Pit Crew CPR

[RocketMedic]

Well, I'm relearning CPR and cardiac arrest management, and I can safely say that it's nothing short of revolutionary as compared to what I've always done. The treatments and timelines are the same, save for a few agency-specific quirks, but the emphasis on remaining outside of patient care whenever possible and orchestrating the resuscitation is a new thing for me. Before, I've always been racing myself against equipment bags, interventions, rounds of drugs, and the need to spell my partner with compressions before they drop off. Heck, up until this year, I hadn't even worked at an agency with capnography that wasn't colormetric!

It's definitely a challenge. I'm having trouble with the timing and this agency's focus on logging everything on the Lifepack, but I'm getting better at it.

It's definitely weird though not building my nest at the head.

 

[Handsome Robb]

I can't stand the event markers on the MRx. Total pain in the butt.

I agree about staying out of things, it took me a while to get used to it. My FTO said you can always tell when I was uncomfortable because I'd revert back to acting like an intermediate and start pounding out interventions before realizing I needed to stop and step back.

No nest? I still hang out with the monitor and my drug bag stays with me or my partner.

 

[RocketMedic]

I can't stand the event markers on the MRx. Total pain in the butt.

I agree about staying out of things, it took me a while to get used to it. My FTO said you can always tell when I was uncomfortable because I'd revert back to acting like an intermediate and start pounding out interventions before realizing I needed to stop and step back.

No nest? I still hang out with the monitor and my drug bag stays with me or my partner.

It's the EMSA way, I guess. They don't want the monitor, airway bag and drug bag all at the head, all faced back at me. It's less of a fighter cockpit and more of a starship bridge.

 

[mycrofft]

Pit Crew?:huh:

 

[RocketMedic]

Predesignated positions for responders based on level of training and responsibility and the order of importance of interventions in resuscitation. Basically, it's preplanned CPR.

 

[shfd739]

Sounds similar to what we do.

We have a card that lists who does what in 2 minute increments. Much more organized and our resusc to neuro intact hospital discharge rate has nearly doubled.

 

[mycrofft]

Always hard to get someone to RECORD.

 

[VCEMT]

It's simple. It's just taking turns on BLS measures and medics following normal ALS protocols.

Continuous CPR
1 breath every 10 compressions

Walk in the park.

 

[leoemt]

CPR changes constantly. In EMT school I had to relearn it from bystander cpr. Now that I work on an ambulance I had to relearn it again as King County has a different CPR than the rest of the country as we are a major research area for the AHA.

Currently there are 3 different forms of CPR being used here in Seattle and all of them are being studied by the AHA. I think the "high performance CPR" that we are currently using will become the new standard in 2014 as it goes along with the trends AHA has been doing lately.

 

[Christopher]

I think the "high performance CPR" that we are currently using will become the new standard in 2014 as it goes along with the trends AHA has been doing lately.

High performance CPR has been the standard since at least 2007 (we were taught to work all codes on scene and use continuous CPR when I started Paramedic school)...just most EMS services have ignored the evidence for it.

The beauty of Pit Crew is officially recognizing riding assignments in EMS. This vastly simplifies a code and seems to have removed the chickens-with-heads-cut-off-CPR of yesteryear.

 

[leoemt]

High performance CPR has been the standard since at least 2007 (we were taught to work all codes on scene and use continuous CPR when I started Paramedic school)...just most EMS services have ignored the evidence for it.

The beauty of Pit Crew is officially recognizing riding assignments in EMS. This vastly simplifies a code and seems to have removed the chickens-with-heads-cut-off-CPR of yesteryear.

Here is what we do in Seattle / King County

http://www.resuscitationacademy.com//?s=high+performance+cpr

 

[Tigger]

CPR changes constantly. In EMT school I had to relearn it from bystander cpr. Now that I work on an ambulance I had to relearn it again as King County has a different CPR than the rest of the country as we are a major research area for the AHA.

Currently there are 3 different forms of CPR being used here in Seattle and all of them are being studied by the AHA. I think the "high performance CPR" that we are currently using will become the new standard in 2014 as it goes along with the trends AHA has been doing lately.

What is being done differently in King County compared to the current AHA guidelines?

 

[NomadicMedic]

What is being done differently in King County compared to the current AHA guidelines?

Nothing. King County just hires good people to write press releases.

I just ran a pit crew code less than 2 hours ago. Smooth and flawless. We're very good at them here.

 

[socalmedic]

logging everything on the Lifepack,

I love the event markers, if your monitor is set up right and you have the ability to auto populate your epcr. it saves sooooooo much time.

download, add doses, who gave what, done.

 

[Handsome Robb]

Nothing. King County just hires good people to write press releases.

I just ran a pit crew code less than 2 hours ago. Smooth and flawless. We're very good at them here.

Is it just me or is anyone else tired of hearing about how "amazing" KCM1 is? Our witnessed VF/VT arrest survival rate is similar to theirs but we don't yap about it all day long. We do "pit crew" CPR or CCR depending on suspected etiology.

I love the event markers, if your monitor is set up right and you have the ability to auto populate your epcr. it saves sooooooo much time.

download, add doses, who gave what, done.

I tried to use the markers on the Philips since they are supposed to auto populate our ePCRs as well but they just show up as notes rather than actual events in the flowchart so I gave up on using them. Maybe the monitor is smarter than me... :lol:

 

[Christopher]

Is it just me or is anyone else tired of hearing about how "amazing" KCM1 is? Our witnessed VF/VT arrest survival rate is similar to theirs but we don't yap about it all day long. We do "pit crew" CPR or CCR depending on suspected etiology.

What sets them apart is their willingness to research and share findings/methods. Additionally they are willing to publicly share how good or bad they are doing. We're going to follow suit here shortly (for accreditation) and publicize our metrics, regardless of how they look.

(Usually in NC everyone complains about hearing all about "Wake County")

 

[Handsome Robb]

What sets them apart is their willingness to research and share findings/methods. Additionally they are willing to publicly share how good or bad they are doing. We're going to follow suit here shortly (for accreditation) and publicize our metrics, regardless of how they look.

(Usually in NC everyone complains about hearing all about "Wake County")

Fair enough.

FWIW we participate in studies as well.

I just always hear people talking up KCM1 because "they save more people than any agency" then I hear all these stories about terrible customer service and questionable medicine by way of turfing calls to BLS crews that should be attended by an ALS provider.

By the way, I'd love to work for Wake County except for the fact that I could never live on the East Coast.

 

[medicsb]

What is being done differently in King County compared to the current AHA guidelines?

It's probably not much now. But, what probably sets them apart is that they've been doing for decades what others are only now starting to do (like actually saving folks from cardiac arrest).

They've likely performed more prehospital-based research than any other EMS system in the world. (I'll bet that no other EMS system even comes close, actually.) If you look up three of the docs most intensely involved with KCM1 (Leonard Cobb, Michael Copass, and Micky Eisenberg), you'll see they've been publishing research on prehospital resuscitation since the 70s - hundreds of publications in peer-reviewed medical journals including NEJM, JAMA, & Lancet. They're pretty transparent. They've got great PR folks. Shame on any other system that doesn't do the same. I'm pretty sure that most of the kick-back against KCM1 is sour grapes. They maybe are not the best, but whoever is better isn't speaking up. I dare anyone to show me a system with better cardiac arrest outcomes (backed by a publication, even if just a yearly report).

I love to look at EMS research and see what data are published. I love to read up on different EMS systems to see what is being done and how. The amount of info available from KCM1 is enormous. They have good press releases AND data to back them up. Credit where credit due. I'm sure they have their problems (e.g. they still don't use CPAP), but in terms of CA resuscitation, anyone else is second place. (I welcome anyone to prove me wrong.)

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Anyhow, about this "pit crew" thing (I hate the term)...
What is most remarkable about it is that someone had to invent the term for the concept to catch on, because I imagine a lot of places have long been doing something similar except that is was referred to something like "good CPR" or just "resuscitation".