Missing the "High" in High Performance CPR?

Missing the “High” in High Performance CPR?

Alan Perry

July 30, 2017

High Performance CPR is a generic term associated with various methods now used in the setting of cardiac arrest aimed at improving the survival rate and long-term outcomes of victims beyond outcomes obtained by standard AHA/ACLS guidelines. It is achieved by improving the quality and consistency of CPR and maximizing the effect of efficacious actions taken during the process.

High performance does not occur by accident or by writing an SOP, It takes education, practice and teamwork. It is a complicated process in which every team player must understand the whole process, what their area of responsibility is and how to best perform each task. It also takes leadership and communication. A gap in any area will decrease performance and potentially have a negative effect on the patient’s outcome.

Education on any high performance variant of CPR will likely require your agency to develop its own system with the approval and participation of your OMD(s). Since High Performance CPR is a skill every operational member of your organization must have for the system to work. Initial and on-going training programs should be put into place that convey the necessary knowledge, skills and abilities.

Because it is a team-based function it will also require regular practice and competency/skill verification. In most systems, providers will not always be working with the same crew members. Practical exercises across shifts/stations/battalions, with members functioning in all roles they might normally fill, will produce greater consistency of performance across the organization.

Teamwork can be difficult to achieve when you are not always working with the same members. This is where training to a standard and having all members of the team knowing the whole process pays off. There can be little variation across shifts/stations/battalions if you want everyone to work collaboratively in this fast-paced and stressful situation.

Leadership is important but not as much dependent on rank as where you find yourself. What is important is that the person taking the lead be competent and communicate effectively with other team members. This is no place to fuss over who’s going to lead, make the call and fall into line. If this falls apart the whole process can implode into utter confusion.

Communication is probably the most important skill. It requires both effective delivery of messages as well as good listening. A closed-loop communication model is best so that critical procedures and information can be tracked accurately by both the sender and receiver. This type of communication also helps keep the whole team aware of where they are in the resuscitation process.

It has been proven that effective CPR delivered early in a witnessed arrest and preceding defibrillation of VF produces the greatest possible benefit for the patient. It has also been proven that minimizing gaps in CPR created by analyzing rhythms, charging defibrillators and switching compressors improves outcomes. This is an excellent place to hone the communication and teamwork.

It should go something like this:

Scribe/Timekeeper:        Approaching 2 minutes CPR

ALS team leader:            Prepare for rhythm check and compressor switch.

                                      (Charge defibrillator)

                                      Switch compressors, clear the patient.

                                      (Examines rhythm, shocks if VF/VT) 2 seconds max.

                                      Resume compressions.

Scribe/Timekeeper:        Records actions/defibrillation/rhythm.

                                      Restarts CPR clock.

Looks simple right? Try this with a crew you have not worked with before, or with providers who have not practiced or don’t remember the process. It won’t be so simple.

Enjoy,

Alan

Resources:

http://www.resuscitationacademy.org/downloads/HPCPRToolkit110309.pdf

http://www.aedchallenge.com/articles/highperformancecpr.php

http://www.ems12lead.com/2016/06/14/high-performance-cpr-performance-not-protocol/

Healthcare in America

Healthcare in America

June 26, 2017

Alan E. Perry

Life, Liberty and the pursuit of happiness, as well as several other “civil rights” are afforded by our constitution. Nowhere does it say we will all have healthcare, or for that matter pick-up trucks, big bank accounts, or a reasonable IQ.

Our lives are shaped by our circumstances and how we react and adapt to move ourselves where we want to be. Each person selects their own priorities and accepts the risk and rewards of those decisions. Some plan, make good decisions, accept responsibility and do better. Some are short sighted, irrational and blame others for their misfortune. Granted some get handed circumstances that are inherently more difficult to manage than others purely because of chance, but this is the exception.

Individual health is affected largely by personal choice. There are exceptions to this, but again this is the exception not the norm and not the subject of this discussion. That being said; there are actions individuals can take to manage certain known risk such as hypertension and diabetes. But back to the issue; individuals must accept the responsibility for their health buy treating their bodies with respect, exercising, staying physically active, eating properly, managing their known conditions and avoiding risk that are not necessary.

The assertion of the “universal healthcare” concept is that everyone has a right to exactly the same healthcare, and that those who cannot afford it will receive it at the expense of those who can. This is the definition of socialism; will it stop here? I think not. This “universal healthcare” idea provides no incentive for (in fact punishes) those who take care of themselves and make wise decisions about their body and provides reward for those who squander their own resources and health. As an example, take a 50-year-old male who has taken care of himself and has no medical problems; he used to be able to get health insurance (if he chose to get it at all) at a very reasonable rate based on his age and absence of risk factors. Another 50-year-old male, who has been reckless, excessive and generally abusive to his body and sedentary has multiple medical problems and disabled as a result. Do they both get treated fairly? The healthy one sees his insurance rates and deductibles go up and he is no longer able to save for his retirement. The unhealthy one gets free healthcare and a disability check.

In 1935 President Roosevelt and the Congress legislated the Social security act which created a financial safety net. In 1965 Medicare and Medicaid where added, Medicare provides financial assistance for healthcare to those 65 and over, Medicaid provides financial assistance for healthcare for low income families and individuals. These programs addressed the need for the elderly and the economically disadvantaged to have access to basic healthcare as a safety net, it never intended to put them on par with those who opted for more extravagant treatments and could afford them. Our government has programs to assist those who have trouble obtaining food, housing, medical care and education. It does not guarantee these. NGO’s have typically also assisted with these basic human needs, but again no guarantee.

By guaranteeing universal healthcare we are opening a very large can of parasitic worms and diminishing the value of personal accountability and self-determination. It will not take long before the authors of this malignancy begin demanding that everyone is entitled to a three-bedroom house with a garage, a new pick-up truck, free cable TV and an all-expense paid vacation semi-annually. Look closely, it’s already happening.

We live in a nation founded on the principals of personal responsibility, self-determination and respect and tolerance for those with differing views. It worked then, as it should now, because each person knew with certainty that if they worked and took responsibility for their actions they would have a much better chance of succeeding than those who choose to sit in the bars or street corners and refuse to contribute or better themselves. We raised our children to understand that if you did not become vested in your future and provide for your family there would be undesirable consequences.

As voters and taxpayers what are we to do when the numbers those receiving this ever-growing list of entitlements exceed the numbers of those paying for them. This Nation will collapse if this occurs, and it will be violent. We must find a way to get healthcare out of the corporation’s hands, out of the government’s hands, and back into the hands of the providers and the patient. We must also look at the broader problem that got us here in the first place and acknowledge that while we are all created equal, our decisions, actions and efforts will determine the amount of resources we will have as individuals and a Nation. as Thomas Jefferson put it " Free men are not equal".