Sunday, December 11, 2005

New Resuscitation Guidelines

The procedures we follow for resuscitating patients in cardiac arrest are set out by the European Resuscitation Council, and the UK Resuscitation Council.

Well we expected the new version of the resuscitation guidelines to include some changes, but I don't think it was expected that virtually the whole bloody lot would change.

Pulse checks are definately out for Lay people, as is looking for signs of life. You now do 30 chest compressions to 2 ventilations instead of 15 to 2, and you don't start with rescue breathing anymore, you launch straight into the 30 compressions. And if you don't like the idea of doing mouth to mouth, then you just do chest compressions only while waiting for the ambulance to arrive.

Not only that, but if someone is breathing "abnormally" - that is to say, taking the odd gasp now and again every few seconds, then you also start CPR straight away. The only problem with this is that some people's respiration rates are quite slow anyway, which is normal for them, and I envisage us in future running to calls that are given as cardiac arrest only to arrive and find the patient trying to fight off their would-be rescuer.

The "compression only" cpr has been trialled by the LAS along with an ambulance firm in Seattle in order to collect evidence. It is not an exaggeration to say that my former crewmate and I noticed overnight the increased number of patients being "blued" in to hospital as post cardiac arrest, so we aren't at all surprised by this change.

However, the way an AED (Automatic External Defibrillator) is operated with a cardiac arrest has changed. Thse that have used one before will know that up until now, a patient whose heart is in what's called a "shockable rhythm" has received a salvo of up to three shocks at a time, with a minute's CPR in between each salvo. Now, you do two minutes CPR, deliver a shock (if in a shockable rhythm), immediately recommence another two minutes of CPR, then shock again, then another two minutes of CPR etc.

For paramedics and hospital staff, the drugs protocols have changed too, with adrenaline being given after every two rounds of CPR (30:2) which works out at approximately every 4 to 5 minutes.

This means that all AEDs have to be re-programmed. This is a huge task, considering all the AEDs in public places now, such as railway stations, airports, shopping centres etc.

It's a huge task for the LAS alone - I have no idea how many AEDs are owned by the LAS, but when you consider there is one on every ambulance (including the Patient Transport ambulances), FRU, Cycle Response Unit, Motorcycle Response Unit, and Duty Station Officer car, it has to be a vast number.

Knowing our luck, we'll spend the next few months and probably thousands of pounds getting these things re-programmed, and next year they'll decide that the original three shock salvo was the better option after all.

Not cynical at all.....

Update: I've just stumbled across the blog of an american paramedic who is really against these new guidelines. His reasons make an interesting read. You can find his blog here. Thanks to Mark Myers for putting the link to this chap's site on his page.


Anonymous Mark Myers said...

The 30:2 thing is news to me -- wonder when they're going to tell us? We've been trialling the no breaths thing for a while -- at the moment we pull a card out at random whenever we get a "suspended" which dictates whether we offer breaths and compressions or just compressions. According to management, less people refuse when it's compressions only, but I haven't noticed a difference. In my experience, people would either do anything to try and resuscitate the patient, or they won't even go near.

We are not supposed to start CPR if someone is breathing abnormally, only if the pattern appears to us to be agonal. Of course, what you say about people whose usual breathing rate is slow still stands, and I guess we will end up instructing a few people to resuscitate non-dead people. But all except the deeply unconscious will be able to put up a fight, and apparently a lot of people have died in the past because agonal breathing wasn't recognised quickly enough. So on the whole I think this is a good thing.

11:29 pm  
Anonymous Mark Myers said...

(That's "we" as in Ambulance Control, in the context of 999 calls, for anyone who doesn't know me!)

11:37 pm  
Blogger Steve said...

Hi Mark

Just a guess, but you may not have been told as apparently we (as the service) are holding back and continuing with 15:2 until the AEDs have all been re-programmed.

And Agonal breathing is what is meant by the abnormal breathing - I don't envy you guys trying to explain that one to the panicking relatives

12:27 am  
Anonymous Mark Myers said...

Ah, that would make sense then. Good old nee naw service, always with the times ;)

I read through the article you posted and am really worried that they treat "agonal breathing" and "abnormal breathing" as one and the same. As you no doubt know, lots of rubbish calls come out as category As as it is because of "abnormal breathing"... at this rate we're going to end up resuscitating patients with broken fingernails :/

11:59 am  

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