Transcript Who`s On First? EMS Team Resuscitation

“Who’s On First”
EMS Team Resuscitation
Jay Gardiner, MBA,EMT-CC
Associate Professor of Emergency Medical Care
Suffolk Community College
Regional Faculty – American Heart Association
Presenter Disclosure Information
• Jay L. Gardiner
• Pre-Hospital Resuscitation for the 21st
Century
• FINANCIAL 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?
Teamwork
• Since 2005 the AHA has stressed the
importance of teamwork in ACLS and
resuscitation.
• The benefits are obvious
– Synergy between participants
– Delineation of tasks and assignments, and
coordination of responsibilities
– Minimizes variability in treatment approach
– Builds on individual core competencies
Fire Service Standard Operating
Procedure
Mass Casualty Incidents
What do all these events have in common?
NASCAR Races
Fire Fighting
Mass Casualty
Incidents
Resuscitations
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 availability
• Selection of destination hospital
Position # 1
COMPRESSOR
PATIENT’S RIGHT SIDE
Position #2
COMPRESSOR/ELECTRICAL
PATIENT’S LEFT SIDE
ü
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Assess patient (all pulse checks)
Initiate Compressions
o 100/minute, 2 inches
o Alternate with Position 2 every 2
minutes
ü Assist, when not compressing:
o Airway and Ventilations
o Advanced airway preparation
ü Start IV access and administer meds
(3-Person Crew)
ü
ü
Position #3
Operates AED/ALS Monitor
Alternates compressions with Position 1
Monitor ECG for Rhythm Changes
Delivery of electrical Therapy:
o Defibrillation
o Cardioversion
o Pacing
Position # 4
AIRWAY
BEHIND PATIENT’S HEAD
IV/IO MEDICATIONS
PATIENT’S RIGHT LEG
Initial Assessment of Airway Patency
Opening of Airway with adjuncts
(OPA/NPA)
ü Ventilation of Patient
ü Advanced Airway Placement (EGD,ET)
ü ITD and Capnography set-up
ü Continuous Monitoring of ETCO2 to guide
perfusion and airway position
ü
ü
ü
ü
ü
ü
ü
Prepare access during first round of
compressions
Gain vascular access after 1st shock or
confirmation of non-shockable rhythm
IV (Right arm) or I/O (Right Tibia or
Humerus)
Prepare at least two rounds of drugs
If possible, serve as recorder
Position #5
CODE TEAM LEADER
AT FOOT OF PATIENT
ON RIGHT SIDE
ü Assess and plan
ü Use entire team
treatment of patient
for constructive
feedback
ü Strong and steady
ü Monitor VS, ECG, ETCO2 and SPO2
ü Plan for transport and destination
ü Serve as recorder.
Our Model for
Today:
Position # 6
FLOAT
AVOID LOCATIONS OF
ACTIVE PROVIDERS
ü
ü
ü
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
o Understand –Why?
o Adapt – How?
o Integrate – When?
Critical Positions
• Compressors
– Need at least two available
– One 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 – COMPRESSOR
PATIENTS RIGHT SIDE
 Assess patient (all pulse checks)
 Initiate Compressions:
 100/min, 2 inches
o alternate with Position 2 every 2 minutes
 Assist when not compressing
Airway and Ventilations
Advanced airway preparation
 Start IV access and administer meds (3-person
crew)
POSITION # 2
COMPRESSOR/ELECTRICAL
PATIENTS LEFT SIDE
 Operates AED/ALS Monitor
 Alternates compressions with Position 1
 Monitor ECG for rhythm changes
 Responsible for delivery of electrical therapy
o Defibrillation
o Cardioversion
o Pacing
Critical Positions
• Airway
– One person needed, ideally person with most airway
experience
– BVM first, if chest rise, then everything else can
wait…remember 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 – AIRWAY
BEHIND PATIENTS HEAD
 Initial Assessment of Airway Patency
 Opening of Airway with adjuncts (OPA/NPA)
 Ventilation of Patient
 Advanced Airway Placement (EGD,ET)
 ITD and Capnography set-up
 Continuous Monitoring of ETCO2 to guide
perfusion and airway position
Critical Positions
• IV Access – Medications
– Provider should have experience in accessing
multiple iv sites and I/O insertion
– Should be familiar with resuscitation drugs,
dosages, and how to draw them up
– Should be able to stay one-step ahead
– Can serve as recorder in between drug orders
POSITION #4
IV/IO MEDICATIONS
PATIENTS RIGHT LEG
Prepare access during first round of
compressions
Gain access after 1st shock or
confirmation of non-shockable rhythm
IV (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 Leader
• Ideally, 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/guidelines
• Good communicator, strong, but steady.
POSITION# 4 – CODE TEAM LEADER
AT FOOT OF PATIENT ON RIGHT SIDE



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Assess and plan treatment of patient
Use entire team for constructive feedback
Strong and steady
Monitor VS, ECG, ETCO2 and SPO2
Plan for transport and destination
Serve as recorder
POSITION # 6
FLOAT
AVOID LOCATIONS OF ACTIVE
PROVIDERS
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
FL
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/ACLS
The Foundation for all Providers
Integration into “Mega –Code” and simulations.

Removes stress on original students
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Promotes concentration on task at hand
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Reinforces team concept
How can we get this
done?
1.
2.
3.
4.
Learn it!
Practice it!
Teach it!
Believe in it
Thanks to:
Ed Stapleton EMT-P
Paul Hinchey, MD
Mark Henry, MD
My ACLS Students
Moe, Larry, and Curly
Write me with your ideas,
questions!
[email protected]
We all want to make a difference!!!!
Thank you for being here!!