2. “Who’s On First” EMS Team Resuscitation Jay Gardiner, MBA,EMT-CC Associate Professor of Emergency Medical Care Suffolk Community College Regional Faculty – American Heart Association

3. Presenter Disclosure Information Jay L. Gardiner Pre-Hospital Resuscitation for the 21 st Century FINANCIAL DISCLOSURE: No relevant financial relationship exists No Unlabeled/Unapproved Uses in Presentation

4. Teamwork - If it was only this easy!!

5. Or Is it More Like This?

6. Teamwork Since 2005 the AHA has stressed the importance of teamwork in ACLS and resuscitation. The benefits are obvious –Synergy between participants –Delineation of tasks and assignments, and coordination of responsibilities –Minimizes variability in treatment approach –Builds on individual core competencies

7. Fire Service Standard Operating Procedure

9. Mass Casualty Incidents

10. What do all these events have in common? NASCAR Races Fire Fighting Mass Casualty Incidents Resuscitations

12. Two Simple Goals: 1. Minimize Stress 2. Maximize Potential for Successful Outcome One Simple Strategy: Reduce the negative effects of Variables!

13. Austin County, TX EMS Model - courtesy of Paul Hinchey,MD

14. How do you design your model? Best Case or Worst Case Scenario? What is your average crew size? What additional manpower can be anticipated? Equipment availability Selection of destination hospital

15. Our Model for Today: o Understand –Why? o Adapt – How? o Integrate – When?

16. Critical Positions Compressors –Need at least two available –One to start immediately upon recognition of cardiac arrest! –Must switch every two minutes for effective CPR delivery (regardless of physical condition of rescuer!) –Can also deliver electrical therapy (AED, manual) –Cannot wildcat – must stay on task

17. Position# 1 – COMPRESSOR PATIENTS RIGHT SIDE Assess patient (all pulse checks) Initiate Compressions: 100/min, 2 inches o alternate with Position 2 every 2 minutes Assist when not compressing Airway and Ventilations Advanced airway preparation Start IV access and administer meds (3-person crew)

18. POSITION # 2 COMPRESSOR/ELECTRICAL PATIENTS LEFT SIDE Operates AED/ALS Monitor Alternates compressions with Position 1 Monitor ECG for rhythm changes Responsible for delivery of electrical therapy o Defibrillation o Cardioversion o Pacing

19. Critical Positions Airway – One person needed, ideally person with most airway experience – BVM first, if chest rise, then everything else can wait…remember ET may require hands-off time! – Extra-glottic airway may be preferred to ET during resuscitation phase due to ease of insertion and minimization of hands-off time. – Airway provider should not run the code. If the airway or chest rise is not adequate…..team leader makes the decisions.

20. POSITION # 3 – AIRWAY BEHIND PATIENTS HEAD Initial Assessment of Airway Patency Opening of Airway with adjuncts (OPA/NPA) Ventilation of Patient Advanced Airway Placement (EGD,ET) ITD and Capnography set-up Continuous Monitoring of ETCO2 to guide perfusion and airway position

21. Critical Positions IV Access – Medications – Provider should have experience in accessing multiple iv sites and I/O insertion – Should be familiar with resuscitation drugs, dosages, and how to draw them up – Should be able to stay one-step ahead – Can serve as recorder in between drug orders

22. POSITION #4 IV/IO MEDICATIONS PATIENTS RIGHT LEG Prepare access during first round of compressions Gain access after 1 st shock or confirmation of non-shockable rhythm IV (Right arm) or I/O (Right Tibia or Humerus) Prepare at least two rounds of drugs If possible, serve as recorder

23. Who Runs the Code?

24. Code Team Leader Ideally, position # 5 – watching, learning, and directing patient care. Alternatively, Positions 4,2,and 1 could handle (3 and 4 person teams) Not a nice to do, but a need to do. Should be knowledgeable in all aspects of resuscitation. Should have good working grasp of protocols/guidelines Good communicator, strong, but steady.

25. POSITION# 4 – CODE TEAM LEADER AT FOOT OF PATIENT ON RIGHT SIDE Assess and plan treatment of patient Use entire team for constructive feedback Strong and steady Monitor VS, ECG, ETCO2 and SPO2 Plan for transport and destination Serve as recorder

26. POSITION # 6 FLOAT AVOID LOCATIONS OF ACTIVE PROVIDERS FL Observe all positions, and be ready to assist as needed Act as recorder and/or supply person Do not assume any task unless directed by the Code Leader

27. Hey, What About Me?

28. What About The Ambulance?  Most resuscitations evolve through the transport  Consistency of design is talked about, but variability exists  Stretcher Placement  Monitor Placement  Drug-IV Supplies Access  Airway /Advanced Airway Tool Access

29. BCLS/ACLS The Foundation for all Providers Integration into “Mega –Code” and simulations.  Removes stress on original students  Promotes concentration on task at hand  Reinforces team concept

30. How can we get this done? 1.Learn it! 2.Practice it! 3.Teach it! 4.Believe in it

31. Thanks to: Ed Stapleton EMT-P Paul Hinchey, MD Mark Henry, MD My ACLS Students Moe, Larry, and Curly

32. Write me with your ideas, questions! gardinj@sunysuffolk.edu We all want to make a difference!!!! Thank you for being here!!