
4. Idris AH, Guffey D, Aufderheide TP, et al. The relationship between chest compression rates and outcomes from cardiac arrest. Circulation. 2012; 125(24):3004–3012.
5. Aufderheide TP, Nichol G, Rea TD, et al. A trial of an impedance threshold device in out-of-hospital cardiac arrest. N Engl J Med. 2011;365(9):798–806.
6. Aufderheide TP, Frascone RJ, Wayne MA, et al. Standard cardiopulmonary resuscitation versus active compression-decompression cardiopulmonary resuscitation with augmentation of negative intrathoracic pressure for out-of-hospital cardiac arrest: A randomized trial. Lancet. 2011;377(9762):271–352.
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When taking a CPR course, many instructors are quite skilled at delivering their curriculum to students. Everyone can expect to learn the basics and obtain what they need to know in order to be certified at performing CPR should an emergency situation arise. Yet the curriculum isn’t the entire story. Like other healthcare related fields, CPR students should consider supporting their coursework with added resources and tools that may help them gain a broader understanding and appreciation for CPR and their place in the field. The following tools can be enriching resources for anyone learning CPR or getting recertified.
Many hospitals, especially large ones, have medical libraries. These libraries are excellent facilities that often contain the latest medical journals in various fields along with computers, research databases, and a wide array of research materials. Moreover, they may even contain mixed media materials like videos that can help people in the healthcare field study or perform research on a given topic like CPR. Medical libraries also employ librarians that may provide knowledgeable assistance about their resource materials and can help point out items that may be useful for anyone training in CPR.
Digital Resources
Many people taking CPR training classes find that apps can be especially useful. The American Heart Association has developed an app called Pocket First Aid & CPR. The app provides concise and clear information as well as step-by-step instructions. For use with both iPhones and Android smartphones, the app and others like it are essential for trainees. Moreover, even people who have completed their CPR training will find this app can bolster all that they have learned which can be especially helpful as people are likely to forget important details of training when they have not used them on a regular basis. A simple Google search will reveal many other important apps that can assist trainees involved with CPR or BLS (Basic Life Support).
Internet Blogs
Many certified CPR instructors post regular blogs as do many other instructors in related fields. Reading blogs is a great way to stay tuned to the latest news stories associated with CPR or BLS and to connect with other certified CPR instructors or trainees. Blogs contain all sorts of useful information–even anecdotes that may impart some important advise that didn’t come up in class. Often CPR blogs will focus on life-saving events where CPR was used to help someone in an emergency situation. See if your CPR training professional has a blog or, perhaps, you may even follow several that can provide you with a multitude of CPR-related posts.
CPR is some of the most important training you can do. Yet one never knows when it may be needed. Therefore, it’s vital to stay up on the topic and to review various aspects of the training. Resources like apps and blogs can certainly help. If you are currently enrolled in CPR training, don’t forget to check the medical library for added support materials that can enhance your coursework.
]]>When most people sign up for CPR training, they may have the idea that their newly acquired skills will be helpful to mankind, possibly even someone among their acquaintance at the grocery store, in the office, or even at home. Yet there have been cases where CPR skills and know-how have saved the life of an animal such as a family pet. Though CPR is usually regarded as a renowned set of procedures that can save a human life, it can actually be used to save the lives of some animals too.
Humans to the Rescue
This past spring the Huffington Post reported on animal CPR and shed light on some astounding instances where CPR was used to save animals. For instance, an Australian woman happened to notice that a pigeon wasn’t breathing. She knelt down, gave it three or four breaths, and pumped its chest; the bird revived and again showed signs of life. Instead of a human in a park, it was a pigeon near a lane and the instance showed how CPR can work wonders on other forms of life too. The report also mentioned that CPR has been employed to save other animals, too, such as a cheetah cub, tapir, hamster, bald eagle, lemur, panda bear, tiger, and many more. (huffingtonpost.com/2013/03/03/animal-cpr-tapir-cheetah_n_2734549.html)
What about Fangs? What about Claws?
It might be worth noting that the cheetah and tiger listed above were young; few certified CPR experts would have the nerve to give a full-grown tiger mouth-to-mouth no matter how out of commission it might seem. That said, coming into such close proximity with a wild animal is a risk. These were unusual instances where individuals assessed their personal risk very quickly and made the decision to help. In essence, these were personal choices. The eagle, mentioned above, was given mouth-to-mouth resuscitation by an Oregon veterinarian who had, of course, considerable experience providing care for animals. The eagle had been hit by a car and the subsequent CPR saved its life.
CPR Tips for Animals
One might thing that bird or cheetah–what’s the difference? Doesn’t a one-size CPR fit all? The fact is that there are some nuances as well as some precautions involved with animal CPR. For one, experts recommend that CPR should not be attempted unless the animal has no pulse and isn’t breathing. First, it’s vital to see if the animal has choked on an object. In the case of the tiger cub, it was choking on some meat it was eating at a zoo. Also, the mouth-to-mouth technique actually works better, according to the news report, if the human delivers life-saving breaths via the nose. For more information about delivering CPR to animals, check with the American Red Cross that has a webpage about pet first aid (redcross.org/prepare/disaster/pet-safety).
While it’s common knowledge among veterinarians and even their staff members that CPR saves pets, it isn’t something most people think of when they sign up for CPR training. On the other hand, since many people have beloved pets, it might be helpful to know how one performs CPR on the family dog or cat. Discuss your questions about specific pets with yourinstructor.
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