Category Archives: Training

How To Perform CPR: The Crucial Steps You Should Know (and Share!)

This important article (and the associated graphics) is reprinted as a guest blog with permission from Monica Gomez, a freelance health and healthcare writer. Originally published at http://carrington.edu/blog/medical/how-to-perform-cpr/.  The animated GIF images alone are worth sharing!

Anybody can and anybody should learn how to perform CPR (Cardiopulmonary resuscitation): According to the American Heart Association, a stunning 70% of Americans don’t know how what to do if somebody is experiencing a cardiac emergency because they don’t know how to administer CPR or they forgot the exact technique. This is especially alarming since almost 90% of cardiac arrests occur at home — where patients depend on the immediate respiratory care response of their family members. In brief, knowing how to perform CPR can save the life of a loved one someday. CPR-How-To CPR-How-To-AdultsCPR-How-To-ChildrenCPR-Cats-and-Dogs

While 400,000 cardiac arrests happen outside of hospitals each year in the U.S. alone, hands-on CPR can actually double or triple an adult’s chance of survival. However, you need to act quickly. At four minutes without oxygen, the patient will suffer from permanent brain damage. At eight to ten minutes, the patient can die. Almost 90% of cardiac arrest patients die because no one performed CPR at the scene.

Before You Start CPR

First of all, check if the patient can respond by tapping them on the shoulder and shouting “Are you okay?? If they don’t respond, call for medical emergency services immediately. If others are around, instruct them to call 911 and if you’re alone, do it yourself. If the patient is an animal, call the closest animal hospital. If you happen to be near an AED (defibrillator), read the instructions and give one shock to the patient (this applies to humans only).

CPR Steps For Adults and Children 9 and Older: Hands-Only CPR

  1. Lay the patient on their back and kneel next to their neck and shoulders.
  2. Place the heel of one hand on the center of the patient’s chest.
  3. Place the heel of your other hand over the first and lace fingers together.
  4. Keep your elbows straight and align your shoulders directly over your hands.
  5. Begin compression:
  • As hard as possible
  • At least 100x/minute
  • Allow the chest to rise fully between compressions.

TIP: Give compressions to the beat of disco hit “Stayin’ Alive?!

CPR Steps For Younger Children and Infants

  1.  Tilt the head back a bit and lift chin to open the airway and check for breathing.
  2. If there’s no breathing, give either of these two rescue breaths:
  • Child: Pinch the nose shut and make a complete seal over their mouth
  • Infant: Make a complete seal over their mouth and nose.
  1. Blow in for one second, so the chest visibly rises and repeat this once.
  2. Give 30 chest compressions (100x/minute):
  • Child: Push with one or two hands about two inches deep
  • Infant: Push with two to three fingers about 1.5 inches deep.
  1. Repeat these steps three to four times.

 

Pet CPR – For Dogs and Cats

[Follow these CPR instructions for puppies]

For Animals Under 10kg/22lbs:

  1.  Use the one-handed technique, wrapping the hand over sternum and chest.
  2. Give 30 chest compressions (100-120x/minute).
  3. Allow the chest to fully recoil between compressions.
  4. Give two mouth-to-snout rescue breaths after each set of compressions (30:2).

For Medium to Giant Dogs:

  • Position the animal on its side.
  • Use the two-handed technique, placing your hands over the widest part of the chest.

For Deep, Narrow-Chested Dogs Like Greyhounds:

  • Use the two-handed technique, placing your hands directly over the heart.

For Barrel-Chested Dogs Like English Bulldogs:

Place animal on its back and use the same positioning and technique as for adult humans Whether you perform CPR on an adult, child, infant, or pets, DO NOT STOP unless:

  • The patient starts breathing
  • An EMS or another citizen responder takes over
  • An AED is ready to use
  • The scene becomes unsafe
  • You are physically incapable of continuing

Make sure to practice and/or brush up your CPR abilities today, so you’re ready to potentially save someone’s life in the future! Furthermore, if you’re interested in making it your profession to help people suffering from respiratory conditions like asthma, bronchitis, lung cancer, heart attack, stroke, chronic obstructive pulmonary disease (COPD) or sleep apnea, you should look into Carrington College’s respiratory care program. This two-year program combines classroom lectures, laboratory instruction, and clinical experience in order to prepare you to work in a variety of healthcare settings. If you’d like to assist and educate people regarding respiratory health concerns, our training program is the ideal fit for you!

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Filed under Dispatch & Communications, Emergency Communications, EMS Health & Safety, EMS Topics, Fire Rescue Topics, Patient Management, Technology & Communications, Training, Training & Development, Videos

Is Our Success Killing Us?

Should we really be upset when people in the community listen to us? After all, EMS protocols and people are notorious for creating our own problems. We write the public a “blank check? saying that if they believe it is an emergency to call 9-1-1 immediately and as a result we have created an increase in calls for non-emergent complaints. We continue to treat every call we can by transporting to the hospital and create a class of consumers called “frequent flyers”. When we need funding, we tell the public that “seconds matter? and we define a parameter that the public uses against us to measure our success. Perhaps they listen much closer than we typically give them credit.

So what happens once we figure out they have heard us – we change our story! And we feel that we must do it dramatically in order to make the point that “we don’t do it like that anymore.? At some point we began to use MAST or PASG as a primary treatment against shock but eventually removed them from every ambulance as they fell from favor by delaying definitive care for a short-term gain. At first it was critical to get cardiac arrest patients to the ED, but now we set policies to work them on scene for better survivability. We drill into each responder that every single fall must be suspected to have a spinal injury and now some have begun to campaign to remove long spine boards from vehicles. Evidence showed us that tourniquets should be used only as last resort measures before learning evidence now shows that proper application early can have the best effect. And then we learn that there is nothing magical that actually requires a doctor to remove them as well! It seems that the “evidence-based? trend in EMS requires that being “progressive? means we lay in wait for some “proof? in order to jump on a previously long held belief so we can debunk it as some old “wive’s tale.? But why must we always go to an extreme new position? Our industry is designed to resist “fashions? by accepting change of practice slowly for safety reasons. While personal beliefs can be more fluid, it takes a while for the protocols to catch up. Perhaps we need to moderate both ends.

Change within a system is not expedited by extreme positioning, but reasoned and thoughtful conversation. The article on Things Your System Should Deliver is well written and certainly worth the read and consideration. You don’t have to become a zealot for change, a thoughtful advocate is powerful enough. Learn from the process we work within and work with it instead of against it if you want it to update more quickly. Engage in dialog with medical direction AND politicians AND the communities you serve. It is through these channels that change is truly affected and we will find the success we can live with.

 

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Filed under Administration & Leadership, EMS Health & Safety, EMS Topics, Firefighting Operations, Funding & Staffing, Training, Training & Development

A Short Take on Long Boards

The National Association of EMS Physicians and the American College of Surgeons Committee on Trauma have made their Position Statementon spinal immobilization for EMS publicly available. So, now what?

It is hard to argue with their findings:

  • Long backboards are commonly used to attempt to provide rigid spinal immobilization among emergency medical services (EMS) trauma patients. However, the benefit of long backboards is largely unproven.
  • The long backboard can induce pain, patient agitation, and respiratory compromise. Further, the long backboard can decrease tissue perfusion at pressure points, leading to the development of pressure ulcers.
  • Utilization of backboards for spinal immobilization during transport should be judicious, so that the potential benefits outweigh the risks.

I know that I have been torn in my own mind while strapping an octogenarian to a rigid long backboard when the only indication for such treatment was that she slipped on the floor of a rest home. Neurologically she may appear completely intact with a normal level of consciousness (GCS of 15), no complaints of numbness, lacking any spinal deformation or distraction injury. However, our protocols say she must be strapped to a rigid device without padding and subjected not only to the jolts of our handling, but every bump of a threshold as the stretcher is wheeled outside and then she continues to suffer the uneven pavement between theEmeritus Senior Living facility and the hospital. If she wasn’t sore due to the fall, she will definitely feel it by the time she is seen by a physician. I know I am protecting myself from any potential injury lawsuit, but am I really protecting my patient?

The Prehospital Emergency Care statement suggests criteria where use of a long backboard would not be indicated. Part of that definition includes the following recommendation: Continue reading

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Filed under Administration & Leadership, EMS Topics, Fire Prevention & Education, Fire Rescue Topics, News, Patient Management, Rescues, Training

Second Thoughts on 'Scene Safety'

In addition to my regular job, I continue to proudly serve as a medical first responder in my home community. But, now, in the wake of a Christmas ambush of firefighters last year and yesterday’s hostage situation during a fake medical call, I am thinking back on the doors I have rushed through attempting to offer my help to someone in need. When I respond to that late night page, I review in my head the details given to me by the dispatcher and construct my index of suspicion regarding the medical condition I will likely encounter and never suspect I am entering any sort of trap. Just like you, I was taught to say “scene safe” during my drills and exams, but that was in a classroom setting which is far different than I have ever experienced in the field. Now matter how good your imagination, that fluorescent lit room full of desks and chairs never becomes the cramped, dimly lighted bedroom down a narrow hallway. So, how do we relate the real-world idea of safety concerns into practice in the field? Back in school, we have simulators for patients that can respond to treatments providing feedback on my care and mock-ups of ambulances that even make noise to disrupt the use of my stethoscope, but where is the effort to really teach recruits caution before entering a home? Or even how to deal with the dangerously irate family member once we reach our patient? Maybe we need to go down the hall of the community college and ask the theater students to join our tidy little scenarios as grieving relatives.

And it doesn’t always have to be the setup of a deranged psychopath to present a danger, there are times I have simply gone to the wrong address. And in my state, a homeowner is justified in using “deadly force” on anyone who “was in the process of unlawfully and forcefully entering a home.” Hopefully by announcing myself and asking who called 9-1-1, I can argue the “unlawful? part if logical debates were possible in those late night situations. Fortunately, I have never found myself in a situation where my life was truly in danger. But I suspect other responders have felt that same casual assurance before things went sideways for them. Arming medics is also not the answer. My “concealed carry” training was very good, but it doesn’t begin to help me understand how to react in a hostage taking situation even assuming my hands weren’t already full of equipment when entering the room.

I read of states like Iowa and New Jersey that are having trouble recruiting volunteers and in some cases offering incentives for service. I have always felt that EMS is a calling however. We don’t just need more bodies in uniform, we need the right people to care enough about helping patients. We also need to do a better job of protecting the professionals (including volunteers) who give of themselves already. We must use the CLIR E.V.E.N.T. database to share experiences of how to make EMS safer and better for responders as well as patients. Take the recent events that have happened and let them make you more aware, not more afraid. Work with others to help them understand the real-world of “scene safety” and practice it in every call. Let your “index of suspicion” always include your own safety, because we need you back doing this job again tomorrow!

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Filed under Command & Leadership, EMS Dispatch, EMS Health & Safety, EMS Topics, Firefighter Safety & Health, Funding & Staffing, In the Line of Duty, News, Training, Training & Development

Excellence Through Challenge

Everyday on the job is a competition for EMS workers against the forces of nature (and sometimes even stupidity). Staying sharp and ready for these challenges can be daunting – especially when you are not asked to exercise all of your skills. Following that logic, friendly competition can help make you better as a emergency care provider. That is why I wanted to post this following announcement from Mike van Mil on the upcoming Paramedic Competition this April. Plan to improve!

11th Annual Paramedic Competition

Think you’re the best at what you do? Do you have the skills to beat out all others? Do you like to show off those skills? Come on up to Oshawa, Ontario Canada and prove it!

Teams compete in one of three divisions: Advanced Care Paramedic, Primary Care Paramedic and Primary Care Student. For competitors unfamiliar with those terms, ACP may likened to EMT-P while PCP may be considered to be EMT/EMT-I/etc. The scope of practice for each paramedic level may be found by reading the National Occupational Competency Profile (updated 2012) created by the Paramedic Association of Canada. If you are unsure of which division you should be competing in, please contact us to discuss your situation.

A “Team” is considered to be 2 Competitors and 2 Judges. The judges will be separated from their teams and will not judge their own team at any time. In the spirit of the competition, judges are expected to be fair and non-biased in their judging of other teams. The competition relies on honesty on the part of both competitors and judges to ensure a fair outcome and a great experience for everyone. Judges are expected to be certified at the same level as the competitors from their team. Should a team not be able to provide two judges, we ask that you let us know as soon as possible so we can find replacement judges. In the event that a team is unable to provide two judges, the lunch and banquet tickets assigned to the missing judges will be given to the replacement judges supplied by the committee.

The competition is a one day event that consists of practical scenarios using human actors as well as high-fidelity patient simulators along with academic tests and challenges. This format has proved popular in the past and will be followed again for 2013

Please visit our website for further information www.paramediccompetition.ca you will also find links to our Facebook and twitter accounts for the most up to date information. We look foraward to seing you there!

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A Country EMS in The Big City

Last night I was fortunate enough to have been given the opportunity by Baltimore City FD to ride-along with one of their EMS crews as part of the EMS Today 2012 conference. My desire was to learn some of the many differences between their service and the more rural EMS service back home. While there clearly were definite differences, the thing that struck me more than anything else was actually how similar we all are, not how different.

I anticipated the promise that each tone held to expose me to some uniquely urban situation. And while the individuals I met were clearly unique, the choreography between us all was mostly a repeat. This is exactly how we are trained in EMS. We take whatever situation is given to us and we bring a defined order to the chaos. We seek sameness in purpose and outcome. The empathy I felt for the apparently homeless patient with the self-induced alteration in LOC and the young woman facing a possible miscarriage was no different here than anywhere. I simply wanted to help. The public attitude toward EMS leading to abuse of the system and the painful inefficiencies it causes was also no surprise. We face the same issues everywhere even if the proportions change.

It was witnessing the banter between calls that told me I wasn’t back home. The teams and even the sports were different, the union issues too. But then then there was the discussion of changes in protocols, the latest findings in medicine, the issues faced in home life. Maybe I am not so far from home after all.

At this conference I have already met medics from truly rural areas as far apart as Georgia and Alaska. I’ve met some who work for private agencies and others who come from city or county services. It is a commonality that brings us together and that allows us to discuss and learn from each other about our unique situations and approaches. The pre-conference session I attended yesterday has also helped me think about operational questions I had never considered before. Personally, I am definitely ready to start this conference today with a proper perspective.

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Filed under Conferences, EMS Topics, Training