PowerPoint Presentation

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!

gardinj@sunysuffolk.eduWe all want to make a difference!!!!Thank you for being here!!