# '400 chest compressions' procedure touted by Okla. EMS



## VentMedic (Oct 16, 2007)

I like the idea of simplifying the CPR procedure for the lay person, but I'm exhausted reading this.  We try to utilize a switch at 2 minutes to maintain effective consistent compressions. Depending on the size of the patient, 2 minutes is a good time to switch.  I also have found our success rate has increased over all in "saves".  And by a save, I mean someone who can talk to me later when I pull their ETT.

However, I'm a little concerned here for the health of the lay person doing the compressions. 

I see "compressions only CPR" was briefly mentioned in another thread.
http://www.emtlife.com/showthread.php?t=5470

Comments from Oklahoma?  Rid?
Any other regions considering adopting this through their dispatch as instructions for CPR?

http://www.ems1.com/managersandsupervisors/articles/313735/

*'400 chest compressions' procedure touted by Okla. EMS*

By Jeff Raymond
The Oklahoman  
Copyright 2007 The Oklahoman

OKLAHOLMA CITY — A change two years ago in CPR methods has improved survival rates and made people more likely to perform the lifesaving intervention, EMSA officials say.

Cardio-pulmonary resuscitation used to involve pressing on a cardiac arrest victim's chest followed by mouth-to-mouth resuscitation and repeating the process. Because many people aren't trained in CPR or fear placing their mouth on a stranger's, EMSA and other responders began instructing callers to perform 400 chest compressions — enough to keep circulation going until the ambulance arrives.

"It was a complete changeover," said T.J. Reginald, who works for EMSA's clinical oversight board. Out of 40 cardiac arrest calls a month in Oklahoma City, the 400 compressions will apply to 32 of them, he said. 

http://www.ems1.com/managersandsupervisors/articles/313735/



> *Obstacles remain*
> 
> Although instructions from dispatchers are simpler, barriers to CPR use persist.
> 
> ...


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## ffemt8978 (Oct 16, 2007)

Nothing like rolling up on two codes instead of one. 

This does show that there is no magic bullet in EMS that will bring back the dead.  Now that we are progressing towards evidenced based medicine, I think we are moving in the right direction.  This type of research, or the research being done in Europe using abdominal CPR may eventually become the standard, but it won't be for a few years yet.


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## Ridryder911 (Oct 16, 2007)

Albeit, I am definitely in favor of research and performing the best care for the patient, however; common sense has to be utilized sometime. 

I was not aware my neighboring EMS was changing their "phone protocols". I as many who keep up on CPR, are quite aware of the newer data that displays that compressions are more apt to be performed by citizens than rescue breathing (no surprise). Data has also surprising demonstrated that just compressions alone has an equal to sometimes better response than accompanied with ventilation's. 

Now, I am interested where that "magic" number of 400 came from. From what scientific data was presented to perform CPR for about 4 minutes then stop? As well, will this type of presentation be better than than the traditional method... if they stop to early (as described with 25 lbs of force) and 400 compressions? Will this not prevent bystanders from intervening too? 

I again, believe it is essential for CPR to be performed well as much as possible before arrival, however; we need to consider if the methodology presented will deter or encourage participants. Would it be better for laymen to be involved or those that will be involved to do it correctly. A double edge sword... 


I will attempt to monitor it and see how it progresses 

R/r 911


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## VinBin (Oct 16, 2007)

I am in favor of it, a huge barrier to bystanders helping is they fear the small details.  It is understandable how a bystander could be worried over whether their CPR class taught 30:2 or 15:2 or 2 person vs 1 person, along with the whole mouth to mouth deal...

Rid, I don't think the 400 compressions was created to be followed to the book, so to speak.  It is a great way for bystanders to have confidence that they are doing it "right".  I think it is safe to assume that given EMS response time, and that most people *can't* feasibly give a steady 400 compressions for at 100/min, it is safe to assume that most will give at a rate of 50-70 per minute.  And as long as the city emphasizes 400, they will keep going until EMS responds, as the city says, between 4-8 minutes.


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## Ridryder911 (Oct 16, 2007)

VinBin said:


> EMS responds, as the city says, between 4-8 minutes.



I have some land for sale, as well as a car that my grandma only drove on Sundays... 

http://www.emsaonline.com/maps.html (>700 square miles/ 1/2 million people.. 12-16 trucks.. ) 

R/r 911


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## triemal04 (Oct 17, 2007)

There's a lot of information coming in about compressions only in the initial (and later) stages of cardiac arrest, but 400...I hope that someone got their facts wrong in the article and it really meant continous compressions until held arrived.  I can just see some poor sap slamming out 400 compressions in about 3 minutes and then sitting and waiting for the next 3-7 for help to arrive.  Not so fun.

If it was accurate my only guess would be that's it's supposed to be for witnessed arrests only; at that stage there is a better chance of ROSC from just compressions in a couple of minutes than later on.  Since the average person may have a hard time checking for a pulse...  Still awful damn risky though.


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## VinBin (Oct 17, 2007)

triemal04 said:


> I can just see some poor sap slamming out 400 compressions in about 3 minutes and then sitting and waiting for the next 3-7 for help to arrive.  Not so fun.


Its close to impossible for an average person to do just about 2.5 compressions continuously for 3 minutes...

I say its a good because its all about getting the message out to the public.  The public won't help if they are unsure of what they are doing, or if they feel they will actually hurt the victim. 

Why do you say its risky triemal?


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## firecoins (Oct 17, 2007)

VinBin said:


> Its close to impossible for an average person to do just about 2.5 compressions continuously for 3 minutes...
> 
> I say its a good because its all about getting the message out to the public.  The public won't help if they are unsure of what they are doing, or if they feel they will actually hurt the victim.



For the patient who has no pulse, I am not to worried about civilians "hurting" the patient.  Doing something might be better than doing nothing.  Of course the probem with this is most people really have no idea how to check if someone is not breathing much less have a pulse.  

There is the old joke.  2 guys are hunting.  1 accidentally shoots the other and he calls 911.  He says "I think my friend is dead"  The dispatcher says "Calm down. First lets make sure he's dead."  The dispatcher hears a gun shot wound.  The hunter says "Okay, now what."


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## triemal04 (Oct 17, 2007)

VinBin said:


> Its close to impossible for an average person to do just about 2.5 compressions continuously for 3 minutes...
> 
> I say its a good because its all about getting the message out to the public.  The public won't help if they are unsure of what they are doing, or if they feel they will actually hurt the victim.
> 
> Why do you say its risky triemal?


Because there is the possibility of someone reaching the 400 mark before help arrives and then waiting.  Never underestimate the scared/drunk/panicked average person when it comes to doing something really stupid.  

My problem is if they're being told "do 400 compressions only" they may take that to mean that they can then stop.  Why not simply tell them "do compressions until help arrives."  That'd have the same result without the risk of someone twiddling their thumbs after a few minutes because that's what they were told to do.

I do agree that having the public do compressions only is definetly a good thing though.  I'm betting that this helps a lot.


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## VentMedic (Oct 17, 2007)

Ridryder911 said:


> Now, I am interested where that "magic" number of 400 came from. From what scientific data was presented to perform CPR for about 4 minutes then stop?



I think the "400" should be left out and it be presented to the public for what it is, Compressions Only.  

Putting a quantitative value places an expectation with a numeric value of measurement. It can also be a distraction from the actual issue or technique.  Granted this may not be the case if adrenaline is flowing but can be from a teaching stand point.   The numbers were also one reason for all of the AHA's simplifications.

It the rate and overall technique is good, even people in the profession start to sweat after 100.  At the community center, I can see checking off someone's technique after just 30 compressions and telling them they have 370 more to go in case of an emergency.   I'm sure I would get a discouraged look from the person as if I just asked for 370 push-ups.  But, many people in the community will still want to help to the best of their abilities. 

The lay person, as still with may healthcare providers, may do compressions at a rate of:
one           -                   one     -    thousand        -               two       -   one      -                 thousand

In may cases it is going to be the middle-aged or older loved one who wants to do the best they can to save the person they care about.   I would rather have them hear "Do compressions only and help is on the way".   They will then feel like they did what they could and not "I only did 150" (didn't do enough) for their memory.

Of course, there is another side of this. Some people will want to know "how many" or "how long".  For them, a recipe approach may be necessary.


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## VinBin (Oct 17, 2007)

VentMedic said:


> Of course, there is another side of this. Some people will want to know "how many" or "how long".  For them, a recipe approach may be necessary.



Exactly, in an emergency situation, for people who have no training on how to handle such situations, we need quantifiable things.  I don't think its dangerous in any way to give a number, as from a purely statistical standpoint, its VERY unlikely that any bystander will finish 400 compressions by EMS arrival, its not feasible, especially given OK's average response times.  I highly doubt people will be trying to "reach" 400 before EMS. In the end, its just something to occupy their mind so they can stay focused on compressions...


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## firetender (Oct 17, 2007)

Once you start, you go until you're told "No." Period.

But where's the part about doing it right? Has that gone the way of breathing? To say go for 400 implies a simplicity that's dangerous. Then, every Yahoo that heard of the concept is gonna think, "Hell, just press that old chest!"

It doesn't work that way.


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## sharps54 (Oct 26, 2007)

I spent 3 years (2003-2006) dispatching for a sheriff's office in NC where we also dispatched fire and EMS. We did EMD using ProQA (we had the flip cards and the computer program) and before I left the 400 compressions were added to the protocols in some cases. The center I work in now (on a military base) doesn't do EMD and I don't remember the wording exactly but it was something like," do 400 chest compressions and let me know when you are done, it's not as long as it sounds". I know that's not the correct wording but it is close. We all laughed and joked and whined when it was implemented but it wasn't ever a big problem on any calls I remember. It wasn't the standard or only CPR instructions given to a caller like the article implies. You guys should be able to see the protocols your dispatchers use, if you have never seen them you might be surprised! We had new EMS personnel (and deputies) sit with us in the center for a few hours but that doesn't seem to be the case everywhere. I am about halfway through an EMT-B course with a local volunteer department and there has been no mention of sitting in with dispatch, in fact there has been quite a bit of dispatcher bashing in the class, but that is another story!


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