Are we really as good as we think we are?

I’ve always suspected that some students come to class for certification only to return to their place of employment to provide patient care that resembles nothing that was taught in class.  In many instances these students are experienced clinicians who have good intensions but intentions based on false reality. 

Stay with me…

In many instances people think they provided appropriate care however the reality is that the care rendered was less than ideal.  Regardless of the system, EMS, ER, Code Team, Surgery, Post Op; etc.… each system is made up of motivated, genuinely caring, and highly educated individuals that over time can lapse into routine and bad habits. 

The issue isn’t the failure of the system to meet the standard, but instead over time, substandard becomes the norm.  The distinction, though, is important. 

While ages vary, a large majority of cardiac arrest patients involve the elderly, having multiple health issues with other contributing factors.  During these incidents, the “code team” will arrive to attempt to resuscitate the patient and in the case of an unsuccessful resuscitation, everyone would simply consider it ‘the patient’s time.”  I mean, he/she was elderly, had an extensive medical history with other contributing risk factors.  Had they failed to resuscitate him/her, that would have been sad, and tragic, and…perfectly acceptable for all the same reasons. *

* How Hospitals Kill Our Loved Ones And Conceal It, March 17, 2017

The disturbing part is in the case of a successful resuscitation, the team will be congratulating itself for saving his/her life while overlooking long pauses in CPR, late medications, improper defibrillation, not switching chest compressors every two minutes, or CPR that isn’t 30:2 as taught in class….

We haven’t even discussed return of spontaneous circulation (ROSC), in some instances we make things worse rather than better.  The patient just came back from the dead and we tend to want to administer fluid (fluid overload) or slow a heart rate that is fast secondary to Epi administration.  We need to give the patient time to normalize.  I’m not saying withhold treatment from a symptomatic patient.  What I am saying is “the enemy of good is better” especially in the ROSC state. 

We have all been on those resuscitations where everything went well, we were on top of our A game and all things worked for the good of the patient.  I would hope those arrest cases outweigh the ones where northing we did reflected the standard taught in class. 

It is reported that medical errors are the third leading cause of death in the US.  More alarming is that number does not reflect the number of deaths caused by the deficiencies in the standard of care.  Many times, patients die of what seems robbing Peter to pay Paul, when and one complication leads to the next issue; when in reality poor treatment was the cause of the decline in the patient’s condition. 

A standard of care is simply that, a standard and over time with good intentions and poor habits the standard can become substandard but considered the norm.  In these instances, a bad outcome is an expected reality, rather than the reality check it ought to be. 

To be clear, sick people will die even when care is appropriate. But when patients die due to a substandard of care, the failings go unnoticed. 

My challenge to each of you is to question yourself and the system.  Did you do everything possible to ensure a successful resuscitation?  Was CPR 30:2, interruptions in CPR less than 10 seconds, were shocks and medications appropriate and timely?  Did the standard of care regress to innumerable and unnecessary lapses in treatment?  Did the patient survive despite our best efforts to kill them?

Take a look at the big picture, debrief after every resuscitation attempt have the courage to discuss what went well and what can be improved upon.  The standard of care is a veil over its own potentially lethal inadequacies. 

Clinicians can unknowingly contribute to a patient’s death, despite hard work and good intentions, and conceal it even from themselves. It hides in plain sight; it is business as usual. It is up to all of us to self-reflect, is my medicine as good as I think it is?  Is there something I can do or the system can do better during a resuscitation?  Cross the T’s, dot the I’s, be an advocate for both the patient and good medicine. 

#practice #acls #pas #smallbusiness #cpr #aha

- Brian Davis

Heartland CPR, llc

405-603-6666

www.HeartlandCPR.com

Cardiac Arrest Management 101

One of the most dire calls we respond to in the EMS world is the patient who is not breathing and is without a pulse.  During the management of the call it is imperative that first responders remain in control both internally and externally to defeat the opponent, in this case death.  During a cardiac arrest, a tempo or pace is dictated by the condition of the patient and the reaction of the resuscitation team.  Tempo can be described both as positive and negative in nature.  Negative tempo is demonstrated by the pulseless patient as in length of downtime, a lack of bystander CPR, the buildup of lactic acid; and the deoxygenation of primary organ systems.  Positive tempo is demonstrated in early chest compressions and/or defibrillation, the establishment of a formal CPR team approach, a solid foundation of BLS followed by solid ALS care.   

What does tempo look like during an arrest? 

If we were honest with ourselves we have all participated in the cardiac arrest where CPR may have been inefficient, drugs may have been late, and skills may have not been performed in a timely manner for a plethora of reasons.  In this case a negative tempo was created and allowed to infiltrate the entire response effort.  In contrast we have participated in resuscitations where we set ourselves and the patient up for success with our training, experience, teamwork, poise, and time management to overcome death.  Regardless of the outcome of the patient, we knew we had provided the best care possible giving the patient every chance of survival. 

What are the factors that separate a good resuscitation from a less than stellar attempt?  Our success during a cardiac arrest is not happenstance, but is the byproduct of good team management; communication, knowledge, and training.  Ever notice there is never time to do something initially, so you cut a corner only to realize there is always time to go back to fix things?  A good team leader is poised, efficient, and methodical while keeping their emotions in check, sometimes defined as emotional intelligence.  A good team leader can recognize when a code is headed south and stop the “snow ball from running downhill.”  During an emergency time will compress and in some instances even stretches.  

Efficient team management includes the following:

·       Early and effective CPR and or defibrillation

·       Use of a metronome, chest compressions rate of 100-120 beats per minute (per AHA)

·       No interruption of chest compressions greater than 10 seconds

·       Ensuring slow and methodical ventilations without hyperventilation

·       Switching chest compressors every 2 minutes

·       Good treatment communication with all team members

·       Successful IV and intubation skills to include capnography

·       Timely and appropriate medication administration

·       Time management

·       Appropriate post resuscitation care

Each member of a resuscitation team is responsible for their contribution, creating a positive tempo during the management of the patient.  During resuscitation it is imperative each member remains calm and poised in order to stay on point with the care being provided.  Calmly speaking and relying on our cumulative experiences, knowledge and training begins long before you arrive at the patient’s side.  It is everyone’s duty to provide the most efficient resuscitation attempt and to ensure best practices in cardiac resuscitation.  By following these simple steps you will give each patient the best chance of survival each and every time.

#sca #acls #smallbusiness #cpr #aha

- Brian Davis

Heartland CPR, llc

405-603-6666

www.HeartlandCPR.com

AEDs and The Elderly

Essential facts you should know about AEDs and the elderly 

A 1994 study titled “The Pre-Hospital Arrest Survival Evaluation” revealed a frightening reality: Of 2,329 out-of-hospital cardiac arrests, only 26 patients survived. Twenty-one years later, in 2015, the American Heart Association (AHA) asserted that over 326,000 people suffer a cardiac arrest outside of hospitals every year – a majority while the victims were in their home. 

Fortunately, modern medicine has a lifesaving answer to this stubbornly persistent threat: The automated electronic defibrillator (AED). In 2002, the FDA approved the first home AED unit, the Philips HeartStart, and two years later the prescription requirement was dropped. 

The American Red Cross states that, “improved training and access to AEDs could save 50,000 lives each year.” Because AEDs extend similar advantages to the elderly as they do younger patients, more and more homeowners and assisted care residents are considering purchasing a unit. 

3 details all senior citizens should know about AEDs 

Help’s required. The “automated” aspect of AEDs refers to the machine’s ability to calibrate the electrical output based on the heart’s fibrillation, a spasm caused by uncoordinated muscle fibers. Victims of sudden cardiac arrest won’t be able to administer AED treatment on themselves. While laws vary from state to state, American Heart Association approved AED and CPR training is highly recommended. Because of this, the capabilities of a person’s living partner or caregiver need to be identified before purchasing an AED, especially in the home. 

The medical world believes in AEDs. A report published in the Journal of the American Geriatrics Society suggested that, “the most optimistic view is that 84% of public access defibrillation cardiac arrest victims … were found in VF (ventricular fibrillation/cardiac arrest), 29% of those aged 70 and older and in VF have been shown to survive to discharge.” While those stats may seem discouraging to those outside of medicine, cardiologists see this as a huge improvement, especially since only 10% of all individuals who suffer sudden cardiac arrest outside of a hospital setting typically survive. The report goes on to state, “To the extent that cardiac resuscitation is offered to any patient, it should at least be considered for the average geriatric patient.” 

DNRs need to be identified. The same Journal of Geriatrics Society paper advised that, “the geriatric population is likely to contain a good number of individuals who have no interest in resuscitation.” While most assisted living residents will have already reported their do not resuscitate (DNR) status upon move-in, the introduction of AEDs to such residencies can lead to concerns about those wishes being identified before an AED is administered. 

Educate yourself 

AED and CPR training can be an excellent way of learning if and how purchasing an in-home AED is the right decision for you or your loved ones, and give you the confidence to use it in an emergency situation.

Don't put off training!  Emergencies occur when we least expect them and being prepared can make the difference between life and death.  Register for a class today or contact us to inquire about investing in a life-saving AED...they're more affordable most people think. 

#elderly #aed #smallbusiness #cpr #aha

- Ginger Davis
Heartland CPR, llc
405-603-6666
www.HeartlandCPR.com

Why Everyone Needs To Know "Hands-Only" CPR

Why “hands-only” CPR is gaining popularity 

If you were at home or out at a restaurant, and someone collapsed from sudden cardiac arrest, would you know what to do? According to American Heart Association statistics, “70 percent of Americans may feel helpless to act during a cardiac emergency because they either do not know how to administer CPR or their training has significantly lapsed.” 

In case you don’t know, cardiac arrest occurs when the “heart’s electrical system malfunctions,” causing irregular heartbeat rhythms. It is different from a heart attack, which is caused by a blockage or narrowing of an artery to the heart, although a heart attack can lead to cardiac arrest. 

Why knowing CPR is so important … for everyone 

For decades, medical professionals and organizations like the American Heart Association have taught the benefits of cardiopulmonary resuscitation (CPR), a technique that uses a combination of chest compressions and mouth-to-mouth breathing that has been shown to save lives. CPR can be especially critical in the case of cardiac events that happen at home or anywhere outside of a hospital, keeping the person alive until an ambulance arrives. 

Look at these stats from the American Heart Association: 

• Nearly 383,000 out-of-hospital sudden cardiac arrests occur annually

• Four out of five cardiac arrests (88%) happen at home

• Less than 8% of people who suffer cardiac arrest outside the hospital survive

• Effective bystander CPR provided immediately after sudden cardiac arrest can double or triple a victim’s chance of survival

A new type of CPR 

In the last several years, a new type of CPR has emerged, which focuses on “hands-only” compressions, with no “mouth-to-mouth” resuscitation (rescue breaths). “Hands-only” is now gaining popularity, with even the American Heart Association touting the potential benefits. The aim of the initiative is to teach the public that untrained rescuers (bystanders) can still perform CPR, emphasizing that people should first call 911 and then provide chest compressions. 

The theory is that most bystanders who see a person go into cardiac arrest aren’t trained in how to do mouth-to-mouth resuscitation or may even be reluctant to put their mouths directly onto a stranger’s. Chest-only compressions can give a bystander enough confidence to start giving CPR right away, which can make a difference in saving lives.
Hands-only CPR can work in certain circumstances because when a person first goes into cardiac arrest, his or her body still has plenty of oxygen. Chest compressions work by keeping the oxygen circulating, thus helping to minimize possible brain damage. 

How to perform hands-only CPR 

According to the American Heart Association “If you see a teen or adult suddenly collapse, call 911 and then push hard and fast in the center of the chest to the beat of any tune that is 100 to 120 beats per minute.” 

Note: A recommended song with the right “beat” is Stayin’ Alive by the Bee Gees. You can watch several PSA instructional videos on “hands only” CPR here

When hands-only CPR should NOT be applied 

While chest compressions alone can help save lives, this method should only be used on adults or teens experiencing a specific type of cardiac arrest.

Hands-only CPR is NOT recommended for…

Child and infant CPR – Pediatric cardiac arrest is generally related to respiratory failure, where the infant or child stops breathing for some reason. By the time  cardiac arrest occurs, the oxygen levels are likely already depleted. CPR with rescue breaths becomes critical in these cases.

Respiratory failure leading to cardiac arrest – This is more likely to occur in cases of drowning, overdose, choking, trauma, or sudden illness, like a severe allergic reaction or asthma that restricts the airways. Here, oxygen levels can become depleted before the heart stops, so rescue breaths are necessary.

A cardiac arrest you don’t witness – If you didn’t see the person collapse, it is impossible to tell how long he or she may have been lying there. It’s more likely oxygen has become depleted so rescue breaths would be necessary*

*One Beat CPR 

Don't take chances with the lives of your family, friends, customers, coworkers, or others you have the ability to help in the event of a medical emergency.  Register for a CPR class today to brush up on your skills, invest in an AED or barrier device, and encourage others to get prepared.  Heartland CPR can help with training and life-saving devices such as AEDs, first aid kits, CPR barriers, and much more!

#handsonlycpr #smallbusiness #cpr #aha

- Ginger Davis
Heartland CPR, llc
405-603-6666
www.HeartlandCPR.com

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AED Rescue Kits

An AED Rescue Kit Should Be Included with Every AED PurchaseEvery Automated External Defibrillator (AED) is purchased with the hopes that, in the event of a cardiac emergency, a life will be saved. An AED Rescue Kit, also referred to as Fast Response Kit, CPR Prep Kit, etc., contains tools and supplies essential for patient care and personal protection. In fact, Federal OSHA guidelines for AEDs call for protection from bloodborne pathogens and other potentially infectious materials. Using personal protective equipment, such as gloves and respiratory barrier devices, provides protection from bloodborne pathogens and other infectious substances.
AED Rescue Kits should include the following items:  

• CPR breathing barrier such as face shield or resuscitation mask

• An extra-absorbent paper towel or cloth 

• A chest hair razor

• Paramedic scissors or trauma shears

• Hypoallergenic nitrile gloves

CPR breathing barriers, such as face shields and resuscitation masks, create a barrier between the rescuer's mouth and nose and those of the injured or ill person. This barrier helps protect from contact with blood and other body fluids such as saliva when rescue breaths are given. These devices also protect from breathing the air that the person exhales. The trauma shears are used for cutting through a patient's clothing to expose the chest; the paper towel or cloth is for wiping away any moisture on the chest; and the razor for shaving those with hairy chests.
It is important to always use standard or universal precautions according to workplace and OSHA guidelines. These protect an individual from exposure to infectious diseases when giving care to a patient.*

*One Beat CPR

If you own an AED (automated external defibrillator) and want to assess your preparedness for an emergency in terms of supplies you have on hand to use with us, we can help.  If you don't yet own an AED and want to learn more, we can help there as well.  Heartland CPR is your single solution for training and life-saving equipment in Oklahoma!

#aed #smallbusiness #cpr #aha

- Ginger Davis
Heartland CPR, llc
405-603-6666
www.HeartlandCPR.com

Michael Eccard Introduces Himself

When Heartland CPR is in need of an additional instructor(s), we don't go about bringing someone onboard in the traditional way.  We are extremely deliberate because we feel very strongly about the values and character of those representing us and feel that the individual fit is more important than the skills set they bring with them.  Besides asking for recommendations from our other instructors that represent us so well, we many times select someone who was first a customer.  Such was the case of Michael Eccard...he is truly a walking miracle and very well known in the EMS world and chances are pretty good you know of him and his story if you've been around EMS for any length of time.  We were pleased to bring him into the fold and he posted the following on his Facebook, which are honored to share here.

Please share: 

Hey guys.... I don't get on FB too often, but I wanted to take a minute to share this link. Heartland CPR is a local business owned and operated by an amazing family. It was founded Brian Davis and wife Ginger; Brian is a friend and longtime Paramedic who also holds the esteemed positions- Chief of EMS and Assistant Chief at Edmond Fire Department. I was first introduced to Brian at EMSA several years ago. He was a liaison for the OMD (Office of the medical director) Brian worked side-by-side with our Medical Director to write, update, and oversee cutting edge protocols. This was a great supportive resource. It gave us grunts access to guidelines, backed by the latest science, that ultimately contributed to field medics providing the highest standard of care possible.  Point is, he gained my respect many years ago.   

Years later, I found myself in a pinch for a PALS recert class. Ginger (who obviously ran the place :-)) bent over backwards to get me in class quickly....while accommodating my ever changing schedule. I was amazed with their assistance, and relieved to find myself in a class (taught by Brian) that matched my own easygoing style of teaching. So impressed in fact, that months later, I jumped at the chance to become a part of the Heartland CPR team as an instructor. The above has convinced me that certain fundamental values practiced here set Heartland CPR apart from many of the other certification providers: 

-The overall philosophy is to teach all classes in a very laid-back, stress free environment.   

-Classes are small and personal; taught in a comfortable, round-table style atmosphere......Not like the mundane, walk-through-the-steps kinda classes taught years ago.  

-Instructors have plenty of experience; both in the field and teaching.....but most importantly we are here because we want to be, and all agree the low-key approach is most effective when conducted in the above mentioned FUN, educational, and low stress approach.  

- Based on the surveys and number of repeat customers, it's clear the methods adopted by Heartland CPR and employed by instructors are successfully facilitating this philosophy.  

- Prices are very reasonable. 

- They accommodate both on and off-site classes for anyone from the general public to clinicians of all levels. Many of our customers are everyday people who've never taken a class, but interested in being CPR certified. Others are layman required to be certified by their company.  Some of the classes we offer are CPR (Public CPR/First aid & Healthcare Provider BLS), Pet CPR, ACLS, & PALS. We offer both the initial certifications and recerts. 

- Heartland CPR will work with you or your company to accommodate schedules. 

- We are centrally located in OKC at the Oak Leaf Business Complex, (8101 NW 10th St. Suite C3 Oklahoma City, OK 73127). 

Curious? Visit the website: http://www.heartlandcpr.com 

For questions not answered by the website, clarification, or to sign up: 1. Shoot us an email at: Contact@HeartlandCPR.com  

2. Call the office: (405)603-6666

#eccard #solesurvivor #acls #pals #handsonlycpr #smallbusiness #cpr #aha 

- Michael Eccard
Heartland CPR, llc
405-603-6666
www.HeartlandCPR.com