So far as I can tell your question is why are the medics you work with doing this. That is a question that I can't answer. But the fact that you said:
When I asked for the reasoning behind it, basically I've been told that it's more of the "book vs. the real world", and "this is how things are really done".
...worries me. See, the number one way to tell if someone knows what they are doing or talking about, and I mean really KNOWS, is to ask them two questions: why and how.
This is the great divide between people who do things "Because that is how we were taught" and people who do things because they understand the physiology of what is happening to their PT and arguably more importantly the empirical data supporting their actions.
Once you get an answer to why and how keep asking how, over and over.
Eventually you will get to the bottom of everyone's knowledge because the answer at the bottom of the rabbit whole for most things is "we don't entirely know how" even things a simple as osmosis. But a good clinician should at least be able to tell you a few levels down, hopefully to the molecular if not at least the cellular.
Now why are your crews are doing that? I hope the answer is not because some other person told them to and they took their word for it.
I'll take a shot at explaining to you the why with sources below.
There are several layers to your issue and you will need to clear up the exact circumstances in order for people on here to give you real detailed information. I'll try to cover as many as I can.
The ratio of 30:2 is still recommended prior to the establishment of an advanced airway.
Compression only CPR is for lay rescuers, not recommended for professionals.
The goal behind compression only CPR for lay rescuers is not actually that CPR is more effective without respiration. It is recommended because it was shown that the biggest hurdle to bystanders doing something in a CPR situation was fear.
The respiration part of CPR was removed in order to simplify the process of lay rescuer intervention so that it was not as frightening and thereby might increase the prevalence of bystanders doing ANYTHING rather than, well, standing by.
This is why compression only CPR is not taught in BLS for Healthcare Providers or ACLS.
Now specifically with ACLS, it is only a concern until an advanced airway is placed as at that point 30:2 goes out the window anyway.
All that being said I'm going to assume that your crews are following the proper ACLS guidelines once an advanced airway is placed. However prior to that airway placement they are having you forgo the 30:2 ratio.
Now, that's not great because there is a lot of misinformation about compression only CPR. The studies and reports of it's "effectiveness" are both greatly over stated and almost always in relation to LAY rescuers preforming compression only CPR PRIOR to the arrival of professionals.
Findings summarized in a 2010 study: "
For prolonged OHCA of cardiac origin, conventional CPR with rescue breathing provided incremental benefit compared with either no CPR or compression-only CPR, but the absolute survival was low regardless of type of CPR.". Showing that classic CPR was incrementally better!
To be fair another study from AZ came up with "
A significantly greater percentage of cardiac arrest victims survived in the chest-compression-only CPR group (13.3 percent) compared to those in the conventional CPR group (7.8 percent).".
As you can see not all the data has shown that compression only CPR is the way to go just yet. (I'm not saying that it's not I'm just saying that we don't really know yet.)
What is clear is that people are significantly more likely to preform compression only CPR than they are to preform traditional CPR, which is what we, as professional rescuers want!
So all this being said many professional rescuers who get most of their knowledge from talking with other EMT's and Paramedics got the idea that compression only CPR had something to do with us. It does not.
This is illustrated by the fact that our AHA guidelines have not changed.
The AHA even states on it's website:
"
Hands-Only CPR (CPR with just chest compressions) has been proven to be as effective as CPR with breaths in treating adult cardiac arrest victims." (emphasis added by me) As effective, not more, the data isn't there yet.
As far as I know there has only been one study that attempted to have ALS providers switch to a compression only, no matter what protocol rather than standard ACLS and it found that:
"
The findings of the present study suggest that when CCC CPR is integrated into an EMS protocol, patients are no more or less likely to survive than if they had been treated with standard ACLS cardiac arrest procedures."
So, what people are doing when they deviate from standards is anybodies guess.
Might they be helping, and it will turn out that compression only CPR is better? Maybe. But at this point it is just as likely that they are doing damage as the studies about compression only CPR never took in to account Paramedics thinking they were supposed to abandon ACLS guidelines (with the exception of the one I posted).
This is dangerous not because of this particular instance but because it illustrates what really boils down to a lack of scientific literacy in EMS. There is no reason for a paramedic to think that they should be preforming compression only CPR, other than misunderstanding that is.
I hope this has shed some light on your situation. There is no “real world” vs. “school”, those kinds of statements are a form of anti-intellectualism that have no place in medicine. They are a throwback to the time when experience trumped all, but now we live in a time where empirical evidence trumps all and things are going to continue to change.
