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Conclusion: The leg-heel cardiocerebral resuscitation can save time. The precious timeand brain cells would be saved if hands were free at the start of resuscitation in the eraof mobile telephones. After a call hands-heels compression–ventilation ratio of 30:2 isrecommended in an agreement with ILCOR guidelines 2005.

doi:10.1016/j.resuscitation.2010.09.386

94 Abstracts / Resuscita

P238

mproving care for in-hospital cardiac arrest patients—The rock study

redman D. 1, Svensson L. 2, Hollenberg J. 1, Ringh M. 1, Rosenqvist M. 1

Karolinska Institutet, Department of Cardiology, Södersjukhuset, Stockholm, SwedenKarolinska Institutet, Department of Clinical Science and Education, Section of Prehospitalentre, Södersjukhuset, Stockholm, Sweden

Background: Cardiac arrest (CA) is a race against time. Every minute counts.In 2004 the average time to defibrillation at our hospital was 4.50 min.Aim of the study: Evaluate how introduction of AEDs can shorten time from CA to

efibrillation preparedness.Material and methods: 48 units were randomized and included in either intervention

r standard care group. Intervention group units were equipped with AED’s and the staffsere trained to use them. In this group CPR + AED training took place four times a year.nits in the standard care group trained CPR once a year.

Units in both groups continued to call for the mobile emergency treatment (MET)eam when CA were suspected but the intervention group now had AED’s available onite to aid their patients.

Patients with suspected cardiac arrest where staff performed CPR and an AED wassed either by the MET or by the unit’s staff are included in the material. Data has beenathered from patient records, AED’s and the Swedish national registry for in-hospitalardiac arrest.

Results: 126 CA are included in the study. Intervention group; 79 and standard care;7. Data shows that intervention group AED’s were in use before arrival of the MET in 83%f the cases.

42 cases were analyzed to see the time frame from start-up of the AED until METeam arrival.

The AED’s were prepared to be used 99 s before arrival of the MET team (mean) (range4–423 s).

Conclusion: If AED’s are made accessible at hospitals, in wards or out-patient clinics,hey are often used before the arrival of the MET team. A concept where the first in line toespond to a cardiac arrest has opportunity and competence to use an AED is most likelyo increase survival for the in-hospital cardiac arrest patient.

oi:10.1016/j.resuscitation.2010.09.383

P239

evelopment, reliability, and content validation of the observational skill-based Clin-cal Assessment tool for Resuscitation (OSCAR)

alker S. 1, Lambden S. 2, McKay A. 3, Gautama S. 4, Vincent C. 1, Sevdalis N. 1

Centre for Patient Safety and Service Quality, Imperial College, London, UKDepartment of Anaesthetics, University College London Hospitals, London, UKDepartment of Outreach and Resuscitation, Imperial College, London, UKDepartment of Anaesthetics, Imperial College, London, UK

Objectives: Evidence shows that clinicians’ non-technical skills have a significantmpact on teamworking, patient safety, efficiency of care provided and patient outcomes.1

uch skills are key for Cardiac Arrest Teams (CATs), which are multi-professional (Anaes-hetists, Physicians and Nurses) and function under high pressure. To date, most tools tossess nontechnical skills in healthcare have focused on surgery2 and anaesthesia.3 Noalidated, robust tools are currently available for assessing non-technical skills in CATs.

Our aim was to develop and validate an Observational Skill-based Clinical Assessmentool for Resuscitation (OSCAR).

Methods: OSCAR was based on a well-validated tool for surgery (OTAS)4 and waseveloped in phases. Six behaviours were included: Communication, Cooperation, Coordi-ation, Monitoring, Leadership and Decision-making. Observable behavioural exemplarsere derived for each one of these behaviours across the three CAT subteams – Anaes-

hetists, Physicians and Nurses (Phase 1). Quantitative expert consensus methodology wasmployed to assess content and face validity and observability of the exemplars (Phase 2).wo clinician observers used OSCAR to blindly rate eight CATs performance in a series ofimulated cardiac arrests. Psychometric analyses of these ratings were used to determinebservable behaviour applicability, internal consistency, and inter-rater reliability (Phase).

Results: 15 of 18 of OSCAR behaviours demonstrated high internal consistency (Cron-ach’s ˛ = 0.736–0.970). Psychometric analyses dictated removal of three behaviouralxemplars (two in Anaesthetic group; one in Physician group) to significantly improventernal consistency. Inter-rater reliability was also high (inter-observer Pearson’s= 0.661–0.911, all p < 0.005). Inter-observer reliability analyses revealed a learning curveetween the two observers, with significant reduction in scoring discrepancies from therst to the eighth observed resuscitations.

Conclusions: OSCAR is a psychometrically robust (reliable, content- and face-valid)ool for the assessment of teamworking skills in cardiac arrest events. The tool is feasibleo use and can be employed for both training and assessment purposes.

eferences

1. Yule S, et al. Non-technical skills for surgeons in the operating room: a review of theliterature. Surgery 2006;139:140–9.

2. Sevdalis N, et al. Reliability of a revised NOTECHS scale for use in surgical teams. Am JSurg 2008;196:184–90.

3. Fletcher G, et al. Anaesthetists’ Non-Technical skills (ANTS): evaluation of a behaviouralmarker system. Br J Anaesth 2003;90:580–8.

1S (2010) S1–S114

4. Undre S, et al. Observational Teamwork Assessment for Surgery (OTAS): refinementand application in urological surgery. World J Surg 2007;31:1373–81.

doi:10.1016/j.resuscitation.2010.09.384

AP240

Blended learning in training basic life support

Te Pas E. 1, De Nijs M.J.M. 1, Landman-van der Boom E. 2, Stomilovic N. 2

1 Dept. of continuing education, Academic Medical Centre, Amsterdam, the Netherlands2 Resuscitation coördinators, Academic Medical Centre, Amsterdam, the Netherlands

Purpose: The main objective of this study was to design a Basic Life Support trainingprogram for health care workers that would decrease the face-to-face training time butwould not have influence on the quality of the training.

Materials and methods: The Academic Medical Center in Amsterdam has chosen for ablended learning approach; one part an e-learning module for the theoretical knowledgeand one part face-to-face training to practice the skills.

The advantages of e-learning were decisive for the choice of developing an e-learningmodule. The module contains background information such as anatomy, physiology andpath physiology. The complete procedure of adult-, children- and newborn BLS but alsothe automated external defibrillator, is explained, based on the ERC guidelines. Accordingto a good didactical approach we made de module highly interactive by using simulations,scenarios and multimedia. An assessment completes the module. The complete theorywill take approximately 3 h.

If the assessment is completed the learner can participate in the skills training. Theskills training is supervised by a certified instructor and will take 2 h.

Results: We started to test our e-learning module with a multidisciplinary pilot in2007 for 100 workers of 10 different care units. In 2008 we implemented the module inthe whole hospital and started with the skills training. In 2009 the number of participantswas 773 and by the end of April 2010 there were 1078 participants.

The time needed for the skills training is decreased by 50% and can be limited to twohours. The e-learning module gives the learners the possibility to study in their own placeand provides opportunities to follow their own learning style.

Conclusions: Blended learning provides sufficient skills to health workers to deliverbasic life support.

doi:10.1016/j.resuscitation.2010.09.385

AP241

Start of cardiocerebral resuscitation by leg-heel method in the era of mobilephones—A manikin study

Gimunova O.

Department of Anaesthesiology and Intensive Care, Teaching Hospital Brno Bohunice, MasarykUniversity, Czech Republic

Purpose of the study: The aim of this study is to prove the efficacy of leg-heel com-pressions at the start of primary cardiac arrest from a new technical and ethical point ofview.

ILCOR guidelines 2005 allow to use alternative compression techniques such as oneleg-heel chest compressions during resuscitation of adults. This method is sometimesused when rescuers feel exhausted after hands-heels compressions. There is a lack ofnew studies with leg-heel compressions.

Materials and methods: Leg-heel compressions are allowed already at the start ofresuscitation. This may allow one standing rescuer to use his/her mobile telephone andcall for help without interrupting chest compressions. It is necessary to compress themiddle of sternum by at least 4–5 cm.

30 volunteers – mainly students were able to provide sufficient leg-heel chest com-pressions on manikin AMB-R10054 connected with biphasic AED/ZL-AED-001-Cz-C witha measurement of each compression intensity. They were able to use their mobile tele-phones at the same time.

Results: This idea is applicable and has some merit. Leaning of a rescuer and ethicaltroubles with one leg-heel compressions can be a problem.

Survival results of out-of-hospital cardiac arrests are not good. The leg-heel methodcan be suggested as a reasonable alternative to compressions by hands-heels.