Mobile CPR

Resus Team Leader - Why?

‘There should be a team leader who is responsible for directing and co-ordinating the resuscitation’ (ANZCOR 2014). ‘Key leadership skills in resuscitation include critical decision-making and clear communication, especially with regard to task allocation and planning (Clarke et al. 2015). ‘The role of the team leader during CPR is known to be pivotal’. A randomised controlled study that involved crisis resource management (CRM) leader training found ‘emphasis on team leader behaviour appears to be beneficial in resuscitation.’ (Castelao et al., 2015).

Aide-Memoire

The use of an aide-memoire (stored in the defibrillator case) will allow the resuscitation team leader to check and progress through skills and tasks of care. As we see so few actual resuscitation cases compared to all other case types, the aide-memoire will reduce our cognitive load and stress during these low frequency-high risk and high emotion cases. The cards are 2-sided, one side for the cardiac arrest patient and the other side for use if/when ROSC is achieved. The cards are split into BLS, ALS and special circumstances. Ambulance Officers should follow the BLS checks and review the special circumstances. If ALS providers attend the case, the ALS sections can then be utilised.

As we review SAAS resuscitation practices it has become clear: 1. We need to continue resuscitative efforts much longer than we previously have in many cases. 2. There is a particular set of cardiac arrest patients who would benefit from transport to a health facility. Ambulance Officers (in the absence of ALS providers) need to consult with the EOC Clinician during an adult cardiac arrest at the 10-minute mark to discuss the case and treatment plan. For paediatric cardiac arrest, an EOC Clinician consult should occur ASAP. Discuss with the EOC Clinician regarding mobilising to local health services vs. continuing resuscitation on-site and waiting for clinical support options. Refer to the relevant Clinical Practice Protocols (access via SAASnet/Office 365 or SAAS Clinical App):

Clinical Practice Protocol - Cardiac Arrest (Adult) - Ambulance Officer [CPP-002-AO]

Clinical Practice Protocol - Cardiac Arrest (Paediatric) - Ambulance Officer [CPP-043-AO]

Ambulance Responders and Ambulance Assist working in the absence of an Ambulance Officer (or ALS provider) should refer to their relevant resuscitation Clinical Practice Protocols.

As a rule, for Ambulance Officers dealing with cardiac arrest patients should “Get Help” or consider “Getting to Help”. Clinical Support can come in the form of: • Paramedic or ICP ambulance crews • Paramedic or ICP solo responders including RTL, CTL, CSO, other managers and staff travelling through your area • RERN Medical Officers • Remote Area Nurses in some locations • Ambulance Officers with Extended Practice credentialing (who can perform certain ALS skills under protocol/consult). If the decision is made to mobilise to a health facility with the patient under CPR, the following needs to be considered: • Any patient movement e.g. extrication from the house, movement to the stretcher, movement of the stretcher to the ambulance and transport in the ambulance to the health facility needs to be planned and safe • Chest compressions ideally should not be stopped for any longer than 10 seconds. This means patient movement is not necessarily going to be rapid. HP-CPR shouldn’t be compromised during movement • Mobile CPR will be particularly difficult without an i-Gel® in place • You will need adequate help to make this happen. This may be other SAAS crews, emergency services or bystanders • Ideally, the pit crew team leader should be in place and directing the movement and resuscitation • Crew and patient safety. Some key points: • Slow, controlled movement: “slow down, we are in a hurry”. • Chest compressions continue while moving the Stryker stretcher. The Stryker allows us to have the correct height to perform quality CPR. Effective compressions are possible on the Stryker mattress. • All moves are pre-planned. Ideally no more than 10 seconds “hands of chest time”. However, you should note with the Stryker powerload system, hands-off chest time when loading in the ambulance will be approximately 13-15 seconds. You cannot do compressions while using the powerload system. • Once in the back of the ambulance, everyone wears a seat belt except the clinician providing chest compressions. • The pit crew resuscitation team leader sits in the front passenger seat and directs the resuscitation from this position. Documentation, ongoing communication with the EOC Clinician and notification to receiving health facility are their responsibility.

Clinical Practice Protocol - Cardiac Arrest (Adult) - Ambulance Responder [CPP-028-AR]

Clinical Practice Protocol - Cardiac Arrest (Paediatric) - Ambulance Responder [CPP-043-AR]

Clinical Practice Protocol - Cardiac Arrest (Adult) - Ambulance Assist [CPP-002-AA]

Clinical Practice Protocol - Cardiac Arrest (Paediatric) - Ambulance Assist [CPP-043-AA]