Recommended Guidelines for Uniform Reporting of Pediatric Advanced Life Support: The Pediatric Utstein Style

PEDIATRICS ◽  
1995 ◽  
Vol 96 (4) ◽  
pp. 765-779 ◽  
Author(s):  
Arno Zaritsky ◽  
Vinay Nadkarni ◽  
Mary Fran Hazinski ◽  
George Foltin ◽  
Linda Quan ◽  
...  
Keyword(s):  
Life Support ◽  
Task Force ◽  
Age Groups ◽  
Advanced Life Support ◽  
Data Set ◽  
Consensus Document ◽  
Eastern Virginia Medical School ◽  
Pediatric Resuscitation ◽  
Recommended Guidelines

This consensus document is an attempt to provide an organized method of reporting pediatric ALS data in out-of-hospital, emergency department, and in-hospital settings. For this methodology to gain wide acceptance, the task force encourages development of a common data set for both adult and pediatric ALS interventions. In addition, every effort should be made to ensure that consistent definitions are used in all age groups. As health care changes, we will all be challenged to document the effectiveness of what we currently do and show how new interventions or methods of treatment improve outcome and/or reduce cost. Only through collaborative research will we obtain the necessary data. For these reasons, and to improve the quality of care and patient outcomes, it is the hope of the task force that clinical researchers will follow the recommendations in this document. It is recognized that further refinements of this statement will be needed; these recommendations will improve only when researchers, clinicians, and EMS personnel use them, work with them, and modify them. Suggestions, emendations, and other comments aimed at improving the reporting of pediatric resuscitation should be sent to Arno Zaritsky, MD, Eastern virginia Medical School, Children's Hospital of The King's Daughter, Division of Critical Care Medicine, 601 Children's Lane, Norfolk, VA 23507.

Recommended Guidelines for Uniform Reporting of Pediatric Advanced Life Support: The Pediatric Utstein Style

Circulation ◽  
1995 ◽  
Vol 92 (7) ◽  
pp. 2006-2020 ◽  
Author(s):  
Arno Zaritsky ◽  
Vinay Nadkarni ◽  
Mary Fran Hazinski ◽  
George Foltin ◽  
Linda Quan ◽  
...  
Keyword(s):  
Life Support ◽  
Advanced Life Support ◽  
Recommended Guidelines ◽  
Utstein Style

Job Stressors and Job Satisfaction in a Major Metropolitan Public EMS Service

1999 ◽  
Vol 14 (4) ◽  
pp. 32-35 ◽  
Author(s):  
J. Shelby Bowron ◽  
Knox H. Todd
Keyword(s):  
Job Satisfaction ◽  
Career Choice ◽  
Emergency Medical Services ◽  
Life Support ◽  
Advanced Life Support ◽  
Emergency Medical Technicians ◽  
Medical Services ◽  
Job Stressors ◽  
Emergency Medical

AbstractIntroduction:Behavioral and social science research suggests that job satisfaction and job performance are positively correlated. It is important that Emergency Medical Services managers identify predictors of job satisfaction in order to maximize job performance among prehospital personnel.Purpose:Identify job stressors that predict the level of job satisfaction among prehospital personnel.Methods:The study was conducted with in a large, urban Emergency Medical Services (Emergency Medical Services) service performing approximately 60,000 Advanced Life Support (Advanced Life Support) responses annually. Using focus groups and informal interviews, potential predictors of global job satisfaction were identified. These factors included: interactions with hospital nurses and physicians; on-line communications; dispatching; training provided by the ambulance service; relationship with supervisors and; standing orders as presently employed by the ambulance service. These factors were incorporated into a 21 item questionnaire including one item measuring global job satisfaction, 14 items measuring potential predictors of satisfaction, and seven questions exploring demographic information such as age, gender, race, years of experience, and years with the company. The survey was administered to all paramedics and Emergency Medical Technicians (Emergency Medical Technicians s) Results of the survey were analyzed using univariate and multivariate techniques to identify predictors of global job satisfaction.Results:Ninety paramedics and Emergency Medical Technicians participated in the study, a response rate of 57.3%. Job satisfaction was cited as extremely satisfying by 11%, very satisfying by 29%, satisfying by 45%, and not satisfying by 15% of respondents. On univariate analysis, only the quality of training, quality of physician interaction, and career choice were associated with global job satisfaction. On multivariate analysis, only career choice (p = 0.005) and quality of physician interaction (p = 0.05) were predictive of global job satisfactionConclusion:Quality of career choice and interactions with physicians are predictive of global job satisfaction within this urban emergency medical service (Emergency Medical Technicians). Future studies should examine specific characteristics of the physician-paramedic interface that influence job satisfaction and attempt to generalize these results to other settings.

Pediatric Resuscitation

2020 ◽  
pp. 67-74
Author(s):  
Matthew Mendes ◽  
Taylor McCormick
Keyword(s):  
Respiratory Failure ◽  
Life Support ◽  
Early Recognition ◽  
Cardiopulmonary Arrest ◽  
Advanced Life Support ◽  
High Stakes ◽  
Pediatric Resuscitation ◽  
Critically Ill Child ◽  
Equipment Sizing ◽  
Equipment System

Respiratory failure is the most common cause of cardiopulmonary arrest in children. Early recognition of the critically ill child and aggressive management of respiratory failure and shock are crucial to preventing cardiopulmonary arrest. Although caring for a sick child can be highly stressful for emergency physicians, pediatric resuscitation largely mirrors that of adults, with special consideration of a few key anatomic and physiologic differences. It is important to have a systematic approach to patient assessment, medication dosing, and equipment sizing in order to cognitively offload the emergency provider. The following will help maximize performance in these high-stakes situations: the Pediatric Assessment Triangle combined with the familiar airway, breathing, circulation, disability, exposure approach; an age-, weight-, or length-based medication/equipment system; and routine application of Pediatric Advanced Life Support algorithms.

Age-related Utilization of Advanced Life Support Services

1991 ◽  
Vol 6 (1) ◽  
pp. 9-14 ◽  
Author(s):  
Steven A. Meador
Keyword(s):  
Life Support ◽  
Age Groups ◽  
Rank Correlation ◽  
Advanced Life Support ◽  
The Elderly ◽  
Population Projections ◽  
Patient Treatment ◽  
Related Case ◽  
Spearman’S Rank Correlation ◽  
Age Related

AbstractPurpose:To investigate the relationship between age and Advanced Life Support (ALS) utilization.Population:All patients from 1 January 1987 to 31 December 1988 transported by ALS ambulances within Lebanon County, a rural/urban county of 112,000.Methods:All runs resulting in patient treatment by ALS personnel were tallied at five-year age intervals and sub-grouped by trauma- and non-trauma-related calls. Utilization rates for each age group were obtained by dividing the calls by the population of each group. Correlation with age was tested by Spearman's rank correlation. Treatment rates for age groups were calculated for the six most frequent medical etiologies. To illustrate the effect of age distributions, age rates were applied to projected state and national population distributions.Results:There was a significant correlation with age for all transports (p < .01; r=.93) and for those not related to trauma (p<.01; r=.98). Correlation was not detected for trauma-related responses (p>.10; r=.19). Non-trauma-related case incidence varied among age groups, ranging from 1.1/1,000 for age five through nine years to 89/1,000 for age 80–84 years. Congestive heart failure, cardiac ischemia, syncope, myocardial infarction, and cardiac arrest evidenced increased incidence with age. Seizure did not. Older populations had a higher projected utilization of ALS services than did the younger age groups.Conclusion:Non-trauma ALS utilization is highly dependent on the age of the patient. Due to projected aging of the population and increased utilization of ALS by the elderly, projected utilization will increase at a rate faster than will the population. Age:rate data can be combined with population projections to estimate future need.

scholarly journals LO38: Does spaced instructional design result in improved retention of pediatric resuscitation skills? A randomized education study

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S20-S20
Author(s):  
C. Patocka ◽  
A. Cheng ◽  
M. Sibbald ◽  
J. Duff ◽  
A. Lai ◽  
...  
Keyword(s):  
Rating Scales ◽  
Life Support ◽  
Spacing Effect ◽  
Advanced Life Support ◽  
Course Completion ◽  
Skill Learning ◽  
Global Rating ◽  
Procedural Skills ◽  
Pediatric Resuscitation ◽  
Significant Difference

Introduction: Survival from cardiac arrest has been linked to the quality of resuscitation care. Unfortunately, healthcare providers frequently underperform in these critical scenarios, with a well-documented deterioration in skills weeks to months following advanced life support courses. Improving initial training and preventing decay in knowledge and skills are a priority in resuscitation education. The spacing effect has repeatedly been shown to have an impact on learning and retention. Despite its potential advantages, the spacing effect has seldom been applied to organized education training or complex motor skill learning where it has the potential to make a significant impact. The purpose of this study was to determine if a resuscitation course taught in a spaced format compared to the usual massed instruction results in improved retention of procedural skills. Methods: EMS providers (Paramedics and Emergency Medical Technicians (EMT)) were block randomized to receive a Pediatric Advanced Life Support (PALS) course in either a spaced format (four 210-minute weekly sessions) or a massed format (two sequential 7-hour days). Blinded observers used expert-developed 4-point global rating scales to assess video recordings of each learner performing various resuscitation skills before, after and 3-months following course completion. Primary outcomes were performance on infant bag-valve-mask ventilation (BVMV), intraosseous (IO) insertion, infant intubation, infant and adult chest compressions. Results: Forty-eight of 50 participants completed the study protocol (26 spaced and 22 massed). There was no significant difference between the two groups on testing before and immediately after the course. 3-months following course completion participants in the spaced cohort scored higher overall for BVMV (2.2 ± 0.13 versus 1.8 ± 0.14, p=0.012) without statistically significant difference in scores for IO insertion (3.0 ± 0.13 versus 2.7± 0.13, p= 0.052), intubation (2.7± 0.13 versus 2.5 ± 0.14, p=0.249), infant compressions (2.5± 0.28 versus 2.5± 0.31, p=0.831) and adult compressions (2.3± 0.24 versus 2.2± 0.26, p=0.728) Conclusion: Procedural skills taught in a spaced format result in at least as good learning as the traditional massed format; more complex skills taught in a spaced format may result in better long term retention when compared to traditional massed training as there was a clear difference in BVMV and trend toward a difference in IO insertion.

Pediatric Advanced Life Support (PALS): The Pharmacist's Role

1996 ◽  
Vol 9 (1) ◽  
pp. 42-56
Author(s):  
Paul C. Blahunka
Keyword(s):  
Pharmaceutical Care ◽  
Life Support ◽  
Advanced Life Support ◽  
Heart Association ◽  
Role Playing ◽  
Medication Administration ◽  
Patient Specific ◽  
Needle Stick Injury ◽  
Pediatric Resuscitation ◽  
Syncytial Virus

The provision of pharmaceutical care to the patient undergoing cardiopulmonary resuscitation (CPR) is an important evolving concept. Pediatric resuscitation and advanced cardiac life support (ACLS) presents a particularly challenging situation for the practicing pharmacist. Etiologies of pediatric arrests include pulmonary conditions such as bronchopulmonary dysplasia, respiratory distress syndrome, respiratory syncytial virus (RSV) infection, and a myriad of accidental factors. Important initial determinations on arriving at a pediatric arrest are described, such as determining the correct weight of the patient, assessing the need for vascular access and/or intubation, and establishing the "code" leader. Recent American Heart Association guidelines for the pharmacotherapy of pediatric ACLS are discussed in detail. Included are recommendations on oxygen delivery, routes of fluid and medication administration, recent changes in epinephrine dosing, and guidelines for the proper use of adjunct medications. A detailed description of a method of using adult emergency drug syringes in the pediatric arrest is provided. Proper use of this method can expedite drug dispensing in an arrest, minimize the potential for needle-stick injury, and optimize the delivery of a patient-specific dose of medication. A "mock code" program is described that includes involvement with pharmacists, nurses, medical residents, and respiratory therapists. This program provides a hands-on role-playing model of a simulated pediatric arrest and serves as a valuable teaching tool for those charged with the responsibility of patient care during an actual arrest. While the ultimate role of the pharmacist in the pediatric arrest continues to be defined, developing the competency to provide pharmaceutical care in this clinical setting can be extremely rewarding. Copyright © 1996 by W.B. Saunders Company

scholarly journals Сardiopulmonary and cerebral resuscitation: new European Resuscitation Council Guidelines for resuscitation 2021

2021 ◽  
Vol 17 (8) ◽  
pp. 6-19
Author(s):  
L.V. Usenko ◽  
А.V. Tsarev ◽  
Yu.Yu. Kobelatsky
Keyword(s):  
Cardiac Arrest ◽  
Healthcare Workers ◽  
Basic Life Support ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Advanced Life Support ◽  
European Resuscitation Council ◽  
Improved Outcomes ◽  
Electrical Defibrillation

The article presents the current changes in the algorithm of cardiopulmonary and cerebral resuscitation (CPCR), adopted by the European Council for Resuscitation in 2021. The article presents the principles of basic life support and advanced life support, inclu-ding taking into account the European recommendations published in 2020, dedicated to the specifics of CPCR in the context of the COVID-19 pandemic. The main focus of CPCR in the COVID-19 pandemic is that the safety of healthcare workers should never be compromised, based on the premise that the time it takes to ensure that care is delivered safely to rescuers is acceptable part of the CPCR process. The principles of electrical defibrillation, including in patients with coronavirus disease who are in the prone position, pharmacological support of CPCR, modern monitoring capabilities for assessing the quality of resuscitation measures and identifying potentially reversible causes of cardiac arrest, the use of extracorporeal life support techno-logies during CPR are highlighted. The modern principles of intensive care of the post-resuscitation syndrome are presented, which makes it possible to provide improved outcomes in patients after cardiac arrest.

Automatic compression improves adherence to advanced life support protocol in two-paramedic team. A randomized simulation study

2020 ◽  
Keyword(s):  
Human Error ◽  
Life Support ◽  
Advanced Life Support ◽  
Supraglottic Airway ◽  
Control Group ◽  
Delivery Time ◽  
Chest Compressions ◽  
Adherence To Guidelines ◽  
Experimental Group

Introduction: The use of protocols reduces the risk of human error and increases healthcare professionals’ adherence to guidelines. In a team of only two providers, following Advanced Life Support (ALS) protocol might be challenging. Automated Chest Compressions Devices (ACCD) may increase the quality of chest compressions. The aim of this study was to evaluate if the use of ACCD in resuscitation by a two-paramedic crew improves adherence to the ALS protocol. Materials and Methods: This study was designed as a prospective randomized high-fidelity cross-over simulation trial. Fifty-two doubleperson teams were enrolled. Each team performed two full resuscitation scenarios: one with ACCD (the experimental group-ACC) and one with manual compressions (the control group-MAN). Results: ACC achieved shorter mean durations of resuscitation loops, being less prolonged in relation to recommended durations than MAN (13 vs. 23 sec over recommended respectively, P = 0.0003). ACC also achieved mean times for supraglottic airway completion significantly faster than MAN: 224 ± 66 s vs 122 ± 35 s (P < 0.0001). In ACC, the intravenous line was obtained earlier then in MAN (162 ± 35 s vs 183 ± 45 s, P = 0.0111). Moreover, the first and second doses of adrenaline (epinephrine) were administered earlier 272± 58 s vs 232 ± 57 s (P = 0.0014) for the first and 486 ± 96 s vs 424 ± 69 s (P = 0.0007) for the second doses, respectively. Mean chest compression fraction (CCF) in MAN group was significantly lower (74 ± 4%) than in ACC group (83 ± 2%) (P < 0.0001). Conclusions: In a simulated setting, ACCD used by two-person paramedic teams yielded earlier achievement of resuscitation endpoints and improved delivery time of compressions. which may have implications for effective clinical resuscitation.

Abstract 146: Evaluation of Out-of-hospital Ventricular Fibrillation Cardiac Arrest Management, With a Simulation Method

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Cécile Ursat ◽  
Guillaume Douge ◽  
Charles Groizard ◽  
Anna Ozguler ◽  
Michel Baer ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Advanced Life Support ◽  
Simulation Method ◽  
Quality Parameters ◽  
Real Patient ◽  
Decision Algorithm ◽  
St Segment Elevation ◽  
Monitoring Devices

Introduction: Feed-back on quality of CPR is an important aspect to consider on cardiac arrest management. This has been pointed out during trainings organized for emergency medicine residents. In parallel, RéAC registry (registry on cardiac arrests in France) showed some difficulties in following guidelines of VF.The aim of this study was to evaluate the performance of Emergency Medical Service (EMS) in the management of patients in cardiac arrest through the use of external chest compression (CC) data from the Resusci Anne Simulator manikin from Laerdal (SimMan®), equipped with SimPad SkillReporter. Methodology: During 2nd to 6th of March 2015, 18 EMS teams (1 physician, 1 paramedic and 1 nurse) were asked to manage a VF on a Resusci Anne Simulator manikin. This allowed the direct measurement of CC quality parameters and the evaluation of decision algorithm, through the use of a same scenario. The scenario was introduced to each team at the beginning of each session. At first, the “patient” was still conscious, on a stretcher and had a ST-segment elevation myocardial infarction. While the patient was installed in the ambulance, he suddenly had a FV cardiac arrest that could be detected on monitoring devices (time 0 of simulation). VF lasted for 10 minutes, followed by 5 minutes of asystole. The manikin software displayed the different parameters as the scenario progressed. The simulation was performed on a stretcher in an EMS premise, with the same equipment and monitoring devices as in an advanced life support ambulance (ALS). Results: CC were performed 71% of CPR time. CC depth was considered as non-compliant to guidelines in 28% of cases, with a mean depth of 4.4 cm, compressions with complete release in 37% of cases. Mean compression rate was 122/minute and was correct in 49% of cases. One third used Amiodarone after the third shock. 13/18 teams resumed chest compressions immediately after defibrillation attempts. Conclusion: This study shows the difficulty to strictly follow guidelines. According to participants, the massage was considered as more difficult with a manikin rather than on a real patient. Although cardiac arrest occurring during transportation is quite rare, quality of CPR at pre-hospital level should be improved.

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