Hostname: page-component-8448b6f56d-sxzjt Total loading time: 0 Render date: 2024-04-24T05:13:03.344Z Has data issue: false hasContentIssue false
  • English
  • Français

The Effect of Operator Position on the Quality of Chest Compressions Delivered in a Simulated Ambulance

Published online by Cambridge University Press:  09 December 2019

Scott Mullin ,
Sinéad Lydon  and
Paul O’Connor Open the ORCID record for Paul O’Connor [Opens in a new window]
Scott Mullin
Affiliation:
Department of Science and Health, Medicine Hat College, Medicine Hat, Alberta, Canada Emergency Medical Services, Alberta Health Services, South Zone, Alberta, Canada
Sinéad Lydon
Affiliation:
Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Co. Galway, Ireland School of Medicine, National University of Ireland Galway, Co. Galway, Ireland
Paul O’Connor*
Affiliation:
Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Co. Galway, Ireland Discipline of General Practice, National University of Ireland Galway, Co. Galway, Ireland
*
Correspondence: Paul O’Connor, PhD Discipline of General Practice 1 Distillery Road National University of Ireland GalwayCo. Galway, Ireland E-mail: paul.oconnor@nuigalway.ie
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Ambulances are where patient care is often initiated or maintained, but this setting poses safety risks for paramedics. Paramedics have found that in order to optimize patient care, they must compromise their own safety by standing unsecured in a moving ambulance.

Hypothesis/Problem:

This study sought to compare the quality of chest compressions in the two positions they can be delivered within an ambulance.

Methods:

A randomized, counterbalanced study was carried out with 24 paramedic students. Simulated chest compressions were performed in a stationary ambulance on a cardiopulmonary resuscitation (CPR) manikin for two minutes from either: (A) an unsecured standing position, or (B) a seated secured position. Participants’ attitudes toward the effectiveness of the two positions were evaluated.

Results:

The mean total number of chest compressions was not significantly different standing unsecured (220; SD = 12) as compared to seated and secured (224; SD = 21). There was no significant difference in mean compression rate standing unsecured (110 compressions per minute; SD = 6) as compared to seated and secured (113 compressions per minute; SD = 10). Chest compressions performed in the unsecured standing position yielded a significantly greater mean depth (52 mm; SD = 6) than did seated secured (26 mm; SD = 7; P < .001). Additionally, the standing unsecured position produced a significantly higher percentage (83%; SD = 21) for the number of correct compressions, as compared to the seated secured position (8%; SD = 17; P < .001). Participants also believed that chest compressions delivered when standing were more effective than those delivered when seated.

Conclusions:

The quality of chest compressions delivered from a seated and secured position is inferior to those delivered from an unsecured standing position. There is a need to consider how training, technologies, and ambulance design can impact the quality of chest compressions.

Keywords

ambulancecardiopulmonary resuscitationchest compressionsout-of-hospital cardiac arrestsimulation
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 35 , Issue 1 , February 2020 , pp. 55 - 60
Copyright
© World Association for Disaster and Emergency Medicine 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Maguire, BJ, Hunting, KL, Smith, GS, Levick, NR.Occupational fatalities in emergency medical services: a hidden crisis. Ann Emerg Med. 2002;40(6):625–632.CrossRefGoogle ScholarPubMed
Smith, N.A National Perspective on Ambulance Crashes and Safety. Guidance from the National Highway Traffic Safety Administration on ambulance safety for patients and providers. EMS World. 2015;44(9):91–92; 94.Google ScholarPubMed
Alberta Health Services EMS. Securing EMS staff, patients, passengers, and equipment in ground vehicles: corporate policy and procedure (PS-EMS-01). Alberta, Canada; 2016.Google Scholar
Wik, L, Kramer-Johansen, J, Myklebust, H, et al.Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest. JAMA. 2005;293(3):299–304.CrossRefGoogle ScholarPubMed
Sutton, RM, Nadkarni, V, Abella, BS.“Putting it all together” to improve resuscitation quality. Emerg Med Clin North Am. 2012;30(1):105–122.CrossRefGoogle ScholarPubMed
Cheskes, S, Byers, A, Zhan, C, et al.CPR quality during out-of-hospital cardiac arrest transport. Resuscitation. 2017;114:34–39.CrossRefGoogle ScholarPubMed
Perkins, GD, Smith, CM, Augre, C, et al.Effects of a backboard, bed height, and operator position on compression depth during simulated resuscitation. Intensive Care Med. 2006;32(10):1632–1635.CrossRefGoogle ScholarPubMed
Yasuda, Y, Kato, Y, Sugimoto, K, et al.Muscles used for chest compression under static and transportation conditions. Prehosp Emerg Care. 2013;17(2):162–169.CrossRefGoogle ScholarPubMed
Havel, C, Schreiber, W, Trimmel, H, et al.Quality of closed chest compression on a manikin in ambulance vehicles and flying helicopters with a real time automated feedback. Resuscitation. 2010;81(1):59–64.CrossRefGoogle ScholarPubMed
Cheng, A, Kessler, D, Mackinnon, R, et al.Reporting guidelines for health care simulation research: extensions to the CONSORT and STROBE statements. Advanc Sim. 2016;1(1):25.CrossRefGoogle Scholar
Sebbane, M, Hayter, M, Romero, J, et al.Chest compressions performed by ED staff: a randomized cross-over simulation study on the floor and on a stretcher. Am J Emerg Med. 2012;30(9):1928–1934.CrossRefGoogle Scholar
Cason, CL, Trowbridge, C, Baxley, SM, Ricard, MD.A counterbalanced cross-over study of the effects of visual, auditory, and no feedback on performance measures in a simulated cardiopulmonary resuscitation. BMC Nurs. 2011;10:15.CrossRefGoogle Scholar
American Heart Association. Highlights of the 2015 American Heart Association guidelines update for CPR and ECC. Dallas, Texas USA: AHA; 2015.Google Scholar
Lewinsohn, A, Sherren, PB, Wijayatilake, DS.The effects of bed height and time on the quality of chest compressions delivered during cardiopulmonary resuscitation: a randomized crossover simulation study. Emerg Med J. 2012;29(8):660–663.CrossRefGoogle ScholarPubMed
Mygind-Klausen, T, Jaeger, A, Hansen, C, et al.In a bed or on the floor? The effect of realistic hospital resuscitation training: a randomized controlled trial. Am J Emerg Med. 2018;36(7):1236–1241.CrossRefGoogle Scholar
Suserud, BO, Jonsson, A, Johansson, A, Petzall, K.Caring for patients at high speed. Emerg Nurs. 2013;21(7):14–18.CrossRefGoogle ScholarPubMed
Brinkrolf, P, Lukas, R, Harding, U, et al.A better understanding of ambulance personnel’s attitude towards real-time resuscitation feedback. Int J Qual Health Care. 2018;30(2):110–117.CrossRefGoogle ScholarPubMed
Poole, K, Couper, K, Smyth, MA, Yeung, J, Perkins, GD.Mechanical CPR: Who? When? How? Crit Care. 2018;22(1):140.CrossRefGoogle Scholar
Du, B, Boileau, M, Wierts, K, Hignett, S, Fischer, S, Yazdani, A.Existing science on human factors and ergonomics in the design of ambulances and EMS equipment. Prehosp Emerg Care. 2019;23(5):631–646.CrossRefGoogle ScholarPubMed
Hightower, D, Thomas, SH, Stone, CK, Dunn, K, March, JA.Decay in quality of closed-chest compressions over time. Ann Emerg Med. 1995;26(3):300–303.CrossRefGoogle ScholarPubMed
Slattery, DE, Silver, A.The hazards of providing care in emergency vehicles: an opportunity for reform. Prehosp Emerg Care. 2009;13(3):388–397.CrossRefGoogle ScholarPubMed