A recent study that tested a method for improving EMTs’ performance of cardiopulmonary resuscitation (CPR) has important lessons for how trained responders in the workplace can be taught to perform it better, said Dr. Bentley J. Bobrow, M.D., FACEP, medical director for the Arizona Department of Health Services’ Bureau of EMS and Trauma System. He is the study’s lead author.
“We’re learning more and more just how important CPR quality is. To not just do CPR, but to do CPR well, and what exactly does that mean,” Bobrow said. “There is mounting evidence that there is an enormous difference between outcomes for cardiac arrest victims when they have good-quality CPR and bad-quality CPR. It’s also really challenging to do high-quality CPR, we think especially without the assistance of some technology that can help people do high-quality CPR.”
CPR is a complex series of motor skills that is challenging even for those who are expert at it, let alone for someone who takes courses every few years and never has the opportunity to practice and receive feedback, he said.
The study, published online recently by Annals of Emergency Medicine, involved scenario-based resuscitation training and a “pit crew” model, with specified roles for those on the responder team, utilized by the Mesa Fire and Medical Department in Mesa, Ariz. The EMTs used AEDs that provided real-time audio and visual feedback on their performance, and they participated in debriefing sessions. Bobrow described these as “a very teachable moment” when those who have performed CPR are motivated to improve their performance the next time. The Mesa EMTs received one-page, graphical depictions of how well they had done it.
The combination was stunningly successful, Bobrow and his colleagues found. “We more than doubled survival, and this is remarkable, especially because the survival rate in this city was already significantly higher than the national average. And their survival rate in the post period, after they implemented, was 56 percent. More than one out of two people who had a sudden cardiac arrest, and their heart was in ventricular fibrillation when the EMS providers got there, more than one out of two of those patients survived and went home with their families.”
Another important element is training dispatchers to do what he called "just-in-time training." They're trained to question callers accurately to determine whether someone is in cardiac arrest and to engage callers to get them to perform CPR.
"I personally think that CPR quality needs improvement everywhere. I've seen enough real-life CPR to know it's really, really difficult to do. I'm not saying everyone will achieve these results; some might achieve better results. But I think that we can dramatically improve our CPR quality, and that will lead to a significant improvement in survival," Bobrow said. "Across the country, if we did this, we would likely have thousands -- if not tens of thousands -- of survivors a year from cardiac arrest if we implemented this type of CPR quality improvement program everywhere. It's very doable."
Just doubling the current national rate of sudden cardiac arrest survival, which is only about 8 percent, could save 50,000 people per year, he said.
To read the study, "The Influence of Scenario-Based Training and Real-Time Audiovisual Feedback on Pre-hospital Cardiopulmonary Resuscitation Quality and Survival from Out-of-Hospital Cardiac Arrest," visit http://tinyurl.com/a6455n6.
SOURCE: Occupational Health and Safety