# What Happened to the Red Cross?!



## Rosenrot (Jun 11, 2012)

First post; It's a pleasure to meet you, nation-wide lifesaving community!

I've been an EMT-B volunteer for the Red Cross here in Minnesota for about a month, and last Thursday RC HQ from Washington D.C. came in to tell us that they're dropping EMTs completely; no more classes, no more refreshers, no more testing, and (to my personal distain) no more venue coverage! My supervising medic told our team that Minneapolis RC EMTs raked in hundreds of thousands in revenue. My question is: can anyone imagine why the Red Cross would do this? The Twin Cities' largest stadiums are now scrambling for replacement medical standby (and may hazard a couple events--God forbid--WITHOUT), and my EMT-B class through the RC had a 93% first-time NREMT exam pass rate! It just makes no sense.

Furthermore, after this bomb was dropped on us on Thursday, the bemoaning of some RC practices began. It turns out that the RC has been trying to prevent instructors from using AAOS textbooks in First Responder and EMT classes for months in favor of their self-published (chalk-full of misinformation and outdated practices) book. The Red Cross teaches back blows in conscious choking, for example, which is a maneuver that the AHA recognizes as significantly more dangerous than helpful. There is an otherwise clear antagony that the RC holds for information produced by the AHA (or anyone else)--even if it's better at saving lives.

They make it seem like if they can't monopolize EMS and EMT certification, they don't want to take part in it. And that's contrary to every healthcare moral I have.

tl;dr
Why is the Red Cross dropping volunteer EMTs when we're both profitable and essential to our metro area?
What motivation would the Red Cross have in propagating misinformation?


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## mycrofft (Jun 12, 2012)

Can't reply directly to the EMT thing. Here they have not, in my memory, taught or managed EMT's, leaving teaching to local community and state colleges and private schools, as well as a couple FD's.

ARC and AHA have had a long history of seemingly taking divergent paths to establish separate brands. If memory serves, they consciously brought their techniques for CPR into accord around 1978, then months later they started diverging again.

Right now, ARC nationally  is undergoing a tremendous upheaval trying to stay afloat and make their local chapters self-supporting. NO idea what they might drop a profitable operation unless either it really isn't profitable, or there is a legal reason, or the service lacks the rigor and responsibility a paid service does so they see it as a potential civil liability.

Both AHA and ARC have studies to cite representing their minimally divergent brands of conscious choking treatment.


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## akflightmedic (Jun 12, 2012)

Interesting...had no idea the RC actually taught or managed EMT courses.


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## DesertMedic66 (Jun 12, 2012)

akflightmedic said:


> Interesting...had no idea the RC actually taught or managed EMT courses.



What would make it even more odd is if those EMT classes were required to take the National Registery..... That is based on AHA....


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## rsj68516 (Jun 18, 2012)

Give me a call and I would be happy to share with you why the changes have occurred in the scope of practice for the volunteer team in the Twin Cities.  

Regarding mycrofft comments on why ARC differs on it's instruction on backblows:  The American Red Cross 2005 Guidelines for Emergency Care and Education recommended using cycles of 5 back blows and 5 abdominal thrusts to treat conscious choking children and adults. A review of the scientific literature suggested that back blows, abdominal thrusts and chest compressions are equally effective. Additionally, the use of more than one method can be more effective to dislodge an object. These findings are consistent with those of international resuscitation societies. Related literature was reviewed during the 2010 Guidelines process and the recommendations remain the same.

Randy Jones, ARC


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## medicdan (Jun 18, 2012)

rsj68516 said:


> Give me a call and I would be happy to share with you why the changes have occurred in the scope of practice for the volunteer team in the Twin Cities.
> 
> Regarding mycrofft comments on why ARC differs on it's instruction on backblows:  The American Red Cross 2005 Guidelines for Emergency Care and Education recommended using cycles of 5 back blows and 5 abdominal thrusts to treat conscious choking children and adults. A review of the scientific literature suggested that back blows, abdominal thrusts and chest compressions are equally effective. Additionally, the use of more than one method can be more effective to dislodge an object. These findings are consistent with those of international resuscitation societies. Related literature was reviewed during the 2010 Guidelines process and the recommendations remain the same.
> 
> Randy Jones, ARC



Thanks for the update. Do you mind citing relevant studies that discuss the equality of back blows, chest thrusts and compressions?


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## WTEngel (Jun 18, 2012)

There is actually more difference than just back blows.

ARC still instructs ABC, and has not gotten fully on board with CAB. They say this is an ease of teaching issue, however, it has really complicated the entire process.

ARC came up with a highly convoluted decision tree for the rescuer to decide whether or not they should perform chest compressions first or give breaths first, then chest compressions, based on whether or not the rescuer thought the victim was in cardiac arrest due to hypoxia or cardiac event. Don't get me started on how much I disapprove of the way ARC interpreted the current guidelines recommendations.

I was under the impression that AHA and ARC use the exact same resuscitation science and recommendations (ILCOR) to justify their guidelines changes, they simply choose to interpret it differently, based on their respective scientific advisory committee recommendations. This is, in my opinion, mostly to differentiate their programs from AHA.

I have taught both ARC and AHA programs for a long time. In my opinion ARC missed the mark big time in the 2010 guidelines update...so much so that I practically refuse to teach CPR for them anymore (only when I teach lifeguarding and HAVE to) because I find it so unpalatable.


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## medicdan (Jun 18, 2012)

WTEngel said:


> There is actually more difference than just back blows.
> ...
> I have taught both ARC and AHA programs for a long time. In my opinion ARC missed the mark big time in the 2010 guidelines update...so much so that I practically refuse to teach CPR for them anymore (only when I teach lifeguarding and HAVE to) because I find it so unpalatable.



I absolutely agree. Ive stopped teaching ARC for many of the same reasons, SABA being another... Their course completion cards have become outlandishly expensive, even in light of the "free materials". I find local representatives to be unresponsive to communication, and it very time consuming to get proprietary materials and supplies. 

Has anyone complied a complete list of the differences between ARC and ILCOR guidelines? AHA mirrors them quite well (or at least their scientific committee agrees, so the courses match), so it really looks like ARC is beating to its own drum again...


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## Flight-LP (Jun 19, 2012)

rsj68516 said:


> Give me a call and I would be happy to share with you why the changes have occurred in the scope of practice for the volunteer team in the Twin Cities.
> 
> Regarding mycrofft comments on why ARC differs on it's instruction on backblows:  The American Red Cross 2005 Guidelines for Emergency Care and Education recommended using cycles of 5 back blows and 5 abdominal thrusts to treat conscious choking children and adults. A review of the scientific literature suggested that back blows, abdominal thrusts and chest compressions are equally effective. Additionally, the use of more than one method can be more effective to dislodge an object. These findings are consistent with those of international resuscitation societies. Related literature was reviewed during the 2010 Guidelines process and the recommendations remain the same.
> 
> Randy Jones, ARC



I too am baffled with this "EMT talk" with reference to the ARC. ARC has never been one to support an alternate form of education and has always focused on their in-house courses to deliver first aid care under their volunteer programs.

Regardless of that, I for one have washed my hands of the ARC. Several rational reasons have already been mentioned, material cost, lack of medical continuity in training, etc. My main reason is that I for one like to emphasize the "why's" of First Aid / CPR / AED. I cannot do that utilizing the ARC recommendations because a few of them just do not make sense from a pathophysiological standpoint. Listen folks, there is a reason why the professionals of the current medical industry have NOT adopted the ARC standards and that is because they do not follow evidentiary based medicine. As such, ILCOR does not come to the same conclusion as to what recommendations are best suited for the lay-person and professional rescuer. There is no scientific evidence  supporting back blows or chest compressions in the conscious choking adult, child, or infant. There is however, common sense aspects that would identify the potential traumatic injuries associated with these maneuvers. It's a matter of simple risk vs. benefit. Sorry ARC, your recommendations increase the risks with no viable evidence of benefit.

To each their own, but I think taking a simple and brief look at the guidelines will show which one works and is potentially beneficial and which one is not.....................


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## Veneficus (Jun 19, 2012)

Flight-LP said:


> I too am baffled with this "EMT talk" with reference to the ARC. ARC has never been one to support an alternate form of education and has always focused on their in-house courses to deliver first aid care under their volunteer programs.
> 
> Regardless of that, I for one have washed my hands of the ARC. Several rational reasons have already been mentioned, material cost, lack of medical continuity in training, etc. My main reason is that I for one like to emphasize the "why's" of First Aid / CPR / AED. I cannot do that utilizing the ARC recommendations because a few of them just do not make sense from a pathophysiological standpoint. Listen folks, there is a reason why the professionals of the current medical industry have NOT adopted the ARC standards and that is because they do not follow evidentiary based medicine. As such, ILCOR does not come to the same conclusion as to what recommendations are best suited for the lay-person and professional rescuer. There is no scientific evidence  supporting back blows or chest compressions in the conscious choking adult, child, or infant. There is however, common sense aspects that would identify the potential traumatic injuries associated with these maneuvers. It's a matter of simple risk vs. benefit. Sorry ARC, your recommendations increase the risks with no viable evidence of benefit.
> 
> To each their own, but I think taking a simple and brief look at the guidelines will show which one works and is potentially beneficial and which one is not.....................



Disclaimer: I have never had any dealing at all with the ARC. 

Having said that though, in my opinion, if I wanted to increase intrathoracic pressure in a conscious adult, a backblow would likely be much safer and tolerable to a patient than a chest thrust.

I will still prefer an abd thrust to both as more effective, simply because it allows for greater volume compression of the cavity. (not really inhibited by ribs)


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## rsj68516 (Jun 19, 2012)

American Red Cross Guidelines are based on the Consensus on Science with Treatment Recommendations (CoSTR)  This information can be found on the web.  Hope this helps.  ~ Randy Jones, ARC


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## Chimpie (Jun 19, 2012)

Hey Randy, 

First, welcome to EMTLife.  We're glad you've decided to become part of our community.  I've been part of the Red Cross for the past fourteen years, in both Health Services and Disaster Services, as both paid and volunteer.



rsj68516 said:


> Give me a call and I would be happy to share with you why the changes have occurred in the scope of practice for the volunteer team in the Twin Cities.



The following will sound harsh, but please understand that I'm not trying to be.

When someone states facts, stats or theories, they better be prepared to back them up with some form of documentation.  And be prepared to back them up here.  Most of our members and guests will not make phone calls.  



rsj68516 said:


> American Red Cross Guidelines are based on the Consensus on Science with Treatment Recommendations (CoSTR)  This information can be found on the web.  Hope this helps.  ~ Randy Jones, ARC



Links to websites is the same above.  If the information can be found online, provide links.  It's good forum etiquette.  

You and I both know that this information is found on CrossNet (intranet site for Red Cross staff) but others outside of the ARC won't be able to access them.

Again, welcome to EMTLife.  It's always nice to see another Red Crosser here.


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## mycrofft (Jun 19, 2012)

WTEngle, I teach both volunteer ARC, AND paid AHA complaint courses. ARC is teaching CAB, but the underlying decision tree is sort of tortuous; I don't teach THAT to students. As I tell them, I can hand them a business card with how to do CPR on one side and they can basically do it. On the other side, I can list the basic steps to landing an airliner full of people. Each work better with the refinements.

That said, I'm sort of a maverick in that I squeeze in extra material about Good Sam, active anatomy of the heart, the little questions about AED ("Do I take off the nipple rings first?"), and scene safety is repeated and repeated with a cute hand gesture which is irritating but sticks in your mind. I teach FAST for strokes. 

OP, have you found out more about the EMT situation where you are? Was it ARC?


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## WTEngel (Jun 19, 2012)

mycrofft said:


> WTEngle, I teach both volunteer ARC, AND paid AHA complaint courses. ARC is teaching CAB, but the underlying decision tree is sort of tortuous; I don't teach THAT to students. As I tell them, I can hand them a business card with how to do CPR on one side and they can basically do it. On the other side, I can list the basic steps to landing an airliner full of people. Each work better with the refinements.
> 
> That said, I'm sort of a maverick in that I squeeze in extra material about Good Sam, active anatomy of the heart, the little questions about AED ("Do I take off the nipple rings first?"), and scene safety is repeated and repeated with a cute hand gesture which is irritating but sticks in your mind. I teach FAST for strokes.
> 
> OP, have you found out more about the EMT situation where you are? Was it ARC?



Actually, ARC has been quite adamant that they *DO NOT SUPPORT OR TEACH THE CAB APPROACH*. See the following link:

http://www.instructorscorner.org/media/resources/SAC/Reviews/SAC_Answers_A-B-C_vs _C-A-B.pdf

Quoted from the SAC clarification stance:

"We do not recommend nor teach the mnemonic C‐A‐B as this sequence only applies to adult non‐ hypoxic cardiac arrest victims"


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## WTEngel (Jun 19, 2012)

rsj68516 said:


> American Red Cross Guidelines are based on the Consensus on Science with Treatment Recommendations (CoSTR)  This information can be found on the web.  Hope this helps.  ~ Randy Jones, ARC



CoSTR is published based on ILCOR's findings. 

Again, ARC and AHA are using the exact same research, simply different interpretations. 

I find it interesting that ILCOR links to AHA and ERC (European Resus. Council) but not to the ARC. Could this be because they disagree with ARC's science advisory council recommendations?


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## mycrofft (Jun 20, 2012)

They don't use the phrase CAB, but teach the sequence. Just another way to differentiate their brand from AHA.


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## Veneficus (Jun 20, 2012)

Consensus is not equal to correctness.

I think it is important to consider that the odd man out may actually be right.

Did you guys know that some very famous medical journals will not publish any study no matter how good it is if it goes against the conventionally accepted knowledge?

Just something to think about.


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## mycrofft (Jun 23, 2012)

_*say it isn't so!!!*_


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## CANDawg (Jun 23, 2012)

mycrofft said:


> _*say it isn't so!!!*_



I sense sarcasm.


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## mycrofft (Jun 23, 2012)

dbo789, the force is strong in you.


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