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Whos On FirstEMS Team ResuscitationJay Gardiner, MBA,EMT-CCAssociate Professor of Emergency Medical CareSuffolk Community CollegeRegional Faculty American Heart Association
Presenter Disclosure Information Jay L. Gardiner Pre-Hospital Resuscitation for the 21st CenturyFINANCIAL DISCLOSURE: No relevant financial relationship exists No Unlabeled/Unapproved Uses in Presentation
Teamwork - If it was only this easy!!
Or Is it More Like This?
TeamworkSince 2005 the AHA has stressed the importance of teamwork in ACLS and resuscitation.The benefits are obviousSynergy between participantsDelineation of tasks and assignments, and coordination of responsibilitiesMinimizes variability in treatment approachBuilds on individual core competenciesFire Service Standard Operating Procedure
Mass Casualty Incidents
What do all these events have in common?NASCAR Races
Fire Fighting
Mass Casualty Incidents
Resuscitations
STRESS !!Two Simple Goals:
1. Minimize Stress 2. Maximize Potential for Successful Outcome
One Simple Strategy:
Reduce the negative effects of Variables!
Austin County, TX EMS Model - courtesy of Paul Hinchey,MD How do you design your model?Best Case or Worst Case Scenario?What is your average crew size?What additional manpower can be anticipated?Equipment availabilitySelection of destination hospital
Our Model for Today:
Understand Why?
Adapt How?
Integrate When?
Critical PositionsCompressors Need at least two availableOne to start immediately upon recognition of cardiac arrest!Must switch every two minutes for effective CPR delivery (regardless of physical condition of rescuer!)Can also deliver electrical therapy (AED, manual)Cannot wildcat must stay on task Position# 1 COMPRESSORPATIENTS RIGHT SIDEAssess patient (all pulse checks)Initiate Compressions: 100/min, 2 inchesalternate with Position 2 every 2 minutesAssist when not compressingAirway and VentilationsAdvanced airway preparationStart IV access and administer meds (3-person crew)
Position # 2 COMPRESSOR/ELECTRICALPATIENTS LEFT SIDEOperates AED/ALS MonitorAlternates compressions with Position 1Monitor ECG for rhythm changesResponsible for delivery of electrical therapyDefibrillationCardioversionPacing
Critical PositionsAirwayOne person needed, ideally person with most airway experienceBVM first, if chest rise, then everything else can waitremember ET may require hands-off time!Extra-glottic airway may be preferred to ET during resuscitation phase due to ease of insertion and minimization of hands-off time. Airway provider should not run the code. If the airway or chest rise is not adequate..team leader makes the decisions.POSITION # 3 AIRWAYBEHIND PATIENTS HEADInitial Assessment of Airway PatencyOpening of Airway with adjuncts (OPA/NPA)Ventilation of PatientAdvanced Airway Placement (EGD,ET)ITD and Capnography set-upContinuous Monitoring of ETCO2 to guide perfusion and airway position
Critical PositionsIV Access MedicationsProvider should have experience in accessing multiple iv sites and I/O insertionShould be familiar with resuscitation drugs, dosages, and how to draw them upShould be able to stay one-step aheadCan serve as recorder in between drug orders
POSITION #4 IV/IO MEDICATIONS PATIENTS RIGHT LEGPrepare access during first round of compressions Gain access after 1stshock or confirmation of non-shockable rhythmIV (Right arm) or I/O (Right Tibia or Humerus)Prepare at least two rounds of drugs If possible, serve as recorder
Who Runs the Code?
Code Team LeaderIdeally, position # 5 watching, learning, and directing patient care. Alternatively, Positions 4,2,and 1 could handle (3 and 4 person teams)Not a nice to do, but a need to do.Should be knowledgeable in all aspects of resuscitation.Should have good working grasp of protocols/guidelinesGood communicator, strong, but steady.
POSITION# 4 CODE TEAM LEADERAT FOOT OF PATIENT ON RIGHT SIDEAssess and plan treatment of patientUse entire team for constructive feedbackStrong and steadyMonitor VS, ECG, ETCO2 and SPO2Plan for transport and destinationServe as recorderTLPOSITION # 6 FLOATAVOID LOCATIONS OF ACTIVE PROVIDERS FL
Observe all positions, and be ready to assist as needed
Act as recorder and/or supply person
Do not assume any task unless directed by the Code Leader
Hey, What About Me?What About The Ambulance?
Most resuscitations evolve through the transport
Consistency of design is talked about, but variability exists
Stretcher Placement
Monitor Placement
Drug-IV Supplies Access
Airway /Advanced Airway Tool Access
BCLS/ACLSThe Foundation for all ProvidersIntegration into Mega Code and simulations.
Removes stress on original studentsPromotes concentration on task at hand
Reinforces team concept
How can we get this done?
Learn it!Practice it!Teach it!Believe in it
30Thanks to:
Ed Stapleton EMT-PPaul Hinchey, MDMark Henry, MDMy ACLS StudentsMoe, Larry, and Curly
Write me with your ideas, questions!
[email protected] all want to make a difference!!!!Thank you for being here!!