Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Reducing Interruptions – How To Send The Wrong Message

The less time off the chest, the better the results for the victim of out-of-hospital cardiac arrest. Educating EMS providers in performing high-quality CPR possible is crucial. (Photo Ryche Guerrero)[1]

JEMS has a good article, and it is on an important topic, but whoever decided to use the picture (above) that accompanies the article needs to cut back on the use of the crack pipe, just a little bit, or maybe just cut back while at work.

The article is about the importance of quality in the performance of chest compressions, but the picture seems to have been staged to demonstrate as many errors as possible. Maybe this is not at all representative of what this crew normally does, but somebody should have looked at it, giggled let out a heavy sigh of despair, and looked for something that does not contradict the message of the article.

Is this a trauma code? The immobilization may be a part of the movement by some in EMS to have us put collars on intubated patients, rather than have us pay attention to the way we move patients. If the goal is to just prevent the tube from being dislodged, we should not tape the head down as, well. The collar does not make a dislodged tube impossible, so if the tube is dislodged, now (depending on the amount and type of tape used) we might wish we hadn’t applied tape.

So I will assume that this is a trauma code, which raises the question – What century are we in? Why are we doing compressions on a trauma code? Why are we transporting a trauma code?

We have four people and a dead body. Each is in his/her own little world, doing his/her own little thing.

Someone behind the door is bagging the patient through the endotracheal tube, because this is about how much more important compressions are than ventilations.

Monitor Guy is doing something monitorish, because otherwise there might not be anything to do – except relieve the guy attempting compressions.

Headset Guy appears to be pushing drugs, because drugs have not been shown to improve outcomes in cardiac arrest.

Headset? Why do we have headsets? Well, it appears that the fashionable attire of Monitor Guy and Headset Guy includes some dandy little flight patches. So, not only does this appear to be an inappropriate transport of a dead guy, but it appears to be an inappropriate flight of a dead guy. On the plus side, the flight is not for mechanism only. Lemonade anyone?

Maybe the flight crew was called for the patient while the patient was still alive and they are only assisting the ambulance crew to the ambulance with the patient. Nobody flies dead people, at least not in this century. Right? Or should this flight service be known as Corpse Flight – nobody is too dead for low altitude at high prices!

One guy left. The guy who is actually doing compressions. Maybe I shouldn’t use the words actually, or doing, since at the angle demonstrated, Arnold Schwarzenegger would have trouble generating effective compressions.

But we don’t have a better way of performing compressions while loading the patient in the ambulance, for the ride to the landing zone, for the flight to the helipad, for the elevator ride(s) (or is it another ambulance ride) to the ED, where someone may feel the need to continue the code for a little while, just to avoid hurting the feelings of everyone who has worked so hard to get him here.

This is resuscitation theater, not medicine.

This is not about the patient, but about putting on a show – and in this case it does not even appear to be a good show.

Why are we endangering all of these people, just to put on a show? Ground crews deserve better. Flight crews deserve better.

Compressions are important. Interruptions in compressions lead to worse outcomes.

it’s clear that educating EMS providers in performing the best quality CPR possible and monitoring those efforts to ensure that these skills are not deteriorating over time is also a crucial component that EMS systems need to direct time and resources to in order to increase OOHCA saves.[1]

I think this is a picture of an interruption of compressions.

This is not CPR.

Is this anything other than just going through the motions?

Educating EMS providers in performing high-quality CPR possible is crucial.[1]

And it should be continuous.

Footnotes:

^ 1 Reducing Interruptions – Continuous chest compression CPR and minimally interrupted CPR result in improved survival
By David P. Keseg, MD, FACEP
2010 Jan 1
JEMS.com
Article

Updated Article Link 7-15-10

The article was also selected by JEMS as one of its Best of JEMS series, where they chose what they believe to be their best article of the year. This is their choice for 2010 – as of the Ides of March, 2010. Late addition – 7-15-10 19:48

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  1. […] Heightman and I may disagree on many things, but I do not doubt his integrity. I wrote Reducing Interruptions – How To Send The Wrong Message back in January. This was also about a photograph providing the wrong initial impression. A.J. […]

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