CAA 2021 Webinar - High Performance CPR (An Insider's Story)

00:57:41
https://www.youtube.com/watch?v=lNuYMc71hmI

Ringkasan

TLDRThe CAA 2021 webinar focuses on 'High Performance CPR,' presented by Mike Helbach, emphasizing the need for effective CPR techniques to improve patient survival rates in cardiac arrest scenarios. Key topics include the integration of quality chest compressions, controlled ventilations, and coordinated team efforts. Helbach shares insights on building high-performance CPR teams through continuous education, performance measurement, and innovative training. He discusses essential metrics such as compression depth and rate, and strategies to eliminate unnecessary pauses during resuscitation efforts. The session highlights success stories from Seattle King County, showcasing significant survival rate improvements linked to adopting high performance CPR methods.

Takeaways

  • 🏥 **High Performance CPR Significantly Improves Outcomes**: Mastery of CPR techniques enhances survival rates for cardiac arrest patients.
  • 📊 **Importance of Metrics**: Measured performance metrics are essential for continuous improvement in CPR quality.
  • 🤝 **Team Coordination is Key**: Effective communication and defined roles during resuscitation contribute to success.
  • 🦸‍♂️ **Ownership of Skills**: Empower all responders, from BLS to ALS, to take ownership of their roles in CPR.
  • 🔄 **Minimize Pauses**: Unnecessary pauses during CPR can drastically affect patient survival—eliminate them!
  • 📅 **Regular Training**: Quarterly CPR training ensures skills remain sharp and effective in high-pressure situations.
  • 🎯 **Compression Fraction Matters**: Aim for a compression fraction of at least 90% during CPR.
  • 📚 **Use of Performance Tools**: Training with mannequins that provide analytics can greatly enhance learning.
  • 👮 **Involve All Stakeholders**: Training should also include police and dispatchers to enhance community response.
  • 🔍 **Feedback Loop**: Provide immediate feedback to responders to reinforce learning and skill improvement.

Garis waktu

  • 00:00:00 - 00:05:00

    The webinar series focuses on high performance CPR, presented by Mike Halbach and supported by Liedel, emphasizing the importance of quality CPR in improving patient outcomes.

  • 00:05:00 - 00:10:00

    David Waters introduces the webinar, stressing that high performance CPR is characterized by quality chest compressions, controlled ventilations, and effective team coordination during cardiac arrest resuscitation.

  • 00:10:00 - 00:15:00

    Mike Halbach shares his extensive experience in developing high performance CPR programs, emphasizing education and training for effective resuscitation of cardiac arrest victims.

  • 00:15:00 - 00:20:00

    Halbach encourages participants to engage with the Resuscitation Academy's resources, including a free e-book on resuscitation techniques.

  • 00:20:00 - 00:25:00

    He highlights the goal of fostering a culture where caregivers expect improvement in patient outcomes during cardiac arrests, particularly for ventricular fibrillation (VF) and pulseless ventricular tachycardia (PVT).

  • 00:25:00 - 00:30:00

    Halbach discusses the principles of high performance CPR, defining it as a choreographed, measured event that integrates advanced life support procedures for effective patient care.

  • 00:30:00 - 00:35:00

    Key survival strategies during cardiac arrest include early, high-quality chest compressions and minimizing interruptions, validated by various international guidelines.

  • 00:35:00 - 00:40:00

    He explains the concept of compression fraction, stressing the significance of minimizing pauses during CPR to maintain blood flow and improve survival rates.

  • 00:40:00 - 00:45:00

    Halbach introduces his 'DVD-R' metric system for CPR performance: Depth, Ventilation, Decompression, and Rate, emphasizing the need for rigorous training and measurement against benchmarks.

  • 00:45:00 - 00:50:00

    He shares successful experiences from Seattle King County CPR training, demonstrating improved survival rates through a cultural shift in emergency response techniques.

  • 00:50:00 - 00:57:41

    Halbach concludes with reminders on teamwork, continuous performance improvement, and the need for regular training to sustain high performance in CPR execution.

Tampilkan lebih banyak

Peta Pikiran

Video Tanya Jawab

  • What is High Performance CPR?

    High Performance CPR is a refined, choreographed, and measured CPR process focusing on high-quality chest compressions, effective ventilation, and excellent team coordination to enhance cardiac arrest survival rates.

  • How often should CPR training occur?

    It is recommended to have CPR training at least quarterly to maintain skill proficiency and ensure high performance during cardiac arrest scenarios.

  • What metrics are essential in evaluating CPR performance?

    Key metrics include compression depth, recoil, rate of compressions, ventilation volume, compression fraction, and analysis of pre-shock and post-shock pauses.

  • How can we eliminate pauses during CPR?

    Minimizing unnecessary pauses is crucial. Implement techniques such as 'hovering' during defibrillation and pre-charging monitors while compressions continue.

  • What training tools are recommended for CPR?

    Using training mannequins equipped with performance analytics, like Laerdal's QCPR, helps instructors measure and improve CPR techniques.

  • Should police and dispatchers participate in CPR training?

    Yes, involving police and dispatchers in CPR training enhances community response to cardiac arrests, especially through telephone-assisted CPR.

  • How do you ensure the success of CPR during patient transport?

    Ideally, resuscitations should occur at the scene until return of spontaneous circulation. If transport is necessary, use mechanical compression devices to maintain perfusion.

  • What is the importance of crew position during CPR?

    Pre-arranged crew positions allow for efficient CPR delivery and ensure that each team member knows their role during a resuscitation attempt.

  • What is the recommended compression fraction for CPR?

    Aiming for a compression fraction of 90% or above is ideal for high performance CPR.

  • How can we improve the culture around cardiac arrest management?

    Fostering a culture of measurement and improvement, along with continuous education and feedback, encourages better practices in CPR execution.

Lihat lebih banyak ringkasan video

Dapatkan akses instan ke ringkasan video YouTube gratis yang didukung oleh AI!
Teks
en
Gulir Otomatis:
  • 00:00:00
    welcome to the caa 2021 webinar series
  • 00:00:05
    today's webinar is high performance cpr
  • 00:00:07
    and insider's story presented by mike
  • 00:00:10
    halbach and proudly supported by liedel
  • 00:00:13
    thanks for joining us and we hope you
  • 00:00:14
    enjoy hi my name is david waters and i'm
  • 00:00:18
    the chief executive of the council of
  • 00:00:19
    ambulance authorities
  • 00:00:21
    welcome to the latest in our webinar
  • 00:00:24
    series
  • 00:00:25
    today's webinar is titled high
  • 00:00:27
    performance cpr an insider's story
  • 00:00:31
    evidence indicates that high quality cpr
  • 00:00:34
    compressions
  • 00:00:35
    combined with minimal interruptions has
  • 00:00:38
    a significant impact on patient outcomes
  • 00:00:41
    high performance cpr consists of mastery
  • 00:00:44
    level high quality chest compressions
  • 00:00:47
    measured performance matrix including
  • 00:00:49
    rate recoil and depth
  • 00:00:51
    controlled ventilations
  • 00:00:53
    and high compression fractions
  • 00:00:56
    equally important is the integration of
  • 00:00:58
    close coordination and communication
  • 00:01:01
    within the high performance cpr team
  • 00:01:04
    in this webinar we will hear from mike
  • 00:01:06
    helbach as he shares his high
  • 00:01:08
    performance cpr experience and insights
  • 00:01:11
    into how you can create educate and
  • 00:01:14
    train high performance cpr teams
  • 00:01:17
    in the resuscitation of cardiac arrest
  • 00:01:19
    victims
  • 00:01:20
    through the use of performance
  • 00:01:22
    measurement and feedback
  • 00:01:24
    mike's role
  • 00:01:25
    with the seattle king county
  • 00:01:27
    resuscitation academy is as a specialist
  • 00:01:30
    in the development and training of the
  • 00:01:32
    high performance
  • 00:01:34
    cpr program
  • 00:01:36
    mike worked for 25 years as a
  • 00:01:38
    firefighter and senior paramedic for the
  • 00:01:41
    city of bellevue fire department in
  • 00:01:43
    washington
  • 00:01:45
    until his promotion to divisional chief
  • 00:01:47
    of ems training and education
  • 00:01:50
    of the seattle king county ems
  • 00:01:52
    service mike completed paramedic
  • 00:01:55
    training at harbourview medical center
  • 00:01:58
    and university of washington
  • 00:02:00
    in the school of medicine
  • 00:02:02
    graduating with first in class honours
  • 00:02:04
    mike has served as the senior instructor
  • 00:02:07
    for the training and education division
  • 00:02:09
    division of the seattle county ems
  • 00:02:12
    service for more than 25 years
  • 00:02:15
    by way of his highly acclaimed training
  • 00:02:17
    style and diverse training experience he
  • 00:02:20
    has received speaking invitations from
  • 00:02:22
    many of the nation's largest ems
  • 00:02:25
    conferences
  • 00:02:26
    and ems agencies across the united
  • 00:02:28
    states
  • 00:02:29
    canada and abroad including europe and
  • 00:02:33
    here in australia and in new zealand
  • 00:02:35
    mike is one of a handful of nationally
  • 00:02:38
    recognized speakers and has delivered
  • 00:02:40
    the keynote address at numerous ems
  • 00:02:42
    conferences around the globe
  • 00:02:44
    as a national and international speaker
  • 00:02:47
    mike has shared his experiences in
  • 00:02:48
    pre-hospital medicine to more than 250
  • 00:02:52
    000 students over the past 30 years
  • 00:02:55
    mike helbrock shares many of his
  • 00:02:57
    training concepts with other instructors
  • 00:02:59
    across the country and also authors and
  • 00:03:01
    produces his entire curriculum
  • 00:03:04
    he continually evaluates his performance
  • 00:03:06
    as an educator
  • 00:03:08
    and develops new and innovative ways to
  • 00:03:10
    educate students in emergency medicine
  • 00:03:13
    and evaluates how the students apply
  • 00:03:14
    this knowledge
  • 00:03:16
    to field performance please join me in
  • 00:03:19
    welcoming mike helbach
  • 00:03:22
    welcome mike
  • 00:03:24
    hi everyone i'm mike kelbach from
  • 00:03:26
    seattle king county part of the
  • 00:03:27
    resuscitation academy i want to share a
  • 00:03:30
    story with you today called high
  • 00:03:31
    performance cpr an insider story or an
  • 00:03:34
    insider's look i'll share with you the
  • 00:03:36
    development of the program share with
  • 00:03:38
    you our successes and
  • 00:03:41
    help you better understand how you can
  • 00:03:43
    incorporate this program in your
  • 00:03:45
    community
  • 00:03:47
    so a little about me i've spent my
  • 00:03:48
    career in the fire service here in the
  • 00:03:50
    seattle king county system
  • 00:03:52
    after more than 20 plus years i retired
  • 00:03:55
    and moved on to a division chief's
  • 00:03:56
    position with seattle king county medic
  • 00:03:58
    one and i'm current faculty of the
  • 00:03:59
    resuscitation academy in seattle i try
  • 00:04:02
    to stay very busy with other programs
  • 00:04:04
    around the world and frankly everybody
  • 00:04:06
    is a real pleasure to be able to share
  • 00:04:08
    this program with you today
  • 00:04:10
    all right let's get into this i want you
  • 00:04:11
    to do something if you're with me if you
  • 00:04:13
    have a smartphone or a tablet with a
  • 00:04:16
    camera on it go ahead and roll that over
  • 00:04:18
    the qr code on the right side left side
  • 00:04:20
    your screen
  • 00:04:22
    and that'll take you to a website called
  • 00:04:23
    resuscitationacademy.org
  • 00:04:26
    in the resuscitation academy this is the
  • 00:04:28
    team of physicians and senior trainers
  • 00:04:30
    and paramedics
  • 00:04:32
    and dispatchers and police officers that
  • 00:04:33
    helped develop curriculum for ems
  • 00:04:36
    education and survival from cardiac
  • 00:04:39
    arrest
  • 00:04:40
    and on the right hand side is an e-book
  • 00:04:42
    that's within this uh website the
  • 00:04:45
    website itself is free all we ask that
  • 00:04:47
    is that you sign in so we can know who
  • 00:04:49
    you are and where you're from and that
  • 00:04:51
    everything behind that sign-in is free
  • 00:04:54
    this is an incredible ebook on the right
  • 00:04:56
    side of your screen called the art and
  • 00:04:57
    science of resuscitation and i really
  • 00:05:00
    encourage you to take a look at it
  • 00:05:01
    download it and see what it does to help
  • 00:05:03
    you
  • 00:05:04
    okay
  • 00:05:05
    my plan today is to try to encourage
  • 00:05:08
    to help you build a culture that where
  • 00:05:10
    everybody that are in
  • 00:05:12
    vf and pvt survive specifically those
  • 00:05:15
    two but of course all cardiac arrest but
  • 00:05:18
    specifically those two and why
  • 00:05:20
    because these two rhythms are absolutely
  • 00:05:23
    survivable rhythms and i want to
  • 00:05:25
    encourage this culture that when you go
  • 00:05:27
    on the next cardiac arrest that you
  • 00:05:28
    expect a change you expect the patient
  • 00:05:32
    to get better and it's uh i'll work
  • 00:05:34
    today to try to share that culture with
  • 00:05:36
    you and hope that i can inspire you to
  • 00:05:38
    do the same
  • 00:05:39
    so what's going to happen for the next
  • 00:05:41
    30 minutes
  • 00:05:42
    well quite frankly everyone i'm going to
  • 00:05:44
    take you on a journey and a journey is
  • 00:05:46
    going to be from where we know and what
  • 00:05:49
    we know works today what we know really
  • 00:05:52
    works for sure
  • 00:05:53
    i'll certainly then spend time on the
  • 00:05:55
    definition of high performance cpr
  • 00:05:57
    from our point of view i'll share all
  • 00:05:59
    these aspects with you we're definitely
  • 00:06:01
    going to get into some of the science
  • 00:06:03
    that helped guide our way as well as
  • 00:06:06
    we'll discuss the metrics of high
  • 00:06:07
    performance cpr and how you can actually
  • 00:06:10
    identify these and work toward
  • 00:06:12
    perfection in your agency and then
  • 00:06:13
    lastly we'll we'll close with a few
  • 00:06:15
    closing remarks and then i think at that
  • 00:06:17
    point we'll have an open q q a to be
  • 00:06:19
    able to ask some questions so with that
  • 00:06:22
    let's get started
  • 00:06:23
    so the real first question i want to ask
  • 00:06:25
    the audience all of you right now is
  • 00:06:27
    what do we know for sure when it comes
  • 00:06:29
    to survival for cardiac arrest what do
  • 00:06:31
    we know for sure well quite frankly
  • 00:06:33
    everybody the list is pretty short and
  • 00:06:36
    in fact here it is
  • 00:06:37
    what we know for sure
  • 00:06:39
    that helps and makes a difference in
  • 00:06:42
    survival from cardiac arrest is early
  • 00:06:45
    high quality chest compressions and the
  • 00:06:47
    better the quality the better
  • 00:06:49
    and if need be early defibrillation we
  • 00:06:51
    know these two
  • 00:06:53
    absolutely make a difference so as we
  • 00:06:55
    move through this whole process i want
  • 00:06:57
    you to remember these two things in fact
  • 00:06:59
    it's uh it's in fact supported not just
  • 00:07:02
    by the australian resuscitation council
  • 00:07:04
    and new zealand council but as well as
  • 00:07:05
    the 20 20 guidelines
  • 00:07:08
    in the american heart association that
  • 00:07:09
    shares that early or immediate chest
  • 00:07:12
    compressions can double if not even
  • 00:07:14
    triple a victim's chance for survival
  • 00:07:16
    but look at the look at the next part
  • 00:07:18
    high performance cpr coupled with early
  • 00:07:20
    defibrillation
  • 00:07:22
    like in the next in the early three to
  • 00:07:24
    five minutes of a cardiac arrest can
  • 00:07:26
    actually achieve survival rates
  • 00:07:28
    as high as 50 if not even mid 70s and
  • 00:07:31
    frankly everyone this is being done
  • 00:07:32
    around the world
  • 00:07:34
    these the survival rates we've seen in
  • 00:07:35
    the last five to 10 years for those
  • 00:07:37
    agencies that incorporate this high
  • 00:07:39
    performance system of cardiac arrest
  • 00:07:42
    management are seeing incredible
  • 00:07:44
    survival rates using wood stain criteria
  • 00:07:48
    all right so the the question i have for
  • 00:07:50
    the audience now is you you've got to
  • 00:07:52
    ask yourself what is high performance
  • 00:07:54
    cpr how do you define it well as you
  • 00:07:57
    know there's lots of different terms
  • 00:07:59
    that are out there between pit crew and
  • 00:08:01
    high quality and certainly now with high
  • 00:08:03
    performance
  • 00:08:04
    allow me to share with you how we see
  • 00:08:06
    this and let you make your own decision
  • 00:08:09
    on that so what is high performance cpr
  • 00:08:11
    well here's the definition and i know
  • 00:08:13
    you're seeing this on the right side
  • 00:08:14
    you're thinking boy mike that's a lot of
  • 00:08:16
    words in a slide well let's do this
  • 00:08:18
    together
  • 00:08:20
    a highly refined high performance cpr is
  • 00:08:22
    a highly refined choreographed and
  • 00:08:24
    measured cpr event that's built around
  • 00:08:27
    mastery level individual skills
  • 00:08:29
    with fully integrated als procedures
  • 00:08:32
    incorporating current evidence-based
  • 00:08:34
    performance metrics i agree it's a
  • 00:08:36
    mouthful but if you look at each one of
  • 00:08:38
    these pieces individually it makes
  • 00:08:40
    perfect sense
  • 00:08:42
    high performance cpr is not just one
  • 00:08:44
    piece or another it's a complete concept
  • 00:08:47
    it's a culture that allows you to look
  • 00:08:50
    at all aspects of a cardiac arrest
  • 00:08:52
    management and refine it as need be in
  • 00:08:54
    your agency
  • 00:08:56
    so one of the things that a lot of folks
  • 00:08:58
    ask me well mike what's the difference
  • 00:09:00
    between like pit crew and high
  • 00:09:01
    performance and here's what i'll say to
  • 00:09:03
    everybody right now anything that you're
  • 00:09:05
    doing that increases the chances of
  • 00:09:08
    likelihood of survival from cardiac
  • 00:09:10
    arrest i applaud absolutely and
  • 00:09:13
    certainly high performance in my opinion
  • 00:09:15
    is both qualitative and quantitative and
  • 00:09:17
    let me share the qualitative sides early
  • 00:09:19
    which by the way is very similar to like
  • 00:09:21
    pit crew or high quality cpr or things
  • 00:09:24
    that are maybe some of the other
  • 00:09:25
    verbiage out there
  • 00:09:26
    there's no doubt that it's a
  • 00:09:28
    choreographed evolution and we can look
  • 00:09:30
    at these bullet points minimal
  • 00:09:31
    interruptions efficiency and rotation
  • 00:09:34
    called concise communication
  • 00:09:36
    interchangeable positions predefined
  • 00:09:38
    positions the use of a team lead or even
  • 00:09:41
    a checklist those are all qualitative
  • 00:09:43
    qualitative aspects which are absolutely
  • 00:09:46
    in line with other programs you may have
  • 00:09:47
    heard around but here is where i believe
  • 00:09:50
    high performance cpr separates itself
  • 00:09:52
    and i want to really encourage you to
  • 00:09:54
    think about this
  • 00:09:55
    everything about a high performance
  • 00:09:57
    evolution is a measured performance it's
  • 00:10:00
    measured both in training to get there
  • 00:10:03
    and then actual field analytics to
  • 00:10:04
    decide how you did for example high
  • 00:10:07
    compression fractions
  • 00:10:09
    we'll talk about compression fractions
  • 00:10:10
    um in a slide coming up but high
  • 00:10:13
    compression fractions mastery level
  • 00:10:15
    individual skills using a acronym that i
  • 00:10:17
    developed many years ago called dvd-r
  • 00:10:19
    and i'll explain that to you in a few
  • 00:10:21
    slides
  • 00:10:23
    complete integration of skills both
  • 00:10:25
    timed and measured against benchmarks
  • 00:10:26
    within your organization and complete
  • 00:10:28
    scene coordination and rotation again
  • 00:10:31
    timed and measured against benchmarks in
  • 00:10:34
    your in your department
  • 00:10:36
    so the quantitative aspects is what
  • 00:10:38
    really puts this uh in front of other
  • 00:10:40
    programs and we'll break all these down
  • 00:10:42
    for you as we move forward so there's
  • 00:10:44
    two points that i really want to drive
  • 00:10:45
    home today if you write these down or
  • 00:10:47
    remember these and i've done a good job
  • 00:10:49
    here today there's two points that you
  • 00:10:51
    absolutely must do in order to be a high
  • 00:10:54
    performance cpr performer in your
  • 00:10:56
    organization the first one is to learn
  • 00:10:58
    to manage the seconds of a cardiac
  • 00:11:00
    arrest now you're saying seconds mike we
  • 00:11:03
    run our durations in 20 or 25 minutes or
  • 00:11:05
    maybe even 30 minutes i understand that
  • 00:11:08
    that's the duration of an arrest i want
  • 00:11:10
    you to pull back and look at the seconds
  • 00:11:13
    of an arrest
  • 00:11:14
    because seconds matter quite frankly and
  • 00:11:16
    in order to manage the seconds you know
  • 00:11:18
    what it takes it simply takes the
  • 00:11:20
    ability to eliminate
  • 00:11:22
    unnecessary pauses
  • 00:11:24
    i'll look you right in the camera and
  • 00:11:25
    say if you're a field provider even in
  • 00:11:27
    hospital you and i both know that we
  • 00:11:29
    pause for many different reasons some we
  • 00:11:32
    can't fix there are some reasons to
  • 00:11:34
    pause
  • 00:11:35
    and i understand that but there are
  • 00:11:37
    there are numerous reasons why we're
  • 00:11:39
    taking a pause and it's not necessary
  • 00:11:42
    it's completely unnecessary i want you
  • 00:11:44
    to think about that learn to manage the
  • 00:11:46
    seconds and i'll give you a little
  • 00:11:47
    information moving forward to help
  • 00:11:49
    support that the next thing i have i ask
  • 00:11:51
    that you do is to learn to master
  • 00:11:53
    performance through both measurement and
  • 00:11:56
    improvement i want to show you something
  • 00:11:57
    on the bottom of your screen the first
  • 00:11:59
    one is on the left this is a tracing
  • 00:12:02
    from a qcpr manic and a laredo product
  • 00:12:04
    that gives you training analytics at the
  • 00:12:07
    end of a training session gives you all
  • 00:12:09
    of the metrics of high performance cpr
  • 00:12:11
    compression rate ventilation uh volume
  • 00:12:14
    of ventilation uh decompression and so
  • 00:12:17
    on that's on the on your left the right
  • 00:12:19
    side is an actual field tracing from an
  • 00:12:22
    actual cardiac event it's from
  • 00:12:24
    physiocontroller striker and it's called
  • 00:12:26
    code stat these are the post cases or
  • 00:12:29
    the post
  • 00:12:30
    analytics that you get from a real case
  • 00:12:32
    but here's the point i want to make on
  • 00:12:33
    this slide
  • 00:12:34
    you cannot expect a high performing
  • 00:12:38
    system that on the graph on the right
  • 00:12:40
    unless you're actually training with the
  • 00:12:42
    graph on the left you can't expect high
  • 00:12:45
    performance in the field if you never
  • 00:12:46
    train and have training analytics to
  • 00:12:48
    tell us where we've done things right or
  • 00:12:51
    tell you or you've done things wrong so
  • 00:12:53
    i really encourage that
  • 00:12:55
    all right let's talk about the science
  • 00:12:57
    the science is actually something that
  • 00:12:58
    just intrigues me but more importantly i
  • 00:13:01
    want to help you which is what we had to
  • 00:13:03
    do too figure out how to operationalize
  • 00:13:06
    the science today more than any time i
  • 00:13:09
    believe the science is pretty clear
  • 00:13:11
    where we need to go so our job as
  • 00:13:13
    educators providers and leadership is to
  • 00:13:16
    operationalize the science and put it
  • 00:13:18
    into play let me give some examples when
  • 00:13:20
    we first developed the program we had to
  • 00:13:22
    ask all four thousand providers in the
  • 00:13:25
    seattle king county region to open your
  • 00:13:27
    minds and relearn how we're doing
  • 00:13:29
    business and we absolutely needed to
  • 00:13:32
    embrace the meaning and value of measure
  • 00:13:35
    and improve and i'll leave that on the
  • 00:13:36
    screen for you just a few more seconds
  • 00:13:39
    measure and improve and i'll close today
  • 00:13:41
    with a quote we use the same thing
  • 00:13:44
    measure and improve
  • 00:13:46
    okay
  • 00:13:47
    well i hope i'm moving at a speed that
  • 00:13:48
    keeps everybody engaged but i want to
  • 00:13:50
    slow down just a second so we can drill
  • 00:13:52
    into something very important a term as
  • 00:13:55
    well as a concept and it's called
  • 00:13:56
    compression fraction now you may have
  • 00:13:58
    heard this term before whether it's you
  • 00:14:00
    maybe it's called flow time or you've
  • 00:14:02
    heard compression density and they're
  • 00:14:04
    all sort of terms that mean the same but
  • 00:14:06
    let me explain it compression fraction
  • 00:14:08
    by definition anyway is the measurement
  • 00:14:11
    of compressions in proportion to the
  • 00:14:13
    overall cpr event okay so i'll share
  • 00:14:16
    with you in our community we look toward
  • 00:14:18
    a compression fraction of at least 90
  • 00:14:21
    percent with a 32 compression
  • 00:14:23
    ventilation ratio and 95 compression
  • 00:14:26
    fraction if they move towards a
  • 00:14:28
    continuous compression scenario either
  • 00:14:30
    with an advanced stairway or manual
  • 00:14:32
    defibrillation so let's break this down
  • 00:14:35
    let's show you how do you achieve 90
  • 00:14:38
    now some of you may have already said
  • 00:14:39
    mike we we do this in our organization
  • 00:14:42
    we're already there i applaud you for
  • 00:14:44
    that thank you for that hard work some
  • 00:14:46
    of you also are saying mike we've also
  • 00:14:48
    been tired tested on this and we're not
  • 00:14:51
    there yet well that just means we've got
  • 00:14:52
    work to do but again i applaud you but i
  • 00:14:55
    think there's a third group out there i
  • 00:14:57
    think there's a group out there so mike
  • 00:14:58
    i have no idea what our compression
  • 00:15:00
    fraction is i we don't measure it i
  • 00:15:02
    don't know how to get it
  • 00:15:04
    i've never heard about it
  • 00:15:06
    you're the group i want to talk about
  • 00:15:07
    let me give an example of how you would
  • 00:15:09
    achieve a 90 compression fraction in a
  • 00:15:11
    given period of time in this case just a
  • 00:15:13
    two minute run in other words rotate
  • 00:15:15
    every two minutes how do we achieve 90
  • 00:15:17
    percent compression fraction in two
  • 00:15:19
    minutes here's how you've got to do 108
  • 00:15:22
    seconds of compressions you can only
  • 00:15:24
    pause for a total of 12 seconds within
  • 00:15:27
    that two minutes again some of you are
  • 00:15:29
    saying piece of cake we do this all the
  • 00:15:31
    time and i again applaud you others are
  • 00:15:34
    saying mike we use an aed and we haven't
  • 00:15:36
    talked about this we've never known
  • 00:15:37
    about compression fraction and quite
  • 00:15:39
    frankly i'll tell you that your numbers
  • 00:15:41
    are probably much less than this it's a
  • 00:15:43
    benchmark and i really want to entice
  • 00:15:46
    you to look into this okay
  • 00:15:49
    so the next question that certainly that
  • 00:15:51
    most of you must ask is
  • 00:15:53
    because compression fraction really is
  • 00:15:54
    just about pauses right so the question
  • 00:15:57
    is is a few pauses here and there really
  • 00:15:59
    make a big difference well specifically
  • 00:16:01
    i think you should be able to say a
  • 00:16:03
    pause is just a pause right how long do
  • 00:16:05
    you think it takes to get a pause back
  • 00:16:08
    well here's a hint everybody
  • 00:16:10
    a two or three or four second pause how
  • 00:16:12
    long does it take to get it back it's
  • 00:16:13
    longer than you think here's why
  • 00:16:16
    if you look at this graph
  • 00:16:18
    on the x-axis it's time you can see this
  • 00:16:20
    it's in seconds in time the y-axis of
  • 00:16:22
    course is uh pressure that is um
  • 00:16:26
    performed while you have chest
  • 00:16:27
    compressions the blue
  • 00:16:29
    are right atrial pressure that goes up
  • 00:16:32
    during compression which is cpr systole
  • 00:16:34
    and then falls back down to the baseline
  • 00:16:37
    during cpr diastole the yellow line is
  • 00:16:40
    aortic pressure you can see that it
  • 00:16:42
    gradually builds but it doesn't fall
  • 00:16:43
    quite as far or as fast as right atrial
  • 00:16:46
    pressure during decompression but here's
  • 00:16:49
    what i want you to see
  • 00:16:50
    it takes about 16 seconds to get in 30
  • 00:16:53
    compressions and if you're during 30 to
  • 00:16:55
    2 at the end of that 16 seconds you
  • 00:16:57
    pause to do a ventilation
  • 00:17:00
    and right here look what happens when
  • 00:17:02
    you pause
  • 00:17:03
    everything goes back to zero
  • 00:17:05
    right atrial pressure plummets to zero
  • 00:17:07
    right away followed slowly by aortic
  • 00:17:09
    pressure but eventually it all goes back
  • 00:17:11
    to zero so here everybody is what i want
  • 00:17:13
    you to remember a three to four second
  • 00:17:16
    pause is not benign and in fact a three
  • 00:17:19
    to four second pause is about a 20
  • 00:17:21
    second pause and quality perfusion and
  • 00:17:24
    in fact there are some studies that
  • 00:17:25
    suggest these three to four second
  • 00:17:27
    pauses happen and sometimes we can get
  • 00:17:30
    away with that but the real egregious
  • 00:17:32
    pause are these longer pauses 15 20
  • 00:17:35
    seconds 25 seconds and you and i both
  • 00:17:37
    know if you're a practitioner you've
  • 00:17:39
    been a part of those in your career as
  • 00:17:41
    well
  • 00:17:42
    so the bottom line pauses count and your
  • 00:17:45
    performance counts everything you do
  • 00:17:48
    when you bring your hand near the chest
  • 00:17:49
    of that patient
  • 00:17:51
    counts and that's really where i'm
  • 00:17:53
    trying to go with all this so some of
  • 00:17:55
    you may ask how do you know this i mean
  • 00:17:57
    where do you get this information well
  • 00:17:59
    in our region certainly there is a
  • 00:18:00
    worldwide science on this but in our
  • 00:18:02
    region we track every quantitative
  • 00:18:05
    aspect of a resuscitation
  • 00:18:07
    get this to include audio yes we listen
  • 00:18:10
    to every single word that's said on a
  • 00:18:12
    cardiac arrest some of you may be
  • 00:18:14
    eyebrow raising right now we listen to
  • 00:18:16
    every single word why is because
  • 00:18:19
    sometimes it helps explain things that
  • 00:18:21
    when when we read get on the readout
  • 00:18:23
    doesn't make sense like a long pause or
  • 00:18:25
    something and we can hear them say we're
  • 00:18:27
    moving the patient from between the
  • 00:18:29
    toilet and the bathtub out into the
  • 00:18:31
    living room to do a
  • 00:18:33
    better arrest so it helps us understand
  • 00:18:35
    the entirety of the call
  • 00:18:38
    but in fact you know what i thought i'd
  • 00:18:39
    do i'm going to take you on a little
  • 00:18:41
    trip and i'm going to take you into what
  • 00:18:42
    we call our tape room and the tape room
  • 00:18:45
    is where we acquire all of these data it
  • 00:18:47
    comes in as a chip now not a tape
  • 00:18:49
    anymore but we listen to every case
  • 00:18:51
    where we'll then review it for
  • 00:18:53
    compliance and for quality we'll
  • 00:18:55
    annotate it as need be to give direction
  • 00:18:58
    and then we loop it back to the very
  • 00:19:00
    providers we're on that call so they can
  • 00:19:02
    understand how they did here is an
  • 00:19:04
    actual case and i thought i'd let you
  • 00:19:06
    see and hear what we go through
  • 00:19:09
    68 male found by wife unconscious and
  • 00:19:11
    pulseless with agonal breathing
  • 00:19:13
    classic cardiac arrest initial response
  • 00:19:16
    paramedics in route but the emts got
  • 00:19:18
    there first using a life pack in aed
  • 00:19:20
    mode everybody
  • 00:19:22
    listen and watch here's the case
  • 00:19:29
    class connected
  • 00:19:31
    gonna analyze the rhythm the green are
  • 00:19:33
    the actions
  • 00:19:36
    the black is the underlying rhythm of
  • 00:19:38
    the patient
  • 00:19:41
    [Applause]
  • 00:19:43
    [Music]
  • 00:19:48
    [Applause]
  • 00:20:03
    [Applause]
  • 00:20:05
    very seconds
  • 00:20:08
    [Music]
  • 00:20:10
    [Applause]
  • 00:20:20
    [Music]
  • 00:20:27
    [Music]
  • 00:20:30
    so the leading t or the paramedic to get
  • 00:20:32
    unseen will actually speak openly into
  • 00:20:34
    the
  • 00:20:35
    defibrillator or aed sharing their
  • 00:20:38
    updates letting them either the
  • 00:20:39
    physician or the physician designee
  • 00:20:42
    whoever reviews this tape like we're
  • 00:20:43
    doing right now understand exactly
  • 00:20:45
    what's going on so it helps us really
  • 00:20:47
    get a complete picture of the evolution
  • 00:20:49
    of the cardiac arrest all right so you
  • 00:20:52
    can see some of the bullet points i want
  • 00:20:53
    to continue to move on so we we make
  • 00:20:55
    sure we're getting our our class here
  • 00:20:58
    and get my computer moving on the right
  • 00:21:00
    place
  • 00:21:01
    i want to share with you that one of the
  • 00:21:02
    first years that we put together
  • 00:21:06
    high performance cpr
  • 00:21:08
    we had an immediate increase in survival
  • 00:21:10
    by 13
  • 00:21:12
    and i'll say that by not adding any new
  • 00:21:14
    equipment
  • 00:21:15
    no additional personnel and no new drugs
  • 00:21:18
    all we did was change the culture of how
  • 00:21:20
    we performed resuscitation now those 13
  • 00:21:23
    percent we were using woodstein criteria
  • 00:21:25
    which i'm sure you're aware shockable
  • 00:21:27
    rhythm witness shockable rhythm okay
  • 00:21:29
    within the next two to three years
  • 00:21:33
    we actually increased our survival to
  • 00:21:35
    well over fifty percent in fact the
  • 00:21:37
    highest we had was sixty-two percent
  • 00:21:39
    using wisdom criteria again for vf pvt
  • 00:21:42
    patients or shockable patients in the
  • 00:21:44
    seattle king county region
  • 00:21:46
    so i want to recommend as we move
  • 00:21:48
    forward continue to move towards a
  • 00:21:51
    high performance response to cardiac
  • 00:21:53
    arrest in your system
  • 00:21:55
    and i'm going to share with you some of
  • 00:21:56
    those key points as we do as we do this
  • 00:21:58
    over the next few minutes
  • 00:22:00
    the one thing you're going to lean need
  • 00:22:01
    to learn to do is to eliminate those
  • 00:22:03
    unnecessary positives as i shared with
  • 00:22:05
    you already you've got to eliminate any
  • 00:22:07
    pause that shouldn't be part of the
  • 00:22:09
    evolution you've got to get rid of it
  • 00:22:11
    and quite frankly you can once you
  • 00:22:14
    actually go into a cardiac arrest when
  • 00:22:16
    you start to watch and and educate and
  • 00:22:18
    train you're going to see complete
  • 00:22:20
    pauses in there that don't need to be
  • 00:22:22
    part of the resuscitation eliminate them
  • 00:22:24
    get rid of them i'll give you a really
  • 00:22:27
    good example of what the first thing we
  • 00:22:28
    did of eliminating pauses if you can
  • 00:22:31
    remember many years ago we you may have
  • 00:22:34
    heard something called i'm clear you're
  • 00:22:35
    clear everybody's clear just before
  • 00:22:37
    defibrillatory shock was offered and we
  • 00:22:39
    all pulled back and pulled our arms back
  • 00:22:41
    we got away from the patient we offered
  • 00:22:43
    the shock and then we scooted back up
  • 00:22:45
    and got going that was a five to seven
  • 00:22:47
    second pause in our system so we
  • 00:22:49
    eliminated it and came up with this idea
  • 00:22:52
    of hover hover is putting your hands
  • 00:22:54
    directly over the chest two to three
  • 00:22:56
    inches right off the top we clear the
  • 00:22:58
    patient everybody hover shock get back
  • 00:23:00
    on the chest that saved us five to seven
  • 00:23:03
    seconds every single time we offer
  • 00:23:06
    defibrillatory shock that's one example
  • 00:23:08
    here's another example our paramedics
  • 00:23:11
    many many years ago
  • 00:23:12
    whether would they come in with the emts
  • 00:23:14
    with an aed put on them put on their
  • 00:23:16
    manual defibrillator in this case it's a
  • 00:23:18
    lifepak 15 but whatever device you use
  • 00:23:21
    and they put the paddles on it's in
  • 00:23:23
    manual mode and they'd say stop cpr take
  • 00:23:25
    a look at the rhythm and if it was a
  • 00:23:27
    shockable rhythm they would say let's
  • 00:23:29
    charge they would charge it up
  • 00:23:30
    and at that point they'd say clear and
  • 00:23:32
    away they went now if you're a new medic
  • 00:23:35
    you're going what what do you mean they
  • 00:23:37
    were they were pausing during that the
  • 00:23:38
    answer is yes
  • 00:23:40
    many years ago we we didn't appreciate
  • 00:23:43
    this this idea of compression fraction
  • 00:23:45
    or certainly a pre-shock pause
  • 00:23:49
    so we we just would watch him do it well
  • 00:23:51
    now we identified about 15 years ago
  • 00:23:54
    something called pre-charge
  • 00:23:56
    during the compressions in the last 15
  • 00:23:58
    seconds of the evolution or what i call
  • 00:24:00
    a buck 45 the paramedic will reach over
  • 00:24:03
    charge the device with compressions
  • 00:24:04
    ongoing read it decide and go ahead and
  • 00:24:08
    pause rotate decide if it's shockable
  • 00:24:10
    shock it and if it's not any button dump
  • 00:24:12
    the charge i thought i'd share a video
  • 00:24:14
    for you it's right here
  • 00:24:16
    compulsory cpr 15 seconds left in the
  • 00:24:19
    cycle compressions ongoing
  • 00:24:22
    pre-charge the device compressions
  • 00:24:25
    [Music]
  • 00:24:27
    five
  • 00:24:28
    four
  • 00:24:29
    three
  • 00:24:30
    two
  • 00:24:31
    one
  • 00:24:32
    two minutes rotate next compression
  • 00:24:34
    hover
  • 00:24:35
    quick look it looks like yep
  • 00:24:38
    shockable back on the chest
  • 00:24:41
    that was a game changer for us as far as
  • 00:24:44
    increasing compression fraction and the
  • 00:24:46
    elimination of that pre-shock pause i
  • 00:24:49
    want you to really think about this
  • 00:24:51
    certainly i've read your guidelines uh
  • 00:24:53
    in your region and it absolutely
  • 00:24:55
    suggests this pre-shock pause early and
  • 00:24:58
    i applaud that good for you all right
  • 00:24:59
    let's keep going i want you to continue
  • 00:25:01
    to work toward building mastery level
  • 00:25:03
    individual skills coupled with a
  • 00:25:06
    complete team approach i share when i do
  • 00:25:08
    this class that everyone who comes near
  • 00:25:11
    this patient in cardiac arrest brings
  • 00:25:13
    value to the cow they bring value so
  • 00:25:16
    integrate all these different skills
  • 00:25:18
    there are different levels of education
  • 00:25:19
    and performance integrate these skills
  • 00:25:22
    in one of the things we did early was to
  • 00:25:24
    identify that all the initial providers
  • 00:25:27
    in this case bls providers they own the
  • 00:25:30
    compression and the ventilation portion
  • 00:25:32
    of high performance because in the old
  • 00:25:34
    days when we before we developed this
  • 00:25:36
    when the paramedics would walk in the
  • 00:25:38
    emts would stop and ask them what would
  • 00:25:40
    you like us to do well get back on the
  • 00:25:42
    chest and start compressions we
  • 00:25:44
    understood that what we did what we were
  • 00:25:46
    doing was we weren't given the value to
  • 00:25:48
    those emts so we gave the ownership of
  • 00:25:51
    compression and ventilation to the emts
  • 00:25:54
    that is their run and i will say with
  • 00:25:57
    all respect
  • 00:25:58
    uh my colleagues from ambulance victoria
  • 00:26:00
    came up with this one i'm giving you all
  • 00:26:02
    the credit you stole this at a recess
  • 00:26:04
    station academy i heard if the emts and
  • 00:26:06
    the bls if they own compressions als own
  • 00:26:10
    rosk i'm giving you all the credit right
  • 00:26:12
    there i love that idea certainly on the
  • 00:26:15
    als would be paramedics or nurses or
  • 00:26:17
    maybe rts or even physicians
  • 00:26:19
    let those initial providers run the
  • 00:26:22
    compression and the ventilation piece
  • 00:26:24
    you own you own the rosk or advanced
  • 00:26:26
    technology or advanced airway
  • 00:26:28
    intervention or whatever else that may
  • 00:26:30
    be but it's a it's a team approach
  • 00:26:34
    all skills
  • 00:26:35
    are dug
  • 00:26:36
    during compressions
  • 00:26:39
    eight nine bag
  • 00:26:42
    okay
  • 00:26:43
    eight nine bags
  • 00:26:46
    two is past the cords
  • 00:26:48
    eight nine bag
  • 00:26:51
    okay
  • 00:26:52
    perfect i think that point's been made
  • 00:26:53
    all right the next thing i really want
  • 00:26:55
    to recommend
  • 00:26:56
    to your organization is you need to
  • 00:26:58
    identify what those metrics are and i'm
  • 00:26:59
    going to share with you in just a minute
  • 00:27:01
    and then one of the things that really
  • 00:27:03
    helped us was to pre-arrange and
  • 00:27:05
    pre-identify crew positions and i'll
  • 00:27:08
    give you that hint in just a moment
  • 00:27:10
    but from there once you are once you've
  • 00:27:12
    identified metrics and crew positions
  • 00:27:14
    and pre-arranged positioning then you
  • 00:27:17
    train you measure and you repeat that's
  • 00:27:20
    going to be the key
  • 00:27:21
    so for example the metrics i'll share
  • 00:27:23
    with you as i did earlier this dvd-r
  • 00:27:26
    acronym it worked perfectly remember
  • 00:27:28
    when we developed this almost more than
  • 00:27:30
    15 years ago we had to convince 4 000
  • 00:27:33
    providers that we needed to do something
  • 00:27:36
    different so i remember talking to my
  • 00:27:38
    colleagues from seattle my three
  • 00:27:40
    colleagues from seattle fire we need to
  • 00:27:42
    make this simple enough where they can
  • 00:27:43
    remember it at two o'clock in the
  • 00:27:45
    morning
  • 00:27:46
    here's what we came up with dvd-r d the
  • 00:27:49
    first one stands for depth of
  • 00:27:50
    compression and as you know for all this
  • 00:27:53
    uh statewide it's two to two point four
  • 00:27:55
    and for all you in the metric system
  • 00:27:57
    it's fifty to sixty or five and six
  • 00:27:59
    depends on which one you wanna use the
  • 00:28:01
    next one is v or ventilation controlled
  • 00:28:04
    ventilation somewhere between 350 to 500
  • 00:28:07
    mils is all you need to achieve initial
  • 00:28:09
    chest rise and most size most adult
  • 00:28:13
    in cardiac arrest so controlled
  • 00:28:15
    ventilation why we've been over
  • 00:28:17
    ventilating and hyperventilating for
  • 00:28:19
    decades everybody we need to pull back
  • 00:28:21
    from that the next d is decompression or
  • 00:28:24
    full recoil it's not a request anymore
  • 00:28:27
    it's a requirement in our organization
  • 00:28:29
    complete chest recoil okay and the last
  • 00:28:32
    one is rate rate of compression
  • 00:28:35
    and i'm going to say something i i
  • 00:28:36
    wonder if you're the just like we are in
  • 00:28:38
    our region of the united states
  • 00:28:40
    we're not as good as we think we are
  • 00:28:42
    having that whatever music or whatever
  • 00:28:45
    metronome in your head is one thing but
  • 00:28:47
    to have a real metronome is another and
  • 00:28:49
    i'll give an example in just a second
  • 00:28:50
    and the last part of high performance is
  • 00:28:52
    high compression fractions now certainly
  • 00:28:54
    greater than 80 as recommended by most
  • 00:28:57
    agencies is fine but i think we should
  • 00:28:59
    push the bar even higher i would like to
  • 00:29:01
    see that a minimum of 90 if 30 to 2 and
  • 00:29:04
    95
  • 00:29:05
    if you're in continuous but let's talk
  • 00:29:07
    about rate again remember you're not as
  • 00:29:09
    good as you think you are so i recommend
  • 00:29:17
    a metronome every single cardiac arrest
  • 00:29:20
    scenario use a metronome take away the
  • 00:29:23
    variable and you can get that a number
  • 00:29:25
    of different ways you can get a
  • 00:29:26
    metronome either on a smartphone or you
  • 00:29:28
    can use the one that's on your machine
  • 00:29:30
    which doesn't change very uh you can't
  • 00:29:33
    change it but it's usually set around
  • 00:29:34
    100 but whatever you might use
  • 00:29:37
    use a metronome all right
  • 00:29:38
    as i said before identify crew positions
  • 00:29:41
    and in fact we we wanted to drill down
  • 00:29:43
    far enough to actually get crew
  • 00:29:45
    positions where they knew where to go
  • 00:29:47
    one of this is called the cpr triangle
  • 00:29:49
    watch this
  • 00:29:51
    every position coming with a piece of
  • 00:29:53
    equipment
  • 00:29:54
    is pre-arranged so they all knew where
  • 00:29:56
    they were already going to go by doing
  • 00:29:59
    this additional personnel coming to the
  • 00:30:01
    scene know exactly where they can go to
  • 00:30:04
    the bottom left of your screen has an
  • 00:30:05
    open spot bottom right has an open spot
  • 00:30:08
    so if you if you practice this way you
  • 00:30:10
    already know how you can insert yourself
  • 00:30:13
    into this case
  • 00:30:14
    the next one is body position go back to
  • 00:30:17
    where you have trained yourself and look
  • 00:30:19
    for every single thing that makes your
  • 00:30:22
    performance perfect not good enough
  • 00:30:25
    perfect so we shot videos to support
  • 00:30:27
    perform chest compressions position the
  • 00:30:29
    hands in the center of the chest
  • 00:30:32
    lock elbows
  • 00:30:34
    and keep arms straight over the patient
  • 00:30:36
    in a perpendicular line
  • 00:30:39
    compress to a minimum depth of at least
  • 00:30:41
    2 inches but no more than 2.4 inches to
  • 00:30:45
    avoid excessive compression depth allow
  • 00:30:47
    full chest recoil to promote blood
  • 00:30:49
    return to the heart and circulation to
  • 00:30:52
    the lungs use a fulcrum motion to
  • 00:30:55
    leverage weight
  • 00:30:58
    compress at a rate of 100 to 120
  • 00:31:01
    compressions per minute
  • 00:31:04
    perfect
  • 00:31:05
    perfect training perfect compressions
  • 00:31:08
    not good enough and the only way to get
  • 00:31:10
    there in a real life is to practice the
  • 00:31:12
    same way and get analytics to support
  • 00:31:14
    that the next thing we looked at with
  • 00:31:16
    high performance is that we're over
  • 00:31:17
    ventilating i shared that with you so we
  • 00:31:19
    developed something called the three
  • 00:31:21
    finger technique pulling that pinky
  • 00:31:23
    finger off the bag takes away your crush
  • 00:31:26
    factor and we talked to a number of
  • 00:31:28
    orthopedic surgeons about this and
  • 00:31:29
    believe it or not it works but whatever
  • 00:31:32
    it takes to make sure we're not over
  • 00:31:34
    ventilating i support the seattle
  • 00:31:37
    program for example dropped to a 700cc
  • 00:31:39
    bag i'm not saying that's what everybody
  • 00:31:41
    should do but here's where i want to go
  • 00:31:43
    this is a training issue so make over
  • 00:31:46
    ventilation an issue and then develop
  • 00:31:49
    training to keep your team in check
  • 00:31:51
    here's a quick video of the three finger
  • 00:31:53
    technique
  • 00:31:54
    or as my colleagues in england or the uk
  • 00:31:58
    call it they call it the queen or the
  • 00:32:00
    pinky out finger the pink the queen's
  • 00:32:02
    technique
  • 00:32:04
    i just love how i can get a 300 pound
  • 00:32:06
    truckman from seattle with his pinky out
  • 00:32:08
    that was one of my favorite videos that
  • 00:32:10
    we produced all right here we go
  • 00:32:13
    the last thing i want everyone to
  • 00:32:14
    understand as we start to get toward the
  • 00:32:16
    end of this is that high performance cpr
  • 00:32:18
    is a true true team event so what we did
  • 00:32:21
    was we asked a team from the local
  • 00:32:23
    seattle area two different agencies to
  • 00:32:25
    work together come into a room we're
  • 00:32:27
    going to put a camera on you we're going
  • 00:32:29
    to put an instrumented mannequin and
  • 00:32:30
    we're going to watch your performance
  • 00:32:32
    using analytics
  • 00:32:34
    and they all said fine everybody i want
  • 00:32:36
    to show you their evolution
  • 00:32:38
    this is a team from north shore fire in
  • 00:32:40
    shoreline fire washington running a high
  • 00:32:42
    performance evolution with five
  • 00:32:44
    providers the folks in white are
  • 00:32:46
    paramedics that's what we wear in the
  • 00:32:48
    seattle king county system the folks in
  • 00:32:50
    blue are bls emts here we go
  • 00:32:54
    as additional ems personnel become
  • 00:32:55
    available it's important to note that
  • 00:32:57
    complete integration as a team is a
  • 00:33:00
    hallmark of high performance or hp cpr
  • 00:33:04
    hp cpr is defined as an expertly
  • 00:33:06
    performed choreographed out of hospital
  • 00:33:09
    cardiac arrest response
  • 00:33:11
    consisting of highly skilled and
  • 00:33:13
    measured individual and team performance
  • 00:33:16
    here are a few things to remember
  • 00:33:18
    the bls crew owns the cbr portion of the
  • 00:33:21
    cardiac arrest scenario and all advanced
  • 00:33:24
    life support or als providers must be
  • 00:33:27
    proficient in performing als skills
  • 00:33:29
    without interrupting hp cpr
  • 00:33:32
    do not interrupt hp cpr during the
  • 00:33:35
    administration of als procedures
  • 00:33:38
    rotate the compressor during the
  • 00:33:40
    analysis of the cardiac rhythm
  • 00:33:42
    the als monitor should be pre-charged
  • 00:33:45
    during the last 15 seconds of the cycle
  • 00:33:48
    the timekeeper maintains a written
  • 00:33:50
    record of the event crew rotations and
  • 00:33:52
    overall team choreography
  • 00:33:55
    hallmarks of hp cpr include fully
  • 00:33:58
    integrated choreographed and expertly
  • 00:34:01
    performed resuscitation
  • 00:34:03
    minimal pauses
  • 00:34:05
    compression depth of 2 to 2.4 inches or
  • 00:34:09
    50 to 60 millimeters
  • 00:34:11
    complete recoil and controlled
  • 00:34:13
    ventilation of 350
  • 00:34:16
    to 500 milliliters per breath
  • 00:34:21
    excellent that was a one take evolution
  • 00:34:23
    for them as well and then the analytics
  • 00:34:25
    we reviewed with them
  • 00:34:27
    and it was an awesome job so what i want
  • 00:34:29
    to share when we start to close is
  • 00:34:30
    whether you're pre-hospital on the left
  • 00:34:32
    or in hospital on the right even though
  • 00:34:34
    our environments are completely
  • 00:34:35
    different as you and i both know
  • 00:34:37
    the metrics for high performance are
  • 00:34:39
    exactly the same they're exactly the
  • 00:34:41
    same you just need to incorporate them
  • 00:34:43
    into your environment
  • 00:34:45
    work hard everybody to continue to build
  • 00:34:47
    the program
  • 00:34:48
    around a culture of excellence and high
  • 00:34:50
    performance evolution
  • 00:34:52
    in closing i want to share with you this
  • 00:34:54
    increasing survival from cardiac or
  • 00:34:56
    arrest takes work it's not easy
  • 00:34:59
    but it's not complicated it takes work
  • 00:35:02
    it's not easy but it's not complicated
  • 00:35:05
    don't underestimate the value and
  • 00:35:06
    culture of measure and improve
  • 00:35:10
    identify strengths and gaps during
  • 00:35:12
    training which will help you develop a
  • 00:35:14
    plan to validate and remediate
  • 00:35:17
    develop mastery level individual skills
  • 00:35:20
    ideally through instrumented mannequins
  • 00:35:22
    giving the feedback
  • 00:35:23
    as well as the actual case events
  • 00:35:26
    and get the team involved in this and
  • 00:35:28
    then send those data back to those
  • 00:35:30
    people that are performing the task the
  • 00:35:32
    last one a piece of equipment everybody
  • 00:35:34
    is just a tool
  • 00:35:35
    performance is what counts
  • 00:35:38
    a piece of equipment's just a tool don't
  • 00:35:40
    allow a piece of equipment to run your
  • 00:35:42
    cardiac arrest evolution
  • 00:35:44
    remember if you're not measuring
  • 00:35:47
    you're not improving we have to know how
  • 00:35:49
    we're doing in order to know where we're
  • 00:35:51
    going to go
  • 00:35:52
    one of my favorite quotes from a great
  • 00:35:53
    colleague in seattle dr mickey eisenberg
  • 00:35:55
    where life is measured in years but
  • 00:35:57
    resuscitation in seconds or even minutes
  • 00:36:01
    life is finite where death is eternal
  • 00:36:03
    and between those two points everybody
  • 00:36:06
    we only have about 10 minutes and i'll
  • 00:36:08
    share with you that those 10 minutes are
  • 00:36:09
    yours what you do with those i hope is a
  • 00:36:12
    high performance evolution
  • 00:36:14
    thank you for everything you do what i'm
  • 00:36:16
    hoping now is we have a lively q a
  • 00:36:18
    session and i'm looking forward to
  • 00:36:20
    speaking with you take care everybody
  • 00:36:24
    hi mike
  • 00:36:26
    that was really fun
  • 00:36:30
    wonderful um thank you so much mike and
  • 00:36:32
    welcome to everyone i am not david as
  • 00:36:35
    you can tell
  • 00:36:36
    so david is stuck in uh wellington in a
  • 00:36:39
    bit of a storm so he's in internet is
  • 00:36:42
    not the best so i stepped in i'm muay
  • 00:36:44
    thai busy mickey i'm the general manager
  • 00:36:46
    for caa and i'm very honored to be
  • 00:36:49
    interviewing you mike today for this q a
  • 00:36:52
    panel uh thank you so much first off for
  • 00:36:54
    a wonderful presentation i have to say i
  • 00:36:57
    can't get enough of uh hearing about uh
  • 00:37:01
    high performance cpr and just sort of
  • 00:37:04
    all the incredible
  • 00:37:05
    little nuances that king county and
  • 00:37:08
    seattle and then across the world people
  • 00:37:11
    are coming up with just to
  • 00:37:13
    to to do an extra little second to just
  • 00:37:16
    really fine-tune it and it's incredible
  • 00:37:19
    to see like you've shared with us today
  • 00:37:21
    on how it makes a massive difference and
  • 00:37:24
    you know i i think we all agree and you
  • 00:37:27
    know the 10 minutes go so so fast and
  • 00:37:30
    sadly we're not even there for the first
  • 00:37:32
    few of them so what we do with when we
  • 00:37:34
    get on site is just absolutely critical
  • 00:37:37
    so thank you so much for that i'm gonna
  • 00:37:40
    open it up for questions here but one
  • 00:37:43
    from me just really quickly use you talk
  • 00:37:45
    about training training training and nes
  • 00:37:48
    measurement what would you suggest for
  • 00:37:51
    an ambulance service but also for all
  • 00:37:54
    our ems colleagues um
  • 00:37:56
    you know
  • 00:37:58
    how often to train
  • 00:38:00
    sure well that's a great question right
  • 00:38:02
    if as educators we would say the answer
  • 00:38:04
    should be all the time right but the
  • 00:38:06
    reality is that can't happen
  • 00:38:09
    so um
  • 00:38:10
    what uh in the seattle king county
  • 00:38:12
    region
  • 00:38:14
    it is a requirement to have a quarterly
  • 00:38:17
    evolution training so all the teams come
  • 00:38:20
    together and at least once a quarter
  • 00:38:23
    for a full evolution which is a measured
  • 00:38:25
    evolution multi-team evolution which is
  • 00:38:29
    either four or five
  • 00:38:31
    those are then reviewed by an evaluator
  • 00:38:34
    for compliance
  • 00:38:36
    and then you're recorded in a record
  • 00:38:38
    recording that says you have it at least
  • 00:38:40
    once a quarter
  • 00:38:42
    so to me that's the minimum
  • 00:38:44
    now for some agencies may go gosh mike
  • 00:38:46
    we only do it like once a year so once a
  • 00:38:49
    quarter may be a lot for us that's a
  • 00:38:51
    minimum and in fact
  • 00:38:53
    many agencies on their own
  • 00:38:56
    will actually do it maybe they'll run a
  • 00:38:59
    10-minute evolution at the beginning of
  • 00:39:01
    every set that they're on for example if
  • 00:39:05
    they're on a three-day set they'll do it
  • 00:39:07
    at the first part of their the first
  • 00:39:09
    shift of their three-day
  • 00:39:11
    so every every organization is a little
  • 00:39:13
    different in seattle king county there
  • 00:39:15
    are some that are like us that want to
  • 00:39:17
    train all the time
  • 00:39:19
    but at a minimum we are we train
  • 00:39:21
    quarterly on a complete high performance
  • 00:39:24
    evolution i think that's a wonderful
  • 00:39:27
    standard to try and aim for
  • 00:39:30
    it can be hard i'm hoping our services
  • 00:39:32
    listening here are going well we might
  • 00:39:34
    have to uh you know look look at that
  • 00:39:37
    and
  • 00:39:37
    you know we're all aware obviously time
  • 00:39:39
    is definitely uh the factory but trying
  • 00:39:42
    to aim towards that would be absolutely
  • 00:39:44
    wonderful i will say this before you go
  • 00:39:46
    on um because there are still some
  • 00:39:47
    agencies that think that we can remember
  • 00:39:49
    this like if we do it once every two
  • 00:39:51
    years
  • 00:39:52
    the old certification time frame right
  • 00:39:54
    well i got certified in an acls two
  • 00:39:56
    years ago i will share with you there's
  • 00:39:59
    absolutely no way you will maintain a
  • 00:40:01
    high level performance if you do it once
  • 00:40:03
    every two years even once a year and i
  • 00:40:06
    um and i've shared that by being in the
  • 00:40:08
    system for more than 40 years just doing
  • 00:40:10
    this over and over and over again so
  • 00:40:13
    i'll share that as much as they can but
  • 00:40:15
    there should at least be
  • 00:40:17
    a minimum standard because we lose skill
  • 00:40:19
    quickly right that time has already been
  • 00:40:21
    identified in many studies within 30 or
  • 00:40:24
    45 days or so we're already starting to
  • 00:40:26
    lose skill so we want to keep that
  • 00:40:28
    yep and i guess it's very different when
  • 00:40:30
    you're talking high performance cpr and
  • 00:40:32
    you're talking you know
  • 00:40:34
    i guess not the alternative not high
  • 00:40:37
    performance cpr those skills will very
  • 00:40:40
    much vary and yes for you know cpr from
  • 00:40:43
    a public member or whatnot as long as
  • 00:40:45
    they know what they're doing they help
  • 00:40:48
    massively but when we come on scene when
  • 00:40:50
    ems or or ambulance uh comes on scene
  • 00:40:54
    you want that absolutely spot on so
  • 00:40:57
    big big difference that's exactly right
  • 00:40:59
    public access we're happy uh you know
  • 00:41:02
    chest compressions only is really the
  • 00:41:04
    the standard now right just get on the
  • 00:41:06
    chest and do it but you're right when
  • 00:41:08
    when a professional team arrives we
  • 00:41:10
    should have high expectations of
  • 00:41:12
    performance
  • 00:41:13
    yeah so thanks for having me and i guess
  • 00:41:15
    that's what uh the public expects of us
  • 00:41:17
    as well anyway yeah sure they they do
  • 00:41:19
    they do you're right yeah wonderful a
  • 00:41:22
    few questions from the audience
  • 00:41:24
    what are your thoughts on head first cpr
  • 00:41:27
    so cruz doing compressions from the head
  • 00:41:30
    versus yeah right that's interesting i'm
  • 00:41:33
    seeing this as well for the first time
  • 00:41:35
    um i frankly um have never really seen
  • 00:41:38
    nor done sort of head first i thought
  • 00:41:40
    the question was going to be about heads
  • 00:41:42
    up cpr
  • 00:41:44
    sort of this new idea and study that's
  • 00:41:45
    going on but they're they're literally
  • 00:41:47
    talking about going toward the head and
  • 00:41:49
    doing over the top of the head down well
  • 00:41:51
    my question would be
  • 00:41:52
    i'm assuming that
  • 00:41:54
    then the ventilator is positioned off to
  • 00:41:57
    the side is this a single ventilator or
  • 00:42:01
    do you require a two person ventilator
  • 00:42:04
    if you're
  • 00:42:05
    prior to an advanced airway as you know
  • 00:42:07
    the heart association recommends a two
  • 00:42:11
    person
  • 00:42:12
    ventilation technique using a bag valve
  • 00:42:14
    mask
  • 00:42:15
    the reality is let's be honest
  • 00:42:18
    not everybody has that much personnel to
  • 00:42:20
    often do that
  • 00:42:21
    so my experience is i have no experience
  • 00:42:24
    with this
  • 00:42:25
    so i can't i would love to see it if
  • 00:42:28
    this person would love to follow up with
  • 00:42:29
    me if they've got some videos send it my
  • 00:42:31
    way i i don't want this to be a a
  • 00:42:34
    one-time shot for us i want to stay
  • 00:42:36
    connected so with that particular
  • 00:42:38
    scenario we definitely do it exactly how
  • 00:42:40
    i showed in the video
  • 00:42:42
    which is a single person at the head
  • 00:42:44
    remember that triangle everybody that i
  • 00:42:46
    showed that triangle is what allows
  • 00:42:48
    additional personnel coming into the
  • 00:42:50
    scene to know where they can go before
  • 00:42:53
    they ever get there as soon as they come
  • 00:42:55
    in they can see that opportunity and the
  • 00:42:57
    top of the triangle the apex of course
  • 00:43:00
    is the ventilator so we do compressions
  • 00:43:02
    currently from the side so that's an
  • 00:43:04
    interesting question have that person
  • 00:43:06
    follow up with me please good question
  • 00:43:08
    and obviously it's uh you know around
  • 00:43:11
    the world mechanical compression yes
  • 00:43:13
    where are your thoughts on that one uh
  • 00:43:16
    there's in australia in new zealand we
  • 00:43:19
    are this is being definitely rolled down
  • 00:43:22
    certainly that's a two-part question i'm
  • 00:43:24
    seeing the same one that you're seeing
  • 00:43:25
    and that is should we prioritize using a
  • 00:43:28
    lucas or a compression device
  • 00:43:31
    as opposed to should we use one at all
  • 00:43:33
    so first i'll answer because everybody
  • 00:43:35
    asks us here in the seattle king county
  • 00:43:37
    do we use them
  • 00:43:39
    as a primary method by which to do chest
  • 00:43:41
    compressions and the answer is no we do
  • 00:43:44
    not
  • 00:43:45
    now there's a number of reasons for that
  • 00:43:47
    it's not just black and white by the way
  • 00:43:50
    we have the ability to put a lot of
  • 00:43:52
    personnel at location on a cardiac
  • 00:43:55
    arrest and in fact you know that there
  • 00:43:57
    are studies that support at a certain
  • 00:43:59
    number of personnel any wing i think
  • 00:44:01
    it's six or seven at scene there is a
  • 00:44:03
    connection with an increase in survival
  • 00:44:05
    a lot of that's simply because of
  • 00:44:06
    personnel
  • 00:44:08
    but
  • 00:44:09
    to
  • 00:44:10
    the other side of that
  • 00:44:11
    is
  • 00:44:12
    i believe that there is an opportunity
  • 00:44:14
    for a
  • 00:44:16
    an assist device like a chest
  • 00:44:17
    compression assist device for those
  • 00:44:20
    agencies that either don't have a lot of
  • 00:44:22
    personnel at the scene have long
  • 00:44:24
    either required transport times or for
  • 00:44:27
    example aero rotor helicopter services
  • 00:44:30
    if they if they re-arrest in a
  • 00:44:32
    helicopter doing cpr is extremely
  • 00:44:34
    difficult so our recommendation is we
  • 00:44:37
    don't use this as a primary tool and in
  • 00:44:40
    fact the current aha guidelines i'm sure
  • 00:44:42
    that um or or at least
  • 00:44:44
    the
  • 00:44:45
    european guidelines suggest that
  • 00:44:48
    it's still a 2b as far as the
  • 00:44:50
    recommendation there's still not a lot
  • 00:44:53
    of clear-cut evidence to suggest that
  • 00:44:55
    that early on
  • 00:44:57
    is still an increase in
  • 00:45:00
    survival to discharge numbers i will say
  • 00:45:02
    this
  • 00:45:03
    regardless of which device you use
  • 00:45:06
    whether it is a band supporting or a
  • 00:45:08
    compression device
  • 00:45:10
    striker versus like zoll
  • 00:45:13
    you must must must train
  • 00:45:16
    in the application of the device you
  • 00:45:19
    can't just put it on a rig and expect
  • 00:45:21
    that it's going to be an easy
  • 00:45:23
    application because it's not
  • 00:45:25
    that pause
  • 00:45:27
    on some of the providers that they'll
  • 00:45:29
    put on is an egregious pause and don't
  • 00:45:31
    miss my talk about pauses pauses count
  • 00:45:35
    right
  • 00:45:36
    some of the worst uh day some of the
  • 00:45:38
    data really suggests it's those 15 20 25
  • 00:45:41
    second pauses which may be the biggest
  • 00:45:44
    culprit to determine outcomes from
  • 00:45:46
    cardiac arrest so if you've got a device
  • 00:45:48
    i think that that's something your
  • 00:45:50
    organization uses you must practice with
  • 00:45:53
    it it takes more it takes energy and you
  • 00:45:56
    can't just put it on the rig
  • 00:45:58
    do it once a year and expect it to be a
  • 00:45:59
    clean evolution so i hope that answers
  • 00:46:02
    the question i believe there's an
  • 00:46:04
    absolute place for this but we don't use
  • 00:46:06
    it as a primary tool
  • 00:46:08
    um in our organization
  • 00:46:11
    it's definitely sort of that it's not
  • 00:46:13
    you know necessarily a primary tool but
  • 00:46:15
    having it in certain circumstances
  • 00:46:17
    especially countries when you you know
  • 00:46:20
    we might not have as many staff as you
  • 00:46:22
    can dedicate to cardiac arrest or when
  • 00:46:24
    we're talking rural and australia
  • 00:46:26
    obviously has a massive massive past
  • 00:46:29
    country then uh definitely a
  • 00:46:33
    good opportunity to to take those and
  • 00:46:35
    agree uh using that in your stock
  • 00:46:37
    standard training so so the the staff
  • 00:46:40
    really know what you're doing about that
  • 00:46:42
    wonderful
  • 00:46:43
    a few more questions we've got really on
  • 00:46:45
    the matrix what would you recommend and
  • 00:46:47
    i know you've gone through that one but
  • 00:46:49
    it's really he's talking yeah the
  • 00:46:51
    specifics more than just those
  • 00:46:53
    generalized observations what what what
  • 00:46:55
    are the matrix that you go these are
  • 00:46:58
    definitely the ones that you need to
  • 00:47:00
    look out for train with and obviously
  • 00:47:02
    then capture back from events
  • 00:47:05
    yes so that's first it's a great
  • 00:47:06
    question thanks for asking that now
  • 00:47:08
    remember
  • 00:47:09
    we still measure those metrics during uh
  • 00:47:12
    training analytics as well in fact we
  • 00:47:14
    use um the laerdal qcpr mannequin with
  • 00:47:17
    the sim pad
  • 00:47:18
    i'll be honest with you um i i gave you
  • 00:47:21
    my
  • 00:47:22
    my disclosure i have no
  • 00:47:24
    financial gain with the company but i
  • 00:47:27
    will tell you they absolutely
  • 00:47:29
    that product is what brought us out and
  • 00:47:32
    put us at a high level using that
  • 00:47:33
    product because we're real to measure
  • 00:47:35
    depth
  • 00:47:37
    we were able to measure recoil
  • 00:47:39
    we measured timing we measured
  • 00:47:41
    ventilation volume as and that was one
  • 00:47:44
    of the things that we really identified
  • 00:47:46
    when the mannequins would come from
  • 00:47:48
    manufacture they were set at four to
  • 00:47:49
    seven hundred mils
  • 00:47:51
    which was too much for us so we were
  • 00:47:53
    able to re-gauge that in the settings
  • 00:47:55
    and that re-taught our 4 000 providers
  • 00:47:58
    how to use between 350 to 500 those that
  • 00:48:01
    laird all product qcpr mannequin was our
  • 00:48:04
    go-to machine so um as you know i'm sure
  • 00:48:08
    most people if you're using post
  • 00:48:10
    analytic
  • 00:48:11
    uh real time cases you're not going to
  • 00:48:13
    get up ventilation volume from that
  • 00:48:16
    you'll get ventilation timing
  • 00:48:18
    so you've got to practice on where to
  • 00:48:20
    get that volume unless you have some
  • 00:48:21
    means uh in the either a add-on device
  • 00:48:25
    which there are some of those coming
  • 00:48:26
    around the product or through the um the
  • 00:48:30
    electrodes that'll get that but we
  • 00:48:32
    specifically identify depth
  • 00:48:35
    recoil
  • 00:48:37
    rate of compressions
  • 00:48:40
    rate of timing of ventilations
  • 00:48:42
    absolutely we look at
  • 00:48:45
    compression fraction specifically break
  • 00:48:47
    that down to pre-shock pause
  • 00:48:50
    and post-shock pause which you all know
  • 00:48:52
    is collectively called an aggregate the
  • 00:48:55
    perry shock pause those are the
  • 00:48:57
    specifics we're looking at and the last
  • 00:48:59
    part don't forget
  • 00:49:00
    we listen to every word that said
  • 00:49:02
    so we have an audio tracing we heard we
  • 00:49:05
    hear every word that you say on the case
  • 00:49:07
    and also again some people might be
  • 00:49:09
    raising an eyebrow but that's important
  • 00:49:11
    to us it helps glue the call together so
  • 00:49:14
    those are those specific
  • 00:49:16
    they're all then reviewed
  • 00:49:18
    and all of those data go very right back
  • 00:49:20
    to the providers that actually ran the
  • 00:49:23
    case so they can look at their
  • 00:49:25
    benchmarks and see if they hit the king
  • 00:49:27
    county benchmarks that we ask him or do
  • 00:49:30
    we need some more remediation
  • 00:49:32
    jed i hope that helps
  • 00:49:34
    so so you've got a system in place to
  • 00:49:37
    obviously then listen to all the
  • 00:49:39
    recordings um review the event itself
  • 00:49:42
    and then you feed back to the providers
  • 00:49:45
    so so that's straight away
  • 00:49:47
    done
  • 00:49:48
    that's correct that's correct
  • 00:49:51
    because we really believe you know
  • 00:49:53
    acquiring data is just the acquisition
  • 00:49:55
    of data it's what you do with it is what
  • 00:49:58
    really comes into play so once we get
  • 00:50:00
    those data points from every cardiac
  • 00:50:02
    arrest we then review it for compliance
  • 00:50:05
    annotate it make sure it's hipaa
  • 00:50:07
    compliant in the u.s i'm not sure if you
  • 00:50:09
    uh in the down there in australia new
  • 00:50:11
    zealand or papua new guinea have hipaa
  • 00:50:13
    but we do we want to make sure there's
  • 00:50:15
    no names of the thing
  • 00:50:17
    anyway and then we send it back to the
  • 00:50:19
    providers and sometimes it's even done
  • 00:50:21
    within 24 hours
  • 00:50:23
    in some agencies before they get off
  • 00:50:25
    shift they know how their performance
  • 00:50:27
    was and certainly they know what the
  • 00:50:29
    outcome of the patient
  • 00:50:31
    that is wonderful and i know a couple of
  • 00:50:34
    services here that will be very very
  • 00:50:36
    jealous of that wonderful feedback look
  • 00:50:38
    we are just about to finish off one last
  • 00:50:41
    question
  • 00:50:42
    how did you go about and it might be
  • 00:50:44
    sort of either now or previous years on
  • 00:50:47
    that getting everyone else on board with
  • 00:50:50
    high performance cpr so obviously
  • 00:50:52
    ambulance services is one thing
  • 00:50:54
    how do you then go about and you know do
  • 00:50:57
    you have some sort of feedback or some
  • 00:50:59
    you know from your experience
  • 00:51:01
    the
  • 00:51:02
    fire departments you know are you
  • 00:51:04
    working with maybe police
  • 00:51:06
    what are all the organizations that
  • 00:51:08
    you're hoping to target and get them to
  • 00:51:11
    start understanding high performance cpr
  • 00:51:13
    and the team the effect all of that
  • 00:51:16
    so i'll i'll make this a two-part answer
  • 00:51:18
    and i'll do the best i can so
  • 00:51:20
    the first thing when we identified
  • 00:51:23
    um that the science is really starting
  • 00:51:25
    to point some clear directions about 10
  • 00:51:28
    15 years ago
  • 00:51:29
    and i would recommend this to all of the
  • 00:51:31
    organizations out there you must have
  • 00:51:33
    strong medical control strong medical
  • 00:51:36
    oversight those physicians or whoever is
  • 00:51:39
    that that medical director
  • 00:51:41
    that understands the need to
  • 00:51:43
    operationalize the current science then
  • 00:51:46
    you couple that with mastery level
  • 00:51:48
    instructors within the organization but
  • 00:51:50
    yet still get the buy-in from the
  • 00:51:52
    providers so what i'm trying to show on
  • 00:51:54
    camera is there's got to be a top-down
  • 00:51:57
    and a bottom-up connection it can't be
  • 00:52:00
    one group point at the other and say do
  • 00:52:02
    a better job it can't work that way it
  • 00:52:05
    has to be medical directors or whoever
  • 00:52:07
    is your medical direction offering good
  • 00:52:10
    leadership
  • 00:52:11
    the team and the trainers providing the
  • 00:52:13
    education the performance and then once
  • 00:52:16
    the performance starts coming back to
  • 00:52:18
    those providers they understand the
  • 00:52:20
    value of this new job we had to train 4
  • 00:52:24
    000 in our program that's just in
  • 00:52:27
    seattle king county that's not the
  • 00:52:28
    united states that's just our program
  • 00:52:31
    it wasn't easy
  • 00:52:33
    but it wasn't hard either once we
  • 00:52:36
    convinced them we can do a better job
  • 00:52:37
    and gave them ownership
  • 00:52:39
    they took it from there now the last
  • 00:52:41
    part of the question is how do we then
  • 00:52:42
    incor incorporate others to be a part of
  • 00:52:45
    it police officers
  • 00:52:47
    how do we get them involved it's the
  • 00:52:49
    same thing we have to train we have to
  • 00:52:51
    acknowledge we have to incorporate their
  • 00:52:53
    organization their their leadership and
  • 00:52:56
    let them know that we believe
  • 00:52:58
    you can be a part of life-saving cardiac
  • 00:53:01
    arrest the public we've been doing
  • 00:53:03
    public training for cpr for decades and
  • 00:53:07
    i'll be honest with all my colleagues
  • 00:53:08
    out there one of the first things you
  • 00:53:10
    should be looking at to increase
  • 00:53:11
    survival in your community
  • 00:53:13
    is to have those dispatchers or
  • 00:53:15
    telecommunicators
  • 00:53:16
    trained
  • 00:53:17
    to do
  • 00:53:18
    um telephone assisted cpr so they're the
  • 00:53:22
    first first responders if you will
  • 00:53:24
    and then get the
  • 00:53:26
    citizens involved with it too
  • 00:53:28
    if the citizens can put hands on the
  • 00:53:30
    chest prior to your ambulance crew
  • 00:53:32
    arriving chance of success
  • 00:53:35
    rockets go straight up um one last
  • 00:53:37
    question and i think then we're gonna
  • 00:53:39
    have to let you go some pointers in when
  • 00:53:42
    you have to move the patient yeah
  • 00:53:45
    how do you sort of maintain that high
  • 00:53:47
    performance yeah i'm reading the same
  • 00:53:49
    question and i'm going to read this with
  • 00:53:51
    the idea that we need to put them from
  • 00:53:52
    the scene into the back of a rig or an
  • 00:53:55
    ambulance right
  • 00:53:56
    well um certainly uh the first thing is
  • 00:53:59
    the culture
  • 00:54:00
    we don't transport patients that are
  • 00:54:03
    still need cpr
  • 00:54:05
    we run a cardiac arrest at location
  • 00:54:08
    until we generate rosk
  • 00:54:10
    pulses
  • 00:54:11
    and we only move once we have rosk
  • 00:54:15
    now that said can they reoffend in the
  • 00:54:17
    back of the rig they can now i
  • 00:54:19
    understand that not everybody's like
  • 00:54:21
    that i understand that so here's what i
  • 00:54:23
    would suggest for those agencies that
  • 00:54:25
    are required
  • 00:54:27
    if they're so far out and maybe the
  • 00:54:29
    medical direction says we need you to
  • 00:54:30
    bring them into the hospital or whatever
  • 00:54:33
    this is where those cpr assist devices
  • 00:54:35
    can really come in handy right you can
  • 00:54:38
    apply the assist device the chest
  • 00:54:40
    compression assist device put them on a
  • 00:54:42
    backboard put them on a gurney and you
  • 00:54:44
    can continue compressions down a hallway
  • 00:54:47
    down a stairwell
  • 00:54:49
    but i'll tell you but remember where
  • 00:54:51
    we're from
  • 00:54:52
    we don't transport cpr and progress
  • 00:54:55
    patients we run the codes at the scene
  • 00:54:58
    until we establish rosk and if we don't
  • 00:55:01
    then we'll call in and we'll make sure
  • 00:55:03
    we have
  • 00:55:04
    agreement and then we will end the
  • 00:55:07
    resuscitation in the field
  • 00:55:09
    thank you so much for your time um the
  • 00:55:12
    presentation was wonderful and uh like i
  • 00:55:14
    said it's so it's so incredible and so
  • 00:55:17
    inspiring seeing the work that you are
  • 00:55:19
    doing and you know you could have ended
  • 00:55:22
    you know or stopped years years back and
  • 00:55:24
    when you know we're doing an awesome job
  • 00:55:26
    but i love that you keep on just
  • 00:55:29
    chipping away and what else like what's
  • 00:55:31
    the extra few seconds or that so i think
  • 00:55:34
    that's inspirational and wonderful
  • 00:55:36
    guidance from you for the for the rest
  • 00:55:39
    of us so thank you on that one i'll say
  • 00:55:42
    goodbye to you for now and i have a
  • 00:55:44
    lovely christmas and happy holidays
  • 00:55:47
    thank you very much
  • 00:55:49
    thank you and i'll say that if anybody
  • 00:55:50
    wants to get a hold of me out there i'm
  • 00:55:52
    not sure how they can connect through
  • 00:55:53
    you guys but i'm available if you want
  • 00:55:55
    to get a hold of me send me an email
  • 00:55:57
    send me connect and we will chat more
  • 00:56:00
    perfect thank you very much yes anybody
  • 00:56:02
    that wants to connect uh just uh uh
  • 00:56:05
    contact us directly and then we will get
  • 00:56:06
    you in touch thank you so much mike
  • 00:56:08
    perfect
  • 00:56:10
    um to everyone else thank you so much
  • 00:56:12
    for continuing to join the cia webinars
  • 00:56:16
    we are going to take a little break in
  • 00:56:17
    january
  • 00:56:19
    and we are going to be back in february
  • 00:56:21
    we've got an exciting exciting plan for
  • 00:56:23
    next year so from february through to
  • 00:56:25
    december we'll be back with our monthly
  • 00:56:28
    webinars on various topics everything
  • 00:56:30
    from women in leadership clinical
  • 00:56:33
    sustainability patient safety you name
  • 00:56:36
    it we will be looking after that don't
  • 00:56:38
    forget to jump on our website once those
  • 00:56:41
    programs and webinars are available in
  • 00:56:43
    bios and and abstract they will be up
  • 00:56:47
    and running and you can continue to
  • 00:56:49
    register and also cpd points are still
  • 00:56:52
    available so just email us with those
  • 00:56:55
    ones um thank you again for joining us
  • 00:56:57
    this year and supporting the webinars
  • 00:57:00
    have a lovely uh christmas and happy
  • 00:57:02
    holidays and goodbye for now from all of
  • 00:57:05
    us here at tmca thank you
  • 00:57:09
    thanks for joining us for high
  • 00:57:10
    performance cpr and insider's story
  • 00:57:12
    presented by mike helbach and proudly
  • 00:57:14
    supported by liedel
  • 00:57:16
    we're taking a break we'll be back with
  • 00:57:18
    more webinars in the new year starting
  • 00:57:20
    the 22nd of february
  • 00:57:23
    in the meantime be sure to follow us on
  • 00:57:24
    social media twitter at caa australasia
  • 00:57:28
    facebook and linkedin the council of
  • 00:57:29
    ambulance authorities australasia
  • 00:57:32
    thanks for joining us in 2021 and we
  • 00:57:34
    look forward to seeing you again in the
  • 00:57:36
    new year
Tags
  • CPR
  • High Performance CPR
  • Cardiac Arrest
  • Mike Helbach
  • Training
  • Performance Measurement
  • Seattle King County
  • Resuscitation Academy
  • EMS
  • Team Coordination