AHA Hands-Only CPR

Well working in an ER and doing CPR often, we concentrate on making sure that you go "hard, Fast and deep" But you have to take into consideration the patients size as to how hard and deep you go. So there is really no Cut and dry method to CPR.
 
let me ask this...

do we think the way CPR is taught to health care providers is adequate?

if not, what do we think is lacking in the way CPR is taught??
 
Its adequate for the standards at the time.. but it changes so much. First its hyperventilate.. then its hypoventilate.. Then its a slow chest compressions allowing time to recoil.. now its Hard fast and deep.

As health care providers I feel that since we do CPR so much, we somewhat teach ourselves and those around us.

make sense?
 
rayemtjax77 said:
Its adequate for the standards at the time.. but it changes so much. First its hyperventilate.. then its hypoventilate.. Then its a slow chest compressions allowing time to recoil.. now its Hard fast and deep.

As health care providers I feel that since we do CPR so much, we somewhat teach ourselves and those around us.

make sense?
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well, then it begs the question... if it is "adequate for the standards at the time", then why is it going wrong in the field?
 
what do U mean why is it going wrong in the field?
 
rayemtjax77 said:
what do U mean why is it going wrong in the field?
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well, studies are finding that professionals routinely overventilate, and do not provide deep enough compressions, or have interruptions in compressions that are too long..

again, this obviously is not a blanket statement, as many do good quality CPR... but there are issues out there... since you asked...

i am just asking if the issues are a function of the way CPR is taught, or if there are other factors at work...
 
skyemt said:
well, studies are finding that professionals routinely overventilate, and do not provide deep enough compressions, or have interruptions in compressions that are too long..

again, this obviously is not a blanket statement, as many do good quality CPR... but there are issues out there... since you asked...

i am just asking if the issues are a function of the way CPR is taught, or if there are other factors at work...
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I am a CPR instructor and I have found over the years that many of my fellow instructors, I'm sure none of whom post on this site, are simply pencil whipping their instruction. One AHA instructor that I co-taught with would simply plug in a movie, then run the staff through the station with minimal observation of their skills.

There is an attitude I have seen many times in EMS instruction that the 'real' education comes in the field, not the classroom and if you are providing the skills on a regular basis, you don't need instruction.

But, when standards change, so does the skill practice and those who are on their 12th recert sometimes need more training rather than less because they are going from habit.

I have flunked people in CPR and refused to issue cards to those who do not perform the skills correctly. My goal is to be absolutely certain that if I, or someone I care about goes into Cardiac Arrest in front of this person.. they will be able to provide adequate CPR. I tell all my students that at the beginning of the class.

I don't think this is so much a factor of AHA, ARC or any individual system of instruction, but rather a direction in business to be more invested in the ability to prove that the information was offered and document that offering, rather than any goal towards making sure the students actually learn.
 
BossyCow said:
I am a CPR instructor and I have found over the years that many of my fellow instructors, I'm sure none of whom post on this site, are simply pencil whipping their instruction. One AHA instructor that I co-taught with would simply plug in a movie, then run the staff through the station with minimal observation of their skills.

There is an attitude I have seen many times in EMS instruction that the 'real' education comes in the field, not the classroom and if you are providing the skills on a regular basis, you don't need instruction.

But, when standards change, so does the skill practice and those who are on their 12th recert sometimes need more training rather than less because they are going from habit.

I have flunked people in CPR and refused to issue cards to those who do not perform the skills correctly. My goal is to be absolutely certain that if I, or someone I care about goes into Cardiac Arrest in front of this person.. they will be able to provide adequate CPR. I tell all my students that at the beginning of the class.

I don't think this is so much a factor of AHA, ARC or any individual system of instruction, but rather a direction in business to be more invested in the ability to prove that the information was offered and document that offering, rather than any goal towards making sure the students actually learn.
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Bossy, thank you for your candor...
i am aware myself of emt's who went through the AHA class, only to have no grasp on why they do what they do, and are more prone to make mistakes, or provide poor quality CPR. then again, others with a different instructor come out very proficient in their skills...

from your perspective, what are possible solutions to the problem??
 
Wow.

I know we've been moving in the direction that compressions are better than nothing.. but saying it is "just as good"?

One of the discussions at the bar last weekend (when we had of course consumed nothing but soda pop) was that the recent changes in CPR were mind-boggaling for the folks who'd been teaching it for eons. To go from "Airway... Airway.... Airway.... Breathe... Breathe.... Shock... Shock... Shock... then press on the chest for a bit and repeat" to "Harder is Better" Compressions, and don't get to obsessed with the airway and breathing bits has some of the instructors confused.

It is sad that we are only now doing the research to back up all the state of the art stuff we've been doing. MAST Pants, anyone?

Anyway... I'm hopefully taking a CPR instructor class (again) on Monday. Should be fun.

I'm NOT going to let the darn thing lapse this time!
 
skyemt said:
Bossy, thank you for your candor...
i am aware myself of emt's who went through the AHA class, only to have no grasp on why they do what they do, and are more prone to make mistakes, or provide poor quality CPR. then again, others with a different instructor come out very proficient in their skills...

from your perspective, what are possible solutions to the problem??
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I think its a matter of personal work ethic. An instructor who doesn't care about the students is going to produce students who reflect that attitude. I don't think you can legislate this.

On the business side, its a matter of dollars and cents. Do you have the time and money to pay for quality instruction and skills assessment of your employees? Or is it cheaper, faster and more efficient to pay for an online OTEP program and be able to show that the information was presented and that the presentation included all the key points required for certification of a skill?

Like with all changes.. first you have to give a :censored:
 
My personal opinion. I used to be a stickler that one should follow each letter of the standards. Then I grew up and wised up, only to read of how, why, and the B.S. of the standards are set.

I have been on the National Faculty level onward, after spending time upon the development to move the standards outward, one learns most of it political in nature and not true methodology of care.

So if the provider that does not check for the 5-10 seconds for a carotid pulse, but checked for 4 seconds, and has worked thousand of codes, I will not fail. Reason, he can detect a dead person, when he walks into the room, even without checking. It is the reason or intent, not so much the exact skill.

Even AHA has now recognized common sense has to be weighed in.

Good compressions is essential in situations that it will work. In reality, and for those that really work on a daily basis, realizes most of the "hard work" is foolish. Codes rarely if ever come back. More studies and finally the medical community is realizing this as well. Hopefully, soon they will recognize in many cardiac arrest situations, the best treatment will be no treatment. Let nature take its course, and allow death to occur. Unless rapid arrival or effective CPR is being performed, death is eminent, just delaying or increasing costs to survivors.

Very rarely, we are able to correct cardiac arrest. It really does take a lot to kill someone or for someone to die. The emphasis should be placed more upon the pre-cardiac arrest and preventative measures. Detecting cardiac problems, CT of vessels, antiplatelet medications, etc.

Yes, we will continue to play or perform as directed of performing CPR, pushing medications that don't work, and not having any luck of increasing our success in saves. Hopefully, we realize to go with clinical based evidence and change resuscitation measures.

R/r 911
 
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skyemt said:
well, then it begs the question... if it is "adequate for the standards at the time", then why is it going wrong in the field?
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I'll give you an example. A friend of mine took his EMT-B course through a different program than the one I'm in. He needed to take the BLS for Health care providers class prior, and the program he was in offered it right before the class.

The instructors could not get into the cabinets that the dummies were in, so they pretty much played the DVD and gave the test.

That terrifies me.
 
Our scout camp staff was going through CPR training (ARC Adult CPR) in one of our pre-camp training periods. What amazed me was the total lack of effort put into the class by the instructor. She didn't even give the test. I'm just dumbfounded that such a carefree CPR class could be given. Had I been certified in that class, I'd have thrown away my card (I had recertified in CPRO before that, thankfully).
 
Recently an article featured in one of our national news papers about the CPR technique. It is amazing to hear and see the public's response regarding this technique.

It obviously made an impression on the people that read the article. Hopefully we'll have more bystander initiated CPR from now on.
 
skyemt said:
here is the problem... doing CPR is not hard... doing QUALITY CPR is not easy...

if the compressions are not deep enough, they are ineffective... if the rate is not there, ineffective... if the interruptions are too long, again, CPR is rendered ineffective... it is all about building up coronary perfusion pressures, and maintaining them... do you teach about that? most heartsaver CPR courses do not... most "health care providers" who are not medics have a hard time explaining the physiology behind CPR... if the understanding is not there, mistakes happen.. there are not "degrees" of CPR... it can not be "pretty good"... it is either quality, effective CPR or a waste of time...

that does not even cover the ventilations... are you aware of the studies finding that health care providers are overventilating during CPR? that this overventilation is building up intrathoracic pressures to the point that it is inhibiting venous return? basically building up pressures that fight against the compressions you are doing... is that really taught in CPR class? it wasn't in mine, and apparently there is a large knowledge gap here, because the overventilation by "professionals" is a serious issue... if one had a true grasp of the concept of negative intrathoracic pressures and it's effect on venous return, they would not dream of overventilating... this theory is behind the development of the impedance threshold devices, designed to lower intrathoracic pressures, creating a vacuum effect.. how many are well versed in this?

so, back to my earlier point... learning CPR is easy... learning to do it really well without mistakes is another story.
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So you know better than the AHA itself on what should be taught in a CPR class? Maybe you need to replace their seasoned Cardiologists than...

CPR is CPR. Its better that someone try it than do nothing at all because its a "waste of time". Doing good CPR is a waste of time anyways in most cases.
 
daedalus said:
So you know better than the AHA itself on what should be taught in a CPR class? Maybe you need to replace their seasoned Cardiologists than...

CPR is CPR. Its better that someone try it than do nothing at all because its a "waste of time". Doing good CPR is a waste of time anyways in most cases.
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Yes, in fact, i know much better than the AHA... i also know much more than the top Cardiologists in the world... I am in the process of rewriting the CPR curriculum that will be accepted nation wide... and the inventor of CPR itself has asked to consult with me on my views.

HAPPY NOW?????
 
LucidResq said:
I agree that personal attacks are not okay, but you do occasionally give off a pretty condescending vibe which I believe makes people feel insulted. It's just something you might want to be aware of, because I think it has led to some of these personal attacks. You may not realize it but you may be making some people feel like you attacked them first.
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I would tend to agree here, skyemt. Your an EMT-Basic. Which means, no matter how much you educate yourself, your still going to be viewed by people who don't know you as the lowest common denominator (advanced first aid). Im not attacking you, but providing feedback to your question on why things tend to be getting personal. I think you are quite brilliant, and I commend you on wanting to educate yourself. But lets try and bring EMT out of the "advanced first aid" arena by supporting its education and not having an attitude with current providers for not knowing what you do.
 
daedalus said:
I would tend to agree here, skyemt. Your an EMT-Basic. Which means, no matter how much you educate yourself, your still going to be viewed by people who don't know you as the lowest common denominator (advanced first aid). Im not attacking you, but providing feedback to your question on why things tend to be getting personal. I think you are quite brilliant, and I commend you on wanting to educate yourself. But lets try and bring EMT out of the "advanced first aid" arena by supporting its education and not having an attitude with current providers for not knowing what you do.
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so, seriously.... what is the issue here? i brought up issues i have with CPR?
and you get your ***** all twisted up?

or is that a basic should not try to expand knowledge while getting certified for ALS?

you say that no matter how much i educate myself, i will still be viewed as the lowest common denominator... i tend to disagree... if someone has the opportunity to talk to me about EMS and protocols and treatments and everything else, i don't really think i will be viewed as the lowest common denominator... and no, i do not think i "know it all", quite the opposite, which is why i am continually educating myself... if you want to discount my views because i am currently a "basic", feel free, but you are then doing the exact same pigeon-holing that you are supposedly against.

i want to support education... i feel the way i can do that is by identifying what i think is lacking and trying to change it...

what is your problem with that? so, we should all just accept the current educational standards to "support ems", why not just stick our heads in the sand...

if you think CPR is the best it can be, i am happy there are no issues for you...

but to criticize someone for having issues, and basically saying the only way to bring EMS out of "advanced first aid" is by "supporting it's education" in it's current form is quite frankly a ridiculous statement... in my most humble opinion...
 
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Thread reopened as long as everyone follows the rules.
 
I wonder why it took so long, especially with the length of time apnea testing has been around.
 
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